The Importance of neutrophil-lymphocyte ratio, monocyte-lymphocyte ratio, and thrombocyte-lymphocyte ratio in addition to abnormal laboratory parameters in COVID-19 pneumonia
Abstract
Aim: We aimed to examine the importance of the neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR) and thrombocyte-lymphocyte ratio (TLR) in addition to laboratory parameters in terms of pneumonia between patients with and without pneumonia diagnosed with COVID-19 infection.
Materials and Methods: In our retrospective study, 506 patients diagnosed with COVID-19 who were hospitalized and treated between April 2020 and July 2020 were included. While 50.6% (n= 256) of the patients had pneumonia, 49.4% (n= 250) did not have. File informations were scanned; the demographic data, hospitalization and discharge laboratory parameters were recorded.
Results: The median age of the patients was 44.5 (16-89) years, 55.5% (n= 281) of them were male. The median age of patients with pneumonia was higher than those without pneumonia, and the frequency of female gender was higher (p <0.05 for both conditions). The lymphocyte count at hospitalization and discharge was significantly lower in patients with pneumonia (p <0.001, 0.007, respectively). The count of eosinophils at hospitalization was significantly lower in patients with pneumonia (p <0.001). NLR and TLR values were significantly higher in patients with pneumonia at admission and discharge (p <0.008, <0.007, respectively for NLR and p <0.001, p<0.001 respectively for TLR). MLR values at discharge were higher in patients with pneumonia (p = 0.001). In ROC analyzes made in terms of predicting pneumonia; hospitalization CRP level, eosinophil, monocyte counts and TLR values were found to be important variables.
Conclusion: In this study, the importance of monocyte, eosinophil counts and TLR values in COVID-19 pneumonia was demonstrated.
References
- Qing Ye, Bili Wang and Jianhua Mao. The pathogenesis and treatment of the ‘cytokine storm’ in COVID-19, J. Inf. Secur. 80 (2020): 607-13.
- Hamed Akbari, Reza Tabrizi, Kamran B. Lankarani et al. The role of cytokine profile and lymphocyte subsets in the severity of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. ELSEVIER, Life Sciences 258 (2020): 118167
- Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX. Neutrophil to lymphocyte ratio as an independent risk factor for mortalitiy in hospitalized patients with COVID-19. Journal of Infection 81 (2020): e6-e12.
- M. S. Asghar, N.A. Khan, S.J.H. Kazmi, et al. Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comperative analysis. medRxiv June 2020.
- Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR, PLR in COVID-19 patients. Int. Immunopharmacol 2020;84: 106504.
- Xue Wang, Xincheng Li, Yu Shang et al. Ratios of neutrophil to lymphocyte and platelet to lymphocyte predict all-cause mortality in inpatients with coronavirus disease 2019: a retrospective cohort study in a single madical centre. Epidemiology and Infection 2020: 148, e211, 1-8. https://doi.org/10.1017.
- Wannarat A. Pongpirul, Surasak Wiboonchutikul, Lantharita Charoenpong et al, Nayot Panitantum, Apichart Vachiraphan, Sumonmal Uttayamakul et al. Clinical course and potential predictive factors for pneumonia of adult patients with Coronavirus Disease 2019 (COVID-19): A retrospective observational analysis of 193 confirmed cases in Thailand. PLoS Negl Trop Dis. 2020: Oct; 14 (10): e0008806: https://doi.org/10.1371/journal.pntd.0008806.
- W. Guan, Z. Ni, Yu Hu et al. He. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020:1708-20.
- Ruchong Chen, MD, Ling Sang, MD, Mei Jiang, PhD et al. Longitudinal hematologic and immunologic variations associated with the progression of COVID-19 patients in China. J Allergy Clin Immunol. 2020: Jul; 146 (1): 89–100 doi: 10.1016/j.jaci.2020.05.003
- Guan W-J, Ni Z-Y, Hu Y. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020: 382 (18): 1708-1713.
- T. A. Khartabila, H. Russchera, Ajam van der Venb, and Y. B. de Rijkea. A summary of the diagnostic and prognostic value of hemacytometry markers in COVID-19 patients. Critical Reviews In Clinical Laboratory Sciences. 2020: June: https://doi.org/10.1080/10408363.2020.1774736.
- Guoguang Lu, Jing Wang. Dynamic changes in routine blood parameters of a severe COVID-19 case. Clinica Chim Acta 508 (2020): 98-102 doi: 10.1016/j.cca.2020.04.034
- Qin C, Zhou L, Hu Z. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020 Jul 28;71(15):762-768. doi: 10.1093/cid/ciaa248.
