Research Article
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Prognostic Significance of Neutrophil-Lymphocyte ratioinCOVID-19 Infection

Year 2022, Volume 44, Issue 3, 268 - 272, 01.10.2022
https://doi.org/10.7197/cmj.1149259

Abstract

Objective: Serum markers, radiological signs and clinical findings may help guide the assessmentof the prognosis of COVID -19 infection.Neutrophil-lymphocyte ratio is a cheap and easily attainable inflammatory marker.This study aims to investigate whether neutrophil-lymphocyte ratio is associated with the clinical course of the disease in COVID-19 patients with the non-severe disease
Materials and Methods: We retrospectively analyzed the results of 189 patients who were followed-up at the pandemic clinic of Erciyes University, Medical Faculty Hospital. Patients were categorized according to the criteria released by the Republic of Turkey Ministry of Health. That guide classifies the patients as mild-moderate and severe.Patients over 18 years of age who were treated with COVID-19 and whose symptoms were not severe were included in this study.Patients who have missing data were excluded from this study.
Results: The findings showed that there was no significant difference in hospitalized patients concerning neutrophil-lymphocyte ratiolevels, white blood cell count, neutrophil count, lymphocyte count in mild or moderate COVID-19 infected patients at admission and discharge. There was a significant difference in CRP levels between admission and discharge however patients did not progress to a clinical deterioration on the follow-up.
Conclusion: Neutrophil-lymphocyte ratiolevels did not change significantly between admission and discharge in mild-moderate patients. In light of previous studies reporting that neutrophil-lymphocyte ratiolevels are high in patients with severe COVID-19, the present study suggest that neutrophil-lymphocyte ratio levels are a proper marker for predicting the tendency to severe COVID -19 disease in the follow-up of the patients.

References

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  • Referans2. Mithani F, Poursheykhi M, Ma B, Smith RG, Hsu SH, Gotur D. New-Onset Seizures in Three COVID-19 Patients: A Case Series. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 2021;38(2):e5-e10.
  • Referans3. Sengupta PP, Chandrashekhar YS. Cardiac Involvement in the COVID-19 Pandemic: Hazy Lessons From Cardiac Imaging? JACC Cardiovascular imaging. 2020;13(11):2480-3.
  • Referans4. Wang H, Li R, Zhou Z, Jiang H, Yan Z, Tao X, et al. Cardiac involvement in COVID-19 patients: mid-term follow up by cardiovascular magnetic resonance. Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance. 2021;23(1):14.
  • Referans5. Ozer S, Candan L, Ozyildiz AG, Turan OE. Evaluation of left ventricular global functions with speckle tracking echocardiography in patients recovered from COVID-19. The international journal of cardiovascular imaging. 2021.
  • Referans6. Greco S, Zenunaj G, Bonsi B, Bella A, Lopreiato M, Luciani F, et al. SARS-CoV-2 and finding of vein thrombosis: can IMPROVE and IMPROVEDD scores predict COVID-19 outcomes? European review for medical and pharmacological sciences. 2021;25(4):2123-30.
  • Referans7. Ozturk S, Turgutalp K, Arici M, Odabas AR, Altiparmak MR, Aydin Z, et al. Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: a nationwide analysis from Turkey. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2020;35(12):2083-95.
