Utility of Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) as A Predictor of Mortality in COVİD-19
Keywords:COVID-19, Neutrophil Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR)
AbstractCoronavirus-19 pandemic has stricken our world since December 2019; the disease, first reported in China, is now a pandemic. More than 400 million people have been affected, and 5 million people have succumbed to the disease. Hence, it is the need of the era to find readily available laboratory parameters to assess the mortality chances in these patients. Our study aims to determine the utility of NLR and PLR ratios as a predictor of severity and clinical outcome of COVID-19 patients.100 patients admitted to a tertiary care hospital in Karnataka, India, during the months April to July 2020 were studied. Only patients with a positive RT-PCR (Reverse Transcriptase Polymerase Chain Reaction) report for COVID-19 were included. Demographic data, comorbidities, and mortality status were collected from electronic hospital records. Lab parameters including- Total Count (TC), Absolute count of neutrophils and lymphocytes, platelet count were taken. NLR and PLR were derived from available lab parameters. Patients were categorized into varying severity depending on their SpO2 levels at admission. Neutrophil count (P=0.001) and NLR (P=0.002) were associated with an increased risk of mortality and disease severity. An increase in PLR ratio (P=0.05) shows a mild association with mortality but not with disease severity (P=0.096). In contrast, comorbidities, increasing age, and gender did not show any statistical significance for mortality. The presence of statistical significance concerning NLR and PLR should be utilized as an aid by clinicians to assess disease severity and chances of mortality. As new variants of the disease are uprising and a single therapeutic measure is not available currently for the treatment of COVID-19, clinicians should be well informed about how to monitor the disease in a cost-effective and easily accessible way to reduce the disease mortality and morbidity.
Erdogan, A., Can, E.F. & Gönüllü, H. 2021. Evaluation of the prognostic role of NLR, LMR, PLR, and LCR ratio in COVID‐19 patients. Journal of Medical Virology, 93(3), 5555–5559. DOI: 10.1002/jmv.27097
Escobar, A.L., Madurga, R., Catellano, J.M., Aguiar, S.R., Velázquez, S., Bucar, M., Jimeno, S. & Ventura P.S. 2021. Hemogram as marker of in-hospital mortality in COVID-19. Journal of Investigative Medicine, 69(5), 962–969. DOI:10.1136/jim-2021-001810
Imran, M.M., Ahamad, U., Usman U., Ali, M., Shaukat, A. & Gul, N. 2021.Neutrophil/lymphocyte ratio—A marker of COVID-19 pneumonia severity. The International Journal of Clinical Pathology, 75(4),1-4. DOI: 10.1111/ijcp.13698
Liao, D., Zhou, F., Luo, L., Xu, M., Wang, H.,Xia, J., Gao, Y., Cai, L., Wang, Z., Yin, P., Wang, Y., Tang, L., Deng, J., Mei, H. & Hu, Y. 2020. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study. The Lancet Haematology, 7(9), 671–78. DOI: 10.1016/S2352-3026(20)30217-9
Liu, J., Liu, Y., Xiang, P., Pu, L., Xiong, H., Li, C.,... & Wang, X. 2020. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. Journal of Translational Medicine, 18(206). DOI: 10.1186/s12967-020-02374-0
Moradi, E.V., Teimouri, A., Rezaee, R., Morovatdar, N. & Foroughian, M. 2020. Increased age, neutrophil-to-lymphocyte ratio (NLR) and white blood cells count are associated with higher COVID-19 mortality. The American Journal of Emergency Medicine, 40(3), 11–14. DOI: 10.1016/j.ajem.2020.12.003
Prozan, L., Shusterman, E., Ablin, J., Mitelpunkt, A., Meilik, A., Adler, A., Choshen, G. & Kehlat, O. 2020. Prognostic value of neutrophil-to-lymphocyte ratio in COVID-19 compared with Influenza and respiratory syncytial virus infection. Scientific Report, 11(1), 21519.DOI: 10.1038/s41598-021-00927-x
Qu, R., Ling, Y., Zhang, Y., Wei, L.,Chen, X., Li, X., Liu, H., Guo, Z., Ren, H. & Wang Q. 2020. Platelet‐to‐lymphocyte ratio is associated with prognosis in patients with coronavirus disease‐19. Journal of Medical Virology, 92(9),1533–1541. DOI: 10.1002/jmv.25767
Samadibrata, D.M., Pandhita, B.A.W., Ananta, M.E. & Tango, T. 2020. Platelet-to-lymphocyte ratio, a novel biomarker to predict the severity of COVID-19 patients: A systematic review and meta-analysis. Journal of the intensive Care Society, 0(0), 1–7. DOI: 10.1111/ijcp.13698
Suastika, N.K.W. & Suega, K. 2021. Platelet to Lymphocyte Ratio is an Accurate Biomarker for Predicting Case Severity in Covid-19. Malaysian Journal of Medicine and Health Sciences, 17(SUPP4), 36-39.
Taj, S., Kasif, A., Fatima, S., Imran, S., Lone, A. & Ahmed, Q. 2021. Role of hematological parameters in the stratification of COVID-19 disease severity. Annals of Medicine and Surgery, 62(4), 68–72. DOI: 10.1016/j.amsu.2020.12.035
Wu, L., Zou, S., Wang, C., Tan, X. & Yu, M. 2019. Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio in Chinese Han population from Chaoshan region in South China. BMC Cardiovascular Disorders, 19(1), 125. DOI:10.1186/s12872-019-1110-7
Yanga, A., Liub, J., Taoc, W., & Lib, H. 2020. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. International Immunopharmacology, 84, 106504. DOI: 10.1016/j.intimp.2020.106504
Zhao, Y., Chao, Y., Wei, N., Shen, H., Qui, M. & Zhao, Y. 2020. Peripheral blood inflammatory markers in predicting prognosis in patients with COVID-19. Some differences with influenza A. Journal of Clinical Laboratory Analysis, 35(1),e23657. DOI: 10.1002/jcla.23657
How to Cite
Publishing your paper with Medical Laboratory Technology Journal (MLTJ) means that the author or authors retain the copyright in the paper. MLTJ granted an author(s) rights to put the paper onto a website, distribute it to colleagues, give it to students, use it in your thesis etc, even commercially. The author(s) can reuse the figures and tables and other information contained in their paper published by MLTJ in future papers or work without having to ask anyone for permission, provided that the figures, tables or other information that is included in the new paper or work properly references the published paper as the source of the figures, tables or other information, and the new paper or work is not direct at private monetary gain or commercial advantage.
MLTJ journal provides immediate open access to its content on the principle that making research freely available to the public supports a greater global exchange of knowledge. This journal is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. This license lets others remix, transform, and build upon the material for any purpose, even commercially. MLTJ journal Open Access articles are distributed under this Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA). Articles can be read and shared for All purposes under the following conditions:
BY: You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.SA: If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.