Neutrophil- and platelet-lymphocyte ratios as valuable prognostic biomarkers in ICU COVID-19 patients

Document Type : Original Article

Authors

1 Pulmonary medicine consultant, King Fahd specialist hospital (KFSH). Burayda, Qassim ministry of health, Kingdom of Saudi Arabia. and Assistant professor of chest diseases, Department of Chest Diseases, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.

2 Pulmonary consultant, Head of pulmonary unit, King Fahd Specialist Hospital (KFSH), Burayda, Qassim ministry of health, Kingdom of Saudi Arabia.

3 Department of clinical and chemical pathology, Beni-Suef University, Beni-Suef, Egypt

4 Department of Biochemistry, Beni-Suef University, Beni-Suef, Egypt.

5 Department of Public health and community medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.

6 Department of Medical Microbiology& Immunology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt.

7 Department of Internal Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt

Abstract

Background: Coronavirus disease 2019 (COVID-19) is a serious pandemic infectious disease that spread all over the world with a wide variety of complications. The need for easily available markers that can assess the severity and prognosis of the disease nowadays is a great demand.  Aim: Study the dynamic changes in NLR and PLR during treatment of confirmed COVID-19 patient in the ICU regarding prognosis and mortality. Method: A retrospective cross-sectional study included 67 patients, with a confirmed COVID-19 by Real time PCR and meet the criteria of hospitalization. Patients were followed up daily for denoting their outcome. NLR and PLR were calculated and compared with other proven biomarkers for COVID-19 to predict prognosis, mortality, and assess their sensitivity and specificity. Result: A total of 67 ICU patients with COVID-19 were enrolled in the current study, 40 were improved and 27 died. Died patients had older age compared with improved patients. Neutrophils were significantly higher among dead patients compared to improved ones (p-value= 0.035). It was found that the NLR & PLR were significantly higher in dead compared to improved patients as follow (p= 0.007) and (p= 0.041), that, may help in the early detection of Covid-19 patients who need more aggressive clinical management. The data showed that there was a high significance of NLR and PLR (p<0.001) in the mortality prediction state. Conclusion: Both NLR and PLR are good predictors biomarkers for severity and mortality in ICU COVID-19 patients.

