Coronavirus disease-2019, C-reactive protein, Ferritin, Neutrophil–lymphocyte ratio
Citation Information :
Maddani SS, Gupta N, Umakanth S, Joylin S, Saravu K. Neutrophil–Lymphocyte Ratio in Patients with COVID-19 as a Simple Tool to Predict Requirement of Admission to a Critical Care Unit. Indian J Crit Care Med 2021; 25 (5):535-539.
Introduction: Coronavirus disease-2019 (COVID-19) pandemic has overloaded the healthcare system beyond its functional capacity. Late referral to higher levels of care may be one of the factors associated with higher mortality. Therefore, we aimed to find simple demographic and laboratory parameters which predict the requirement of admission to a critical care unit.
Materials and methods: A case–control study was undertaken in adult age population >18 years, admitted in a dedicated COVID hospital in South India. A total of 50 patients with severe disease (cases) were compared with 143 mild or asymptomatic cases (controls). Those demographic and laboratory parameters that were found to be significant on univariate analysis were used for multiple logistic regression analysis.
Results: Univariate analysis of demographic and laboratory data showed higher age, male sex, presence of diabetes mellitus, higher values of C-reactive protein, ferritin, D-dimer, neutrophil–lymphocyte ratio (NLR), and lactate dehydrogenase to be significantly associated with cases. Multivariate logistic regression analysis of these significant variables showed NLR and ferritin to be the independent predictors of the requirement of admission to a critical care unit. The receiver-operating characteristic curve showed an NLR value of 5.2 and a ferritin value of 462 µg/L that were able to predict the requirement of admission in critical care units.
Conclusion: High ferritin and NLR were independent predictors of the requirement of admission in critical care units. NLR is a simple tool that can be used in resource-limited settings for triage and early referral to higher levels of care.
World Health Organization. Novel coronavirus (2019-nCoV): situation report – 22. 11 February 2020. World Health Oragnization; 2020.
Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382(18):1708–1720. DOI: 10.1056/NEJMoa2002032.
Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area. JAMA 2020;323(20):2052–2059. DOI: 10.1001/jama.2020.6775.
Soni SL, Kajal K, Yaddanapudi LN, Malhotra P, Puri GD, Bhalla A, et al. Demographic and clinical profile of patients with COVID-19 at a tertiary care hospital in north India. Indian J Med Res 2020. DOI: 10.4103/ijmr.IJMR_2311_20.
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323(13):1239–1242. DOI: 10.1001/jama.2020.2648.
World Health Organization. Clinical management of COVID-19: interim guidance, 27 May 2020. World Health Organization; 2020.
Gold JAW, Rossen LM, Ahmad FB, Sutton P, Li Z, Salvatore PP, et al. Race, Ethnicity, and Age Trends in Persons Who Died from COVID-19 – United States, May–August 2020. MMWR Morb Mortal Wkly Rep 2020;69(42):1517–1521. DOI: 10.15585/mmwr.mm6942e1.
Mahale N, Rajhans P, Godavarthy P, Narasimhan VL, Oak G, Marreddy S, et al. A retrospective observational study of hypoxic COVID-19 patients treated with immunomodulatory drugs in a tertiary care hospital. Indian J Crit Care Med 2020;24(11):1020–7. DOI: 10.5005/jp-journals-10071-23599.
Bhadade R, Harde M, deSouza R, Kasbe A, Deshpande C, Dave S, et al. Appraisal of critically ill COVID-19 patients at a dedicated COVID hospital. J Assoc Physicians India 2020;68(9):14–19. PMID: 32798339.
Sharma D, Dayama A, Banerjee S, Bhandhari S, Chatterjee A, Chatterjee D. To study the role of absolute lymphocyte count and RDW in COVID 19 patients and their association with appearance of symptoms and severity. J Assoc Physicians India 2020;68(8):39–42. PMID: 32738839.
Dosi R, Jain G, Mehta A. Clinical characteristics, comorbidities, and outcome among 365 patients of coronavirus disease 2019 at a tertiary care centre in Central India. J Assoc Physicians India 2020;68(9):20–23. PMID: 32798340.
Verity R, Okell LC, Dorigatti I, Winskill P, Whittaker C, Imai N, et al. Estimates of the severity of coronavirus disease 2019: a model-based analysis. Lancet Infect Dis 2020;20(6):669–677. DOI: 10.1016/S1473-3099(20)30243-7.
Williamson EJ, Walker AJ, Bhaskaran K, Bacon S, Bates C, Morton CE, et al. Factors associated with COVID-19-related death using OpenSAFELY. Nature 2020;584(7821):430–436. DOI: 10.1038/s41586-020-2521-4.
Onder G, Rezza G, Brusaferro S. Case-fatality rate and characteristics of patients dying in relation to COVID-19 in Italy. JAMA 2020;323(18):1775–1776. DOI: 10.1001/jama.2020.4683.
Danwang C, Endomba FT, Nkeck JR, Wouna DL, Robert A, Noubiap JJ. A meta-analysis of potential biomarkers associated with severity of coronavirus disease 2019 (COVID-19). Biomark Res 2020;8(1):1–3. DOI: 10.1186/s40364-020-00217-0.
Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, et al. Hematological findings and complications of COVID-19. Am J Hematol 2020;95(7):834–847. DOI: 10.1002/ajh.25829.
Li X, Liu C, Mao Z, Xiao M, Wang L, Qi S, et al. Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis. Crit Care 2020;24(1):647. DOI: 10.1186/s13054-020-03374-8.
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. DOI: 10.1016/j.intimp.2020.106504. PMID: 32304994. PMCID: PMC7152924.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054–1062. DOI: 10.1016/S0140-6736(20)30566-3.