- Song C-Y, Xu J, He J-Q. COVID-19 early warning score: a multi-parameter screening tool to identify highly suspected patients. medRxiv. March 8, 2020: doi: https://doi.org/10.1101/2020.03.05.20031906.
- Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis Clin Chim Acta. 2020: 506:145-8.
- Yang M, Li CK, Li K. Hematological findings in SARS patients and possible mechanisms (review). Int J Mol Med. 2004: 14 (2): 311-5.
- Tian S, Zhu X, Sun X. Longitudinal analysis of laboratory findings during the process of recovery for patients with COVID-19. medRxiv. April 7, 2020: doi: https://doi.org/10.1101/2020.04.04.20053280.
- Feng Z, Yu Q, Yao S. Early prediction of disease progression in 2019 novel coronavirus pneumonia patients outside Wuhan with CT and clinical characteristics. medRxiv. 2020. doi: https://doi.org/10.1101/2020.02.19.20025296.
- Patrice Forget, Céline Khalifa, Jean‑Philippe Defour et al. What is the normal value of the neutrophil to lymphocyte ratio? BMC Res Notes (2017): 10:12 DOI 10.1186/s13104-016-2335-5.
- Junnan Peng, Di Qi, Guodan Yuan et al. Diagnostic value of peripheral hematologic markers for coronavirus disease 2019 (COVID-19): A multicenter, crosssectional study J Clin Lab Anal. 2020: 34: e23475.
- Gong J, Ou J, Qiu X. A tool to early predict severe 2019-novel coronavirus pneumonia (COVID-19): a multicenter study using the risk nomogram in Wuhan and Guangdong, China. medRxiv. 2020. doi: https://doi.org/10.1101/2020.03.17.20037515.J.
Anormal laboratuvar parametrelerine ilave olarak, nötrofil-lenfosit, monosit-lenfosit ve trombosit-lenfosit oranlarının COVID-19 pnömonisindeki önemi
Abstract
Amaç: COVID-19 pnömonisi olan ve olmayan hastalar arasındaki klinik ve hematolojik parametrelerdeki farklılıkların irdelenmesi, yatış ve taburculuk değerlerinin kıyaslanması, laboratuvar parametrelerinin yanında nötrofil-lenfosit oranı (NLO), monosit-lenfosit oranı (MLO) ve trombosit-lenfosit oranı (TLO)’ nın pnömoni açısından öneminin karşılaştırılması amaçlandı.
Gereç ve Yöntem: Retrospektif yaptığımız çalışmada Enfeksiyon Hastalıkları servisinde Nisan 2020-Temmuz 2020 tarihleri arasında yatarak tedavi alan COVID-19 tanılı 506 hasta dahil edildi. Hastaların 256’sı pnömoni tablosu olan (%50,6), 250’si pnömoni tablosu olmayan (%49,4) COVID-19 tanılı olgular idi. Her iki hasta grubunda dosya bilgileri taranarak demografik veriler, yatış ve taburculuklarındaki laboratuvar parametreleri, NLO, MLO ve TLO irdelenip karşılaştırıldı. Bulgular: Hastaların medyan yaşı 44,5 (16-89) yıl olup, %55,5 (n= 281)’i erkek idi. Pnömonisi olan hastaların medyan yaşı pnömonisi olmayanlara göre daha yüksekti ve bu grupta kadın cinsiyet sıklığının daha fazla olduğu görüldü (her iki durumda p<0,05). Pnömonisi olanların hastanede ortanca kalış süresi pnömoni olmayanlara göre daha yüksekti (p:0,009). Pnömonisi olanlarda olmayanlara göre yatış ve taburculuk lenfosit sayısı anlamlı olarak daha düşük idi (p değeri sırasıyla: <0,001, 0,007). Pnömonisi olanlarda olmayanlara göre yatış eozinofil sayısı anlamlı olarak daha düşük gözlendi (p<0,001). Pnömonisi olan hastaların yatış ve taburculuk NLO pnömonisi olmayan hastalara göre anlamlı olarak daha yüksek gözlendi (p sırasıyla <0,008, <0,007). Her iki grupta taburculuk NLO değeri yatış değerine göre düşük saptandı (her iki durumda p; <0.001). TLO pnömonisi olanlarda olmayanlara göre hem yatış hem de taburculukta daha yüksek görüldü (her iki durumda p <0,001). MLO incelendiğinde taburculuk MLO değerleri pnömonisi olanlarda daha yüksek gözlendi (p=0,001). Pnömoniyi öngörme açısından yapılan ROC analizinde; yatış eozinofil değerinin ≤0,02/μL olmasının AUC:0,668, %56,3 sensitivite, %71,2 spesifiteye, monosit değerinin ≤0,5/μL olmasının AUC:0,631, %55,1 sensitivite, %67,6 spesifiteye, TLO değerinin >105,7 olmasının AUC:0,611, %75,4 sensitivite, %46,0 spesifiteye sahip olduğu gözlendi. Sonuç: Bu çalışmada özellikle monosit, eozinofil sayıları ve TLO oranlarının COVID-19 pnömonisindeki önemi gösterilmiş oldu.