Keywords

Main Subjects

References

  1. Feng W, Zong W, Wang F, Ju S. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): a review. Mol Cancer. 2020; 19(1):100-5.
  2. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020; 395(10223):507–13
  3. Manjili RH, Zarei M, Habibi M, Manjili MH. COVID-19 as an acute infammatory disease. J Immunol. 2020; 205(1):12–9.
  4. Azkur AK, Akdis M, Azkur D, Sokolowska M, van de Veen W, Bruggen MC, et al. Immune response to SARS-CoV-2 and mechanisms of immunopathological changes in COVID-19. Allergy. 2020; 75(7):1564–81.
  5. Chenga MH, Zhanga S, Porrittb RA, Rivasb MN, Pascholdd L, Willscherd E, et al. Superantigenic character of an insert unique to SARS-CoV-2 spike supported by skewed TCR repertoire in patients with hyperinflammation. Proc Natl Acad Sci U S A.2020; 117(41): 25254-25262.
  6. Li H, lera AL, Malchiodi EL, Mariuzza RA: The structural basis of T cell activation by superantigens. Annu. Rev. Immunol. 1999;17, 435–466.
  7. Krakauer T. Staphylococcal superantigens: Pyrogenic toxins induce toxic shock. Toxins (Basel) 2019;11, 178.
  8. Zhou F 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, 1054–1062
  9. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China. Clinical Infectious Diseases. 2020; 71, 762–768.
  10. Wang X, Li X, Shang Y, Wang J, Zhang X, Su D, et al. Ratios of neutrophil-to-lymphocyte and platelet-tolymphocyte predict all-cause mortality in inpatients with coronavirus disease 2019 (COVID-19): a retrospective cohort study in a single medical centre. Epidemiology and Infection. 2020; 148, e211, 1–8. https://doi.org/ 10.1017/S0950268820002071.
  11. Li X , Liu C, Zhi M , 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; 24:647
  12. Templeton AJ, McNamara MG, Seruga B, Vera-Badillo FE, Aneja P, Ocana A, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst. 2014; 106(6):124.
  13. Kim S, Eliot M, Koestler DC, Wu WC, Kelsey KT. Association of neutrophilto-lymphocyte ratio with mortality and cardiovascular disease in the Jackson heart study and modifcation by the dufy antigen variant. JAMA Cardiol. 2018; 3(6):455–62.
  14. Paliogiannis P, Fois AG, Sotgia S, Mangoni AA, Zinellu E, Pirina P, et al. Neutrophil to lymphocyte ratio and clinical outcomes in COPD: recent evidence and future perspectives. Eur Respir Rev. 2018; 27:147.
  15. Kong W, He Y, Bao H, Zhang W, Wang X. Diagnostic value of neutrophillymphocyte ratio for predicting the severity of acute pancreatitis: a metaanalysis. Dis Markers. 2020; 2020:9731854.
  16. Lagunas-Rangel FA. Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019
  17. Liu J, Li S, Liu J, Liang B, Wang X., Wang H, et al. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine. 2020; 55, 102763. [CrossRef] [PubMed]
  18. Gormez S, Ekicibasi E, Degirmencioglu A, Paudel A, Erdim R, Gumusel HK, et al. Association between renin–angiotensin–aldosterone system inhibitor treatment, neutrophil–lymphocyte ratio, D-Dimer and clinical severity of COVID-19 in hospitalized patients: A multicenter, observational study. J. Hum. Hypertens. 2020. [CrossRef]
  19. Rizo-Téllez SA, Méndez-García LA, Flores-Rebollo C, Alba-Flores F, Alcántara-Suárez R, Manjarrez-Reyna AN, et al. The Neutrophil-to-Monocyte Ratio and Lymphocyte-to-Neutrophil Ratio at Admission Predict In-Hospital Mortality in Mexican Patients with Severe SARS-CoV-2 Infection (Covid-19). 2020 Oct 10; 8(10):1560. doi: 10.3390/microorganisms8101560.
  20. Liu J, Liu Y, Xiang P, et al. Neutrophil-to-lymphocyte ratio predicts severe illness patients with 2019 novel coronavirus in the early stage. medRxiv. 2020.
  21. Kolaczkowska E, and Kubes P. Neutrophil recruitment and function in health and inflammation. Nat. Rev. Immunol. 2013; 13, 159–175. [CrossRef]
  22. Hemmat N, Derakhshani A, Baghi HB, Silvestris N, Baradaran B, De Summa S. Neutrophils, Crucial, or Harmful Immune Cells Involved in Coronavirus Infection: A Bioinformatics Study. Front. Genet. 2020; 11, 641. [CrossRef] [PubMed]
  23. Wang K, Chen W, Zhou Y-S, et al. SARS-CoV-2 invades host cells via a novel route: CD147-spike protein. bioRxiv. 2020.
  24. Perdersen SF, and Ho Y-C. SARS-CoV-2: a storm is raging. J Clin Invest. 2020 Perdersen SF, Ho Y-C. SARS-CoV-2: a storm is raging. J Clin Invest. 2020
  25. Diao B et al. (2020) Reduction and functional exhaustion of T cells in patients with coronavirus disease 2019 (COVID-19). Frontiers in Immunology 11, 827.
  26. Nicolai L and Massberg S. Platelets as key players in inflammation and infection. Current Opinion in Hematology. 2020; 27, 34–40.
  27. Eickmann M, Gravemann U, Handke W, et al. Inactivation of three emerging viruses severe acute respiratory syndrome coronavirus, Crimean‐Congo haemorrhagic fever virus and Nipah virus ‐ in platelet concentrates by ultraviolet C light and in plasma by methylene blue plus visible light. Vox Sang. 2020. https://doi.org/10.1111/vox.12888
  28. Poon TCW, Pang RTK, Chan KCA. Proteomic analysis reveals platelet factor 4 and beta‐thromboglobulin as prognostic markers in severe acute respiratory syndrome. Electrophoresis. 2012; 33(12):18941900.
  29. Pilaczyńska‐Cemel M, Gołda R, Dąbrowska A, Przybylski G. Analysis of the level of selected parameters of inflammation,circulating immune complexes,and related indicators (neutrophil/lymphocyte, platelet/lymphocyte, CRP/CIC) in patients with
  30. Qu R, Ling Y, Zhang Y,  Wei L, Chen X, Li X, et al. Platelet‐to‐lymphocyte ratio is associated with prognosis in patients with coronavirus disease‐ J Med Virol . 2020 Sep; 92(9):1533-1541. doi: 10.1002/jmv.25767. Epub 2020 Mar 26.
  31. Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, et al. D-dimer levels on admission to predict in-hospital mortality in patients with Covid-19. J. Thromb. Haemost. 2020; 18, 1324–1329.
  32. Lin Z, Long F, Yang Y, Chen X, Xu  L, Yang M. Serum ferritin as an independent risk factor for severity in COVID-19 patients. J. Infect. 2020; 81, 647–679.
Egyptian Journal of Medical Research
Volume 4, Issue 4
October 2023
Pages 78-93

Files

Share

How to cite

Statistics