Predictive role of NLR, SII, and PLR in COVID-19 patient mortality and disease severity
Predictive role of NLR, SII, and PLR in COVID-19 patient mortality and disease severity
Background: In this study, it was aimed to evaluate the factors affecting the prognosis and mortality of patients hospitalized for coronavirus disease 2019 (COVID-19).Methods: Patients hospitalized with COVID-19 infection between March and November 2020 were examined retrospectively. The Systemic Immune-Inflammation Index (SII), platelet lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR) values were evaluated for their effect on prognosis.Results: Of the 1013 patients included in the study, 204 (20.1%) had a severe infection. In the multivariate analysis, it was determined that the prognosis was significantly worse in patients who were >65 years of age, had a Charlson Comorbidity Index (CCI) score of >2, and had a high NLR rate. The C-reactive protein (CRP), PLR, SII values were detected as insignificant variables. Mortality was found to be statistically significant in patients with a CCI score of 2 or more and in patients with high CRP, NLR, PLR, and SII values at the time of admission (p<0.05) in the multivariate analysis.Conclusions: It was found that the most important factor affecting the severity of the disease was advanced age and high comorbidities, and a high NLR value. The most important prognostic factors affecting mortality were high levels of comorbidities, and high NLR, PLR, SII, and CRP values.
___
- 1. Ma X, Ng M, Xu S, Xu Z, Qiu H, Liu Y, et al. Development and
validation of prognosis model of mortality risk in patients with
COVID-19. Epidemiol Infect. 2020;148.
- 2. Usul E, Şan İ, Bekgöz B, Şahin A. Role of hematological parameters
in COVID-19 patients in the emergency room. Biomark Med.
2020;14(13):1207–15.
- 3. Peng J, Qi D, Yuan G, Deng X, Mei Y, Feng L, et al. Diagnostic value
of peripheral hematologic markers for coronavirus disease 2019
(COVID‐19): A multicenter, cross‐sectional study. J Clin Lab Anal.
2020;34(10):e23475.
- 4. Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive
role of NLR, d-NLR and PLR in COVID-19 patients. Int
Immunopharmacol. 2020;84:106504.
- 5. Pourbagheri-Sigaroodi A, Bashash D, Fateh F, Abolghasemi H.
Laboratory findings in COVID-19 diagnosis and prognosis. Clin
Chim Acta. 2020;510:475.
- 6. Fois AG, Paliogiannis P, Scano V, Cau S, Babudieri S, Perra R, et al.
The systemic inflammation index on admission predicts in-hospital
mortality in COVID-19 patients. Molecules. 2020;25(23):5725.
- 7. World Health Organization. Clinical management of severe
acute respiratory infection when Middle East respiratory
syndrome coronavirus (MERS-CoV) infection is suspected:
interim guidance. 2019. Available at: https://apps.who.int/iris/
handle/10665/178529 Accessed February 11, 2020.
- 8. World Health Organization. Laboratory testing for 2019
novel coronavirus (2019-nCoV) in suspected human cases:
interim guidance. 2020. Available at: https://www.who.int/
publications/i/item/10665-331501 Accessed January 14, 2020.
- 9. World Health Organization. Clinical management of severe
acute respiratory infection when novel coronavirus (2019-nCoV)
infection is suspected. 2019. https://www.who.int/csr/ disease/
coronavirus_infections/InterimGuidance_ClinicalManage ment_
NovelCoronavirus_11Feb13u.pdf?ua=1&ua=1. Accessed February
11, 2020.
- 10. Beddhu S, Bruns FJ, Saul M, Seddon P, Zeidel ML. A simple
comorbidity scale predicts clinical outcomes and costs in dialysis
patients. Am J Med. Elsevier; 2000;108:609–13.
- 11. Duan J, Pan L, Yang M. Preoperative elevated neutrophil-tolymphocyte
ratio (NLR) and derived NLR are associated with poor
prognosis in patients with breast cancer: A meta-analysis. Medicine
(Baltimore). 2018;97(49):e13340.
- 12. Diem S, Schmid S, Krapf M, Flatz L, Born D, Jochum W, et
al. Neutrophil-to-Lymphocyte ratio (NLR) and Platelet-to-
Lymphocyte ratio (PLR) as prognostic markers in patients with
non-small cell lung cancer (NSCLC) treated with nivolumab.
Lung Cancer. 2017;111:176-181.
