Comparison between Neutrophil Lymphocyte Ratio and Derived Neutrophil Lymphocyte Ratio as the Risk Factor of COVID-19

Dwi Aryani, Dea Noviana Pramatik


Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Respiratory disorders were the most common sign and symptom of COVID-19. Inflammation on SARS-CoV-2 infection is presumed to play a role in the pathogenesis of COVID-19. The Neutrophil Lymphocyte Ratio (NLR) is one of many biomarkers that has been widely used to assess the risk factors of COVID-19. The derived Neutrophil Lymphocyte Ratio (d-NLR) is a simple, inexpensive, and widely available inflammation biomarker. However, its usage for COVID-19 remains to be further studied. This study aimed to determine the NLR and d-NLR ratio as a risk factor of COVID-19. This study was a retrospective study with a study population of 84 subjects, consisting of 33 patients with positive COVID-19 and 51 patients with negative COVID-19. The result showed that the odds ratio of NLR to COVID-19 was 2.665 with the p-value of 0.047 and confidence interval of 95% 0.998-7.038 at cut-off ≥ 3.1. The odd ratio of d-NLR to COVID-19 was 2.808 with the p-value of 0.026 and confidence interval of 95% 1.129-7.038 at cut-off ≥ 2.0. In conclusion, despite a higher odd ratio of d-NLR compared to NLR, both NLR and d-NLR can be used as a biomarker for the risk factor of COVID-19.


COVID-19, risk factor, NLR, d-NLR

Full Text:



Kementerian Kesehatan Republik Indonesia. Pedoman

pencegahan dan pengendalian Coronavirus Disease

(COVID-19). Jakarta, Kemenkes, 2020; 17.

Perhimpunan Dokter Paru Indonesian. Pneumonia

COVID-19 diagnosis dan penatalaksanaan di

Indonesia. Jakarta, Perhimpunan Dokter Paru

Indonesia, 2020; 4-7.

Wiersinga JW, Rhodes AJ, Cheng MD, Peacock SJ,

Prescott HC, Pathophysiology, transmission,

diagnosis, and treatment of Coronavirus Disease 2019

(COVID-19) a review. JAMA, 2020; 324(8): 782-793.

Ilmu Penyakit Dalam RS Dr M. Hoesin/FK UNSRI

Palembang. Praktis COVID-19, Palembang, 2020; 7-8.

Yang AP, Liu JP, Tao WQ, Li Hiu-ming. The diagnostic

and predictive role of NLR, d-NLR, and PLR in COVID-19

patients. International Immunopharmacology, 2020;

: 2-4

Liu Y, Du X, Chen X, Jin Y, Peng L, et al.

Neutrophil-to-lymphocyte ratio as an independent

risk factor for mortality in hospitalized patients with

COVID-19. Journal of Infection, 2020; 81: 6-12.

Kerboua KE. NLR: A cost-effective nomogram to guide

therapeutic interventions in COVID19. Immunological

Investigation, 2020; 50(8): 1-9.

Eskiizmir G, Uz U, Onur G, Ozgur B, Cicriki GK, et al. The

evaluation of pre-treatment neutrophil-lymphocyte

ratio and derived neutrophil-lymphocyte ratio in

patients with laryngeal neoplasms. Brazilian Journal of

Otorhinolaryngology, 2019; 85(5): 578-587.

Li Y, Shao Y, Bai L, Zhou X. Increased derived

neutrophil-to-lymphocyte ratio and breast

imaging-reporting and data system classification

predict poor survival in patients with non-distant

metastatic HER2+ breast cancer treated with

neoadjuvant chemotherapy. Shanxi, 2018; 10:


Usul E, San I, Bekgos B, Shahin A. The role of

hematological parameters in COVID-19 patients in the

emergency room. Biomark Med, 2020; 317: 2-7.

Liao D, Zhou F, Luo L, Xu M, Wang H, et al.

Haematological characteristics and risk factors in the

classification and prognosis evaluation of COVID-19:

A retrospective cohort study. Lancet Haematology,

; 7: 671-78.

Nalbant A, Kay T, Varin C, Cinemre S. Can the

Neutrophil/Lymphocyte Ratio (NLR) have a role in the

diagnosis of Coronavirus 2019 Disease (COVID-19)?.

Revista da Associação Médica Brasileira, 2020; 66(6):


Yan X, Li F, Wang X, Yan J, Zhui F, et al. Neutrophil to

lymphocyte ratio as a prognostic and predictive factor

in patients with Coronavirus Disease 2019: A

retrospective cross‐sectional study. Journal of

Medical Virology, 2020; 1-9.

Pimantel GD, Dela Vega, Laviano A. High neutrophil to

lymphocyte ratio as a prognostic marker in COVID-19

patients. European Society for Clinical Nutrition and

Metabolism. Roma, Elsevier Ltd, 2020; 1-2.

Cox S, Hurt C, Grenadier T, Mukherjee S, Bridgewater J,

et al. The prognostic value of derived neutrophil to

lymphocyte ratio in oesophageal cancer treated with

definitive chemoradiotherapy. London, Elsevier

Ireland Ltd, 2017; 154-159.



  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.