  • Referans8. Kumaran NK, Karmakar BK, Taylor OM. Coronavirus disease-19 (COVID-19) associated with acute necrotising pancreatitis (ANP). BMJ case reports. 2020;13(9).
  • Referans9. Dietrich CG, Hubner D, Marx G, Bickenbach J, Bootsveld A. Primary presentation of COVID-19 solely with gastrointestinal symptoms: a problem for the containment of the disease. Eur J Gastroenterol Hepatol. 2020;32(11):1475-8.
  • Referans10. Lei P, Zhang L, Han P, Zheng C, Tong Q, Shang H, et al. Liver injury in patients with COVID-19: clinical profiles, CT findings, the correlation of the severity with liver injury. Hepatology international. 2020;14(5):733-42.
  • Referans11. Gisondi P, S PI, Bordin C, Alaibac M, Girolomoni G, Naldi L. Cutaneous manifestations of SARS-CoV-2 infection: a clinical update. Journal of the European Academy of Dermatology and Venereology : JEADV. 2020;34(11):2499-504.
  • Referans12. Wendel Garcia PD, Fumeaux T, Guerci P, Heuberger DM, Montomoli J, Roche-Campo F, et al. Prognostic factors associated with mortality risk and disease progression in 639 critically ill patients with COVID-19 in Europe: Initial report of the international RISC-19-ICU prospective observational cohort. EClinicalMedicine. 2020;25:100449.
  • Referans13. Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progression. Critical reviews in clinical laboratory sciences. 2020;57(6):389-99.
  • Referans14. Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes. 2017;10(1):12.
  • Referans15. Hirahara T, Arigami T, Yanagita S, Matsushita D, Uchikado Y, Kita Y, et al. Combined neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predicts chemotherapy response and prognosis in patients with advanced gastric cancer. BMC cancer. 2019;19(1):672.
  • Referans16. Huang Z, Fu Z, Huang W, Huang K. Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: A meta-analysis. The American journal of emergency medicine. 2020;38(3):641-7.
  • Referans17. Ohtaka M, Kawahara T, Takamoto D, Mochizuki T, Ishida H, Hattori Y, et al. Neutrophil-to-Lymphocyte Ratio in Renal Transplant Patients. Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 2018;16(5):546-9.
  • Referans18. Dong CH, Wang ZM, Chen SY. Neutrophil to lymphocyte ratio predict mortality and major adverse cardiac events in acute coronary syndrome: A systematic review and meta-analysis. Clin Biochem. 2018;52:131-6.
  • Referans19. Ma A, Cheng J, Yang J, Dong M, Liao X, Kang Y. Neutrophil-to-lymphocyte ratio as a predictive biomarker for moderate-severe ARDS in severe COVID-19 patients. Crit Care. 2020;24(1):288.
  • Referans20. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. The Journal of infection. 2020;81(1):e6-e12.
  • Referans21. Jimeno S, Ventura PS, Castellano JM, Garcia-Adasme SI, Miranda M, Touza P, et al. Prognostic implications of neutrophil-lymphocyte ratio in COVID-19. European journal of clinical investigation. 2021;51(1):e13404.
  • Referans22. 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. Thrombosis research. 2020;192:3-8.
  • Referans23. Nalbant A, Kaya T, Varim C, Yaylaci S, Tamer A, Cinemre H. Can the neutrophil/lymphocyte ratio (NLR) have a role in the diagnosis of coronavirus 2019 disease (COVID-19)? Revista da Associacao Medica Brasileira. 2020;66(6):746-51.
  • Referans24. Zhao Y, Zhao Z, Wang Y, Zhou Y, Ma Y, Zuo W. Single-Cell RNA Expression Profiling of ACE2, the Receptor of SARS-CoV-2. American journal of respiratory and critical care medicine. 2020;202(5):756-9.
  • Referans25. Wang L. C-reactive protein levels in the early stage of COVID-19. Medecine et maladies infectieuses. 2020;50(4):332-4.

