Netrophil-Lymphocyte Ratio (NLR) as a Predictor of Severity in Covid-19 Patients
DOI:
10.29303/jbt.v22i2.3356Published:
2022-04-16Downloads
Abstract
Early identification is needed to predict the condition of patients who are at risk of worsening symptoms to become more severe. Simple laboratory tests such as measurement of the neutrophil-lymphocyte ratio are known to be used as factors to determine the patient's prognosis in various clinical situations. The purpose of this study was to analyze the value of the neutrophil-lymphocyte ratio as a predictor factor for COVID-19. This study is retrospective, using medical record data of 327 Covid-19 patients at the Dr Chasan Boesoirie Hospital Ternate from April to September 2021. Subjects were classified as not severe and severe COVID-19. The value of the neutrophil-lymphocyte ratio was determined based on the results of a routine blood test (sysmex XN-1000B3 BF). Data were analyzed using SPSS version 16, Pearson's test to determine the relationship between NLR and severity and using the ROC (Receiver Operating Characteristic) curve to determine the strength of the relationship with the Cut-off value, p < 0.05 and AUC to determine the sensitivity and specificity of NLR to COVID-19 severity. Results: From 327 subjects consisting of 229 non-severe and 98 severe, the neutrophil-lymphocyte ratio (NLR) in the non-severe (3.45±2.02) was significantly different from the severe (9.73±5.64) (p < 0.00). The ROC (Receiver operating Characteristic) curve shows that the NLR has a sensitivity of 83%, specificity of 82% with a cut-off of 3.5 with a positive predictive value (PPV) of 88.2% and a negative predictive value (NPV) of 83.6%. The results of this study can be used as a reference for determining clinical prognosis using neutrophil ratio data.
Keywords:
Neutrophil-lymphocyte Ratio (NLR), Covid -19, predictors, disease severity.References
Bhat, R. (2017). Platelet indices in neonatal sepsis: A review. World J Clin Infect Dis, 7(1): 6-10.
Camacho-Gonzales, A., Spearman, P.W., & Stoll, BJ. (2013). Neonatal Infectious disease.Evaluation of neonatal disease. Pediatr Clin N Am, 60: 367-389.
Choudhary, D.K., Tiwari, A.K., Narang, S., & Chhabra, J. (2017). Correlation of platelet count and platelet indices with neonatal sepsis - Diagnostic and prognostic indicator. International Journal of Pediatic Research, 4(8): 511-518
Darnifayanti (2012). Rasio Neutrofil Imatur Dengan Neutrofil Total Dalam Menegakkan Diagnosis Dini Sepsis Bakterialis PadaNeonatus, Fakultas Kedokteran Universitas Sumatera.
Dewitte, A., Lepreux, S., Villeneuve, J., Rigothier, C; Combe, c., Ouattara, A,Ripoche, J. (2017). Blood platelets and sepsis pathophysiology: a new therapeutic prospect in critical ill patients? Annals of Intensive Care, 7: 115-133.
Gao, Y, Li, Y., Yu, X., Guo, S., Ii, X., Sun, T., Lan, C., Lavergne, V., & Ghannoum, M.,Li, L. (2014). The impact of various platelet indices as prognostic markers of septic shock. PLOS One, 9(8): 1-7.
Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of Coronavirus disease (2019). in China. New England Journal of Medicine [Internet]. 2020; (18): 1708-20. Available from: http://www.nejm.org/doi/10.1056/NEJMoa2002032 (accessed 26 Sept, 2020)
Guclu, E., Durmaz, Y, Karabay, O. (2013). Effect of severe sepsis on platelet count and their indices. African Helath SCiences, 13(2): 333-338.
Kame, T.K., Joshi, D.D., Zile, U., & Patil, S. (2017). Study of platelet count and platelet indices in neonatal sepsis in tertiary care institute. VIVP Journal qf Medical Sciences, 4(1): 55-60.
Kementrian Kesehatan (2020). Pedoman pencegahan dan pengendalian Coronavirus disease. 2020; 1 (revisi ke-5); 1-125.
Lagunas‐Rangel, F. A. (2020). Neutrophil‐to‐lymphocyte ratio and lymphocyte‐to‐C‐reactive protein ratio in patients with severe coronavirus disease 2019 (COVID‐19): A meta‐analysis. Journal of medical virology. doi: https://doi.org/10.1002/jmv.25819
Lee, J. S., Kim, N. Y., Na, S. H., Youn, Y. H., & Shin, C. S. (2018). Reference values of neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, and mean platelet volume in healthy adults in South Korea. Medicine, 97(26). doi: 10.1097/MD.0000000000011138)
Liu J, Liu Y, Xiang P, Pu L, & Xiong H, Li C, (2020). Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 Coronavirus disease in the early stage. J Transl Med, 2020; 18: 1.
Liu Y, Du X, Chen J, Jin Y, Peng L, & Wang HHX, (2020). Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect, 2020; 17(28): 1-7.
Mittal, A., Arya, S., Charan, L., Saluja, S., & Chellani, H. (2018). Evaluation of platelet indices as additional diagnostic tool for neonatal sepsis. Astocyte, 4: 205-209. Orak, M., Karakoc, Y, Ustundag, M., Yildirim, Y., Celen, M.K., Guloglu., C. 2018.
Peng J, Qi D, Yuan G Deng X & Mei Y (2019). Daignostic value of peripheral hematologic markers for corona virus disease 2019 (COVID-19): a multicenter cross-sectional study: J Clin: ab Anal. 2020; 34(10): e23475 doi: 10.1002/jcla23475.
Rodriguez-Morales, Aj, Cardona Ospina, Gutierrez-Ocampo (2020). Clinical Laboratory and imaging features of covid-19: A sysmatic review and metaanalysis, Travel Med Infect Dis, 34:1011623
Sun S, Cai X, Wang H, He G, & Lin Y, (2020). Abnormalities of peripheral blood system in patients with COVID-19 in Wenzhou, China. Clinica Chimica Acta. Elsevier; 507: 174-180.
Vabret N, Britton GJ (2020). Immunology of COVID-19: Current state of the science.Immunity, 2020; 52(6):910-941
Vergano S, Sharland M, Kazembe P, Mwansambo C, (2005). Heath PT. Neonatal sepsis: an international perspective. Arch Dis Child Fetal Neonatal. 2005; 90.
Wang Y,Chen Y, & Qin Q, (2020). Unique epidemiological and clinical features of the emerging 2019 novel Corona virus pneumonia (COVID-19) implicated spesial control measures. J Med Virol, 2020; 92(6); 568-76.
WHO (2017). Sepsis and Other Infectious Condition of the Newborn. Global health Observatory data repository. www.who.int/gho/ data/ view.main.CM1002017WO RLD-CH12. Diakses Oktober 2020.
Yang AP, Liu JP, Tao WQ, & Li HM (2020). The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. International Immunopharmacology, 2020: 106504. Available from: https://doi.org/10.1016/j.intimp.2020.106504 (accessed 9 April, 2020).
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