Analysis of Neutrophil Lymphocyte Ratio and Absolute Lymphocyte Count as Predictors of Severity of COVID-19 Patients

Yunianingsih Selanno, Yuyun Widaningsih, Tenri Esa, Mansyur Arif

Abstract


It is important to predict the severity of COVID-19 during the pandemic. Both Neutrophil Lymphocyte Ratio (NLR) and
Absolute Lymphocyte Count (ALC) are two easy, low-cost, and fast inflammatory markers, which positively correlate with the
severity of COVID-19. The purpose of this research was to analyze the value of NLR and ALC as predictors of COVID-19
severity. This research was a retrospective study using medical record data of 376 COVID-19 patients during
April-September 2020 at the Hasanuddin University Hospital and Makassar City Regional Hospital. Patients were classified
into non-severe and severe COVID-19. Neutrophil lymphocyte ratio and ALC values were determined based on routine
blood test (Sysmex XS-800i) results, statistical analysis using Independent T-test, while NLR and ALC diagnostic values were
analyzed with Receiver Operating Characteristics (ROC) curve to obtain the cut-off value, p < 0.05 was significant. The
samples consisted of 372 non-severe and 49 severe COVID-19 patients. Neutrophil lymphocyte ratio value in non-severe
(4.02±5.22) was significantly different from severe COVID-19 (9.81±7.06) (p < 0.001), similar to ALC in non-severe
(2.00±0.83x103/μL) and severe COVID-19 (1.22±0.78x103/μL) (p < 0.001). Receiver operating characteristics curve showed
that NLR had a sensitivity of 91.8% and specificity of 66.4% with a cut-off ≥ 3.17 with Negative Predict Value (NPV) of 98.2%
and Positive Predict Value (PPV) of 29.0%; while ALC had a sensitivity of 81.6% and specificity of 64.8% at cut-off
≤ 1.74x103/μL with NPV of 95.9% and PPV of 25.8%. Increased NLR and decreased ALC in severe COVID-19 patients
occurred due to an increased inflammatory response resulting in a decreased cellular immunity. Receiver operating
characteristics curve showed a cut-off for NLR of 3.17 and ALC of 1.74x103/μL, indicating an optimum sensitivity and
specificity. It was concluded that NLR and ALC can be used as predictors of COVID-19 severity with a cut-off ≥ 3.17 and
≤ 1.74x103/μL, respectively.


Keywords


COVID-19, neutrophil lymphocyte ratio, absolute lymphocyte count, predictor

Full Text:

PDF

References


Wang Y, Wang Y, Chen Y, Qin Q. Unique

epidemiological and clinical features of the emerging

novel Coronavirus pneumonia (COVID-19)

implicate special control measures. J Med Virol, 2020;

(6): 568-76.

World Health Organisation. A Coordinated global

research roadmap: 2019 novel Coronavirus [Internet].

R&D Vlueprint. 2020; 65. Available from:

http://dx.doi.org/10.1038/s41591-020-0935-z

(accessed 3 August, 2020).

Kementrian Kesehatan. Pedoman COVID REV-4.

Pedoman pencegah dan pengendali Coronavirus dis.

; 1(revisi ke-4): 1-125.

Divisi Pencegahan dan Pengendalian Infeksi Satuan

Penjaminan Mutu Rumah Sakit UNHAS. Panduan

pencegahan dan pengendalian infeksi COVID-19 di

RS UNHAS, 2020; 1-2.

PDPI. Panduan Praktik Klinik (PPK) Perhimpunan

Dokter Paru Indonesia, 2020; 12-23.

Burhan E, Susanto AD, Nasution SA, Ginanjar E, Pitoyo

CW, Susilo A, et al. Protokol pelaksanaan COVID-19.

; 1-50. Available from: http://inaheart.org/perki/

u p l o a d / f i l e s / p r o t o k o l % 2 0 T a t a l a k s a n a % 2 0

COVID-19%205OP%20FINAL(4).pdf (accessed 27

April, 2020).

COVID-19 kemenkes.go.id. Situasi terkini

perkembangan Coronavirus Disease (COVID-19).

Available from https://Covid19.kemkes.go.id/situasi

-infeksi-emerging/info-corona-virus/situasi-terkini

-perkembangan-coronavirus-disease-COVID-19-3

-agustus-2020/#.XykMYlUzbIU (accessed 3 August,

.

Soraya GV, Ulhaq ZS. Crucial laboratory parameters in

COVID-19 diagnosis and prognosis: An updated

meta-analysis. Med Clin (Barc), 2020; 1-25.

Yi Y, Lagniton PNP, Ye S, Li E, Xu RH. COVID-19: What

has been learned and to be learned about the novel

Coronavirus disease?. Int J Biol Sci, 2020; 16(10):

-66.

Fu J, Kong J, Wang W, Wu M, Yao L, Wang Z, et al. The

clinical implication of dynamic neutrophil to

lymphocyte ratio and D-dimer in COVID-19: A

retrospective study in Suzhou China. Thromb Res

[Internet]. 2020; 192: 3-8. Available from:

https://doi.org/10.1016/j.thromres.2020.05.006

(accessed 5 August, 2020).

Farkas J. Neutrophil-Lymphocyte Ratio (NLR): Free

upgrade to your WBC. 2019; 1-29. Available from:

http://www.emcrit.org/pulmcrit/nlr. (accessed 5

August, 2020).

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

Neutrophil-to-lymphocyte ratio as an independent

risk factor for mortality in hospitalized patients with

COVID-19. J Infect, 2020; 17(28): 1-7.

Fan BE, Chong VCL, Chan SSW, Lim GH, Lim KGE, Tan

GB, et al. Hematologic parameters in patients with Heo JY. Clinical and epidemiological characteristics of

Coronavirus disease 2019 in the early stage of

outbreak. Korean J Med, 2020; 95(2): 67-73.

Huang lan, Pranata R. Lymphopenia in severe

Coronavirus Disease 2019 (COVID-19): Systemic

review and meta-analysis. Journal of Intensive Care,

; 36(8): 1-10.

Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical

characteristics of Coronavirus disease 2019 in China.

New England Journal of Medicine [Internet]. 2020;

(18): 1708-20. Available from: http://www.nejm.

org/doi/10.1056/NEJMoa2002032 (accessed 26 Sept,

.

Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al.

Neutrophil-to-lymphocyte ratio predicts critical

illness patients with 2019 Coronavirus disease in the

early stage. J Transl Med, 2020; 18: 1.

Sun S, Cai X, Wang H, He G, Lin Y, et al. Abnormalities

of peripheral blood system in patients with COVID-19

in Wenzhou, China. Clinica Chimica Acta. Elsevier,

; 507: 174-180.

Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and

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

patients. International Immunopharmacology, 2020;

: 106504. Available from: https://doi.org/10.1016/

j.intimp.2020.106504 (accessed 9 April, 2020).




DOI: http://dx.doi.org/10.24293/ijcpml.v27i2.1738

Refbacks

  • There are currently no refbacks.


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