- 13. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, et al. Neutrophilto-
lymphocyte ratio as an independent risk factor for mortality in
hospitalized patients with COVID-19. J Infect. 2020;81(1):e6-e12.
- 14. Fu J, Kong J, Wang W, Wu M, Yao L, Wang Z, et al. The clinical
implication of dynamic neutrophil to lymphocyte ratio and
D-dimer in COVID-19: A retrospective study in Suzhou China.
Thromb Res. 2020;192:3-8.
- 15. Kalabin A, Mani VRK, Valdivieso SC, Donaldson B. Role of
neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and
platelet-to-lymphocyte ratios as predictors of disease severity in
COVID-19 patients. Le Infez Med. 2021;29:46–53.
- 16. Merad M, Martin JC. Pathological inflammation in patients with
COVID-19: a key role for monocytes and macrophages. Nat Rev
Immunol. 2020;20(6):355-362.
- 17. Chan AS, Rout A. Use of neutrophil-to-lymphocyte and plateletto-
lymphocyte ratios in COVID-19. J Clin Med Res. 2020;12:448.
- 18. Henry BM, De Oliveira MHS, Benoit S, Plebani M, Lippi G.
Hematologic, biochemical and immune biomarker abnormalities
associated with severe illness and mortality in coronavirus
disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med.
2020;58:1021–8.
- 19. Wu C, Chen X, Cai Y, Zhou X, Xu S, Huang H, et al. Risk factors
associated with acute respiratory distress syndrome and death
in patients with coronavirus disease 2019 pneumonia in Wuhan,
China. JAMA Intern Med. 2020;180:934–43.
- 20. Wang K, Chen W, Zhang Z, Deng Y, Lian JQ, Du P, et al. CD147-
spike protein is a novel route for SARS-CoV-2 infection to host
cells. Signal Transduct Target Ther. 2020;5(1):283.
- 21. Ye W, Chen G, Li X, Lan X, Ji C, Hou M, et al. Dynamic changes
of D-dimer and neutrophil-lymphocyte count ratio as prognostic
biomarkers in COVID-19. Respir Res. 2020;21:1–7.
- 22. Liu YP, Li GM, He J, Liu Y, Li M, Zhang R, et al. Combined use
of the neutrophil-to-lymphocyte ratio and CRP to predict 7-day
disease severity in 84 hospitalized patients with COVID-19
pneumonia: a retrospective cohort study. Ann Transl Med.
2020;8(10):635.
- 23. Qu R, Ling Y, Zhang Y, Wei L, Chen X, Li X, et al. Platelet‐tolymphocyte
ratio is associated with prognosis in patients with
coronavirus disease‐19. J Med Virol. 2020;92:1533–41.
- 24. Zeng F, Huang Y, Guo Y, Yin M, Chen X, Xiao L, et al. Association
of inflammatory markers with the severity of COVID-19: A metaanalysis.
Int J Infect Dis. 2020;96:467-474.
- 25. Hariyanto TI, Japar KV, Kwenandar F, Damay V, Siregar JI, Lugito
NPH, et al. Inflammatory and hematologic markers as predictors
of severe outcomes in COVID-19 infection: A systematic review
and meta-analysis. Am J Emerg Med. 2021;41:110-119.
- 26. Ullah W, Thalambedu N, Haq S, Saeed R, Khanal S, Tariq S, et
al. Predictability of CRP and D-Dimer levels for in-hospital
outcomes and mortality of COVID-19. J community Hosp Intern
Med Perspect. 2020;10:402–8.
- 27. Austin SR, Wong YN, Uzzo RG, Beck JR, Egleston BL. Why
Summary Comorbidity Measures Such As the Charlson
Comorbidity Index and Elixhauser Score Work. Med Care.
2015;53(9):e65-72.
- 28. Imam Z, Odish F, Gill I, O’Connor D, Armstrong J, Vanood A, et al.
Older age and comorbidity are independent mortality predictors in a
large cohort of 1305 COVID‐19 patients in Michigan, United States. J
Intern Med. 2020;288:469–76.
- 29. Kuswardhani RAT, Henrina J, Pranata R, Lim MA, Lawrensia S,
Suastika K. Charlson comorbidity index and a composite of poor
outcomes in COVID-19 patients: A systematic review and metaanalysis.
Diabetes Metab Syndr Clin Res Rev. Elsevier; 2020;