Prognostic implications of neutrophil‐lymphocyte ratio in COVID‐19. (25th September 2020)

• Record Type: Journal Article
• Authors: Jimeno, Sara; Ventura, Paula S.; Castellano, Jose M.; García‐Adasme, Salvador I.; Miranda, Mario; Touza, Paula; Lllana, Isabel; López‐Escobar, Alejandro
• Is Part Of: European journal of clinical investigation. Volume 51:Number 1(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2020-09-25
• Subjects: COVID‐19 -- endothelial dysfunction -- hyperinflammatory response -- Neutrophil–lymphocyte ratio; Pathology -- Periodicals; Medical research -- Periodicals; 616.075
• DOI: 10.1111/eci.13404
• Languages: English
• ISSNs: 0014-2972

Abstract

Abstract: Background: The clinical presentation of COVID‐19 ranges from a mild, self‐limiting disease, to multiple organ failure and death. Most severe COVID‐19 cases present low lymphocytes counts and high leukocytes counts, and accumulated evidence suggests that in a subgroup of patients presenting severe COVID‐19, there may be a hyperinflammatory response driving a severe hypercytokinaemia which may be, at least in part, signalling the presence of an underlying endothelial dysfunction. In this context, available data suggest a prognostic role of neutrophil‐lymphocyte ratio (NLR) in various inflammatory diseases and oncological processes. Following this rationale, we hypothesized that NLR, as a marker of endothelial dysfunction, may be useful in identifying patients with a poor prognosis in hospitalized COVID‐19 cases. Design: A retrospective observational study performed at Hospital Universitario HM Puerta del Sur, Madrid, Spain, which included 119 patients with COVID‐19 from 1 March to 31 March 2020. Patients were categorized according to WHO R&D Expert Group. Results: Forty‐five (12.1%) patients experienced severe acute respiratory failure requiring respiratory support. Forty‐seven (12.6%) patients died. Those with worse outcomes were older ( P = .002) and presented significantly higher NLR at admission ( P = .001), greater increase in Peak NLR ( P < .001) and higher increasing speed of NLR ( P = .003) compared with follow‐up patients. In a multivariable logistic regression, age, cardiovascular disease and C‐reactive protein at admission and Peak NLR were significantly associated with death. Conclusions: NLR is an easily measurable, available, cost‐effective and reliable parameter, which continuous monitoring could be useful for the diagnosis and treatment of COVID‐19.