Year 2022, Volume 44, Issue 3, 268 - 272, 01.10.2022
https://doi.org/10.7197/cmj.1149259

Abstract

References

  • Referans1. Salzberger B, Buder F, Lampl B, Ehrenstein B, Hitzenbichler F, Hanses F. [Epidemiology of SARS-CoV-2 infection and COVID-19]. Der Internist. 2020;61(8):782-8.
  • Referans2. Mithani F, Poursheykhi M, Ma B, Smith RG, Hsu SH, Gotur D. New-Onset Seizures in Three COVID-19 Patients: A Case Series. Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society. 2021;38(2):e5-e10.
  • Referans3. Sengupta PP, Chandrashekhar YS. Cardiac Involvement in the COVID-19 Pandemic: Hazy Lessons From Cardiac Imaging? JACC Cardiovascular imaging. 2020;13(11):2480-3.
  • Referans4. Wang H, Li R, Zhou Z, Jiang H, Yan Z, Tao X, et al. Cardiac involvement in COVID-19 patients: mid-term follow up by cardiovascular magnetic resonance. Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance. 2021;23(1):14.
  • Referans5. Ozer S, Candan L, Ozyildiz AG, Turan OE. Evaluation of left ventricular global functions with speckle tracking echocardiography in patients recovered from COVID-19. The international journal of cardiovascular imaging. 2021.
  • Referans6. Greco S, Zenunaj G, Bonsi B, Bella A, Lopreiato M, Luciani F, et al. SARS-CoV-2 and finding of vein thrombosis: can IMPROVE and IMPROVEDD scores predict COVID-19 outcomes? European review for medical and pharmacological sciences. 2021;25(4):2123-30.
  • Referans7. Ozturk S, Turgutalp K, Arici M, Odabas AR, Altiparmak MR, Aydin Z, et al. Mortality analysis of COVID-19 infection in chronic kidney disease, haemodialysis and renal transplant patients compared with patients without kidney disease: a nationwide analysis from Turkey. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2020;35(12):2083-95.
  • Referans8. Kumaran NK, Karmakar BK, Taylor OM. Coronavirus disease-19 (COVID-19) associated with acute necrotising pancreatitis (ANP). BMJ case reports. 2020;13(9).
  • Referans9. Dietrich CG, Hubner D, Marx G, Bickenbach J, Bootsveld A. Primary presentation of COVID-19 solely with gastrointestinal symptoms: a problem for the containment of the disease. Eur J Gastroenterol Hepatol. 2020;32(11):1475-8.
  • Referans10. Lei P, Zhang L, Han P, Zheng C, Tong Q, Shang H, et al. Liver injury in patients with COVID-19: clinical profiles, CT findings, the correlation of the severity with liver injury. Hepatology international. 2020;14(5):733-42.
  • Referans11. Gisondi P, S PI, Bordin C, Alaibac M, Girolomoni G, Naldi L. Cutaneous manifestations of SARS-CoV-2 infection: a clinical update. Journal of the European Academy of Dermatology and Venereology : JEADV. 2020;34(11):2499-504.
  • Referans12. Wendel Garcia PD, Fumeaux T, Guerci P, Heuberger DM, Montomoli J, Roche-Campo F, et al. Prognostic factors associated with mortality risk and disease progression in 639 critically ill patients with COVID-19 in Europe: Initial report of the international RISC-19-ICU prospective observational cohort. EClinicalMedicine. 2020;25:100449.
  • Referans13. Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progression. Critical reviews in clinical laboratory sciences. 2020;57(6):389-99.
  • Referans14. Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Res Notes. 2017;10(1):12.
  • Referans15. Hirahara T, Arigami T, Yanagita S, Matsushita D, Uchikado Y, Kita Y, et al. Combined neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predicts chemotherapy response and prognosis in patients with advanced gastric cancer. BMC cancer. 2019;19(1):672.
  • Referans16. Huang Z, Fu Z, Huang W, Huang K. Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: A meta-analysis. The American journal of emergency medicine. 2020;38(3):641-7.
  • Referans17. Ohtaka M, Kawahara T, Takamoto D, Mochizuki T, Ishida H, Hattori Y, et al. Neutrophil-to-Lymphocyte Ratio in Renal Transplant Patients. Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 2018;16(5):546-9.
  • Referans18. Dong CH, Wang ZM, Chen SY. Neutrophil to lymphocyte ratio predict mortality and major adverse cardiac events in acute coronary syndrome: A systematic review and meta-analysis. Clin Biochem. 2018;52:131-6.
  • Referans19. Ma A, Cheng J, Yang J, Dong M, Liao X, Kang Y. Neutrophil-to-lymphocyte ratio as a predictive biomarker for moderate-severe ARDS in severe COVID-19 patients. Crit Care. 2020;24(1):288.
  • Referans20. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. The Journal of infection. 2020;81(1):e6-e12.
  • Referans21. Jimeno S, Ventura PS, Castellano JM, Garcia-Adasme SI, Miranda M, Touza P, et al. Prognostic implications of neutrophil-lymphocyte ratio in COVID-19. European journal of clinical investigation. 2021;51(1):e13404.
  • Referans22. 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. Thrombosis research. 2020;192:3-8.
  • Referans23. Nalbant A, Kaya T, Varim C, Yaylaci S, Tamer A, Cinemre H. Can the neutrophil/lymphocyte ratio (NLR) have a role in the diagnosis of coronavirus 2019 disease (COVID-19)? Revista da Associacao Medica Brasileira. 2020;66(6):746-51.
  • Referans24. Zhao Y, Zhao Z, Wang Y, Zhou Y, Ma Y, Zuo W. Single-Cell RNA Expression Profiling of ACE2, the Receptor of SARS-CoV-2. American journal of respiratory and critical care medicine. 2020;202(5):756-9.
  • Referans25. Wang L. C-reactive protein levels in the early stage of COVID-19. Medecine et maladies infectieuses. 2020;50(4):332-4.

Details

Primary Language English
Subjects Health Care Sciences and Services
Journal Section Medical Science Research Articles
Authors

Merve YILDIRIM This is me
CUMHURİYET ÜNİVERSİTESİ, TIP FAKÜLTESİ, TIP PR.
0000-0001-7368-6435
Türkiye


Oktay BULUR> (Primary Author)
CUMHURİYET ÜNİVERSİTESİ, TIP FAKÜLTESİ
0000-0002-0332-3871
Türkiye

Publication Date October 1, 2022
Published in Issue Year 2022, Volume 44, Issue 3

Cite

APA Yıldırım, M. & Bulur, O. (2022). Prognostic Significance of Neutrophil-Lymphocyte ratioinCOVID-19 Infection . Cumhuriyet Medical Journal , 44 (3) , 268-272 . DOI: 10.7197/cmj.1149259