Keywords
References
- Qing Ye, Bili Wang and Jianhua Mao. The pathogenesis and treatment of the ‘cytokine storm’ in COVID-19, J. Inf. Secur. 80 (2020): 607-13.
- Hamed Akbari, Reza Tabrizi, Kamran B. Lankarani et al. The role of cytokine profile and lymphocyte subsets in the severity of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. ELSEVIER, Life Sciences 258 (2020): 118167
- Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX. Neutrophil to lymphocyte ratio as an independent risk factor for mortalitiy in hospitalized patients with COVID-19. Journal of Infection 81 (2020): e6-e12.
- M. S. Asghar, N.A. Khan, S.J.H. Kazmi, et al. Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comperative analysis. medRxiv June 2020.
- Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR, PLR in COVID-19 patients. Int. Immunopharmacol 2020;84: 106504.
- Xue Wang, Xincheng Li, Yu Shang et al. Ratios of neutrophil to lymphocyte and platelet to lymphocyte predict all-cause mortality in inpatients with coronavirus disease 2019: a retrospective cohort study in a single madical centre. Epidemiology and Infection 2020: 148, e211, 1-8. https://doi.org/10.1017.
- Wannarat A. Pongpirul, Surasak Wiboonchutikul, Lantharita Charoenpong et al, Nayot Panitantum, Apichart Vachiraphan, Sumonmal Uttayamakul et al. Clinical course and potential predictive factors for pneumonia of adult patients with Coronavirus Disease 2019 (COVID-19): A retrospective observational analysis of 193 confirmed cases in Thailand. PLoS Negl Trop Dis. 2020: Oct; 14 (10): e0008806: https://doi.org/10.1371/journal.pntd.0008806.
- W. Guan, Z. Ni, Yu Hu et al. He. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020:1708-20.
- Ruchong Chen, MD, Ling Sang, MD, Mei Jiang, PhD et al. Longitudinal hematologic and immunologic variations associated with the progression of COVID-19 patients in China. J Allergy Clin Immunol. 2020: Jul; 146 (1): 89–100 doi: 10.1016/j.jaci.2020.05.003
- Guan W-J, Ni Z-Y, Hu Y. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020: 382 (18): 1708-1713.
- T. A. Khartabila, H. Russchera, Ajam van der Venb, and Y. B. de Rijkea. A summary of the diagnostic and prognostic value of hemacytometry markers in COVID-19 patients. Critical Reviews In Clinical Laboratory Sciences. 2020: June: https://doi.org/10.1080/10408363.2020.1774736.
- Guoguang Lu, Jing Wang. Dynamic changes in routine blood parameters of a severe COVID-19 case. Clinica Chim Acta 508 (2020): 98-102 doi: 10.1016/j.cca.2020.04.034
- Qin C, Zhou L, Hu Z. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020 Jul 28;71(15):762-768. doi: 10.1093/cid/ciaa248.
- Song C-Y, Xu J, He J-Q. COVID-19 early warning score: a multi-parameter screening tool to identify highly suspected patients. medRxiv. March 8, 2020: doi: https://doi.org/10.1101/2020.03.05.20031906.
- Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis Clin Chim Acta. 2020: 506:145-8.
- Yang M, Li CK, Li K. Hematological findings in SARS patients and possible mechanisms (review). Int J Mol Med. 2004: 14 (2): 311-5.
- Tian S, Zhu X, Sun X. Longitudinal analysis of laboratory findings during the process of recovery for patients with COVID-19. medRxiv. April 7, 2020: doi: https://doi.org/10.1101/2020.04.04.20053280.
- Feng Z, Yu Q, Yao S. Early prediction of disease progression in 2019 novel coronavirus pneumonia patients outside Wuhan with CT and clinical characteristics. medRxiv. 2020. doi: https://doi.org/10.1101/2020.02.19.20025296.
- Patrice Forget, Céline Khalifa, Jean‑Philippe Defour et al. What is the normal value of the neutrophil to lymphocyte ratio? BMC Res Notes (2017): 10:12 DOI 10.1186/s13104-016-2335-5.
- Junnan Peng, Di Qi, Guodan Yuan et al. Diagnostic value of peripheral hematologic markers for coronavirus disease 2019 (COVID-19): A multicenter, crosssectional study J Clin Lab Anal. 2020: 34: e23475.
- Gong J, Ou J, Qiu X. A tool to early predict severe 2019-novel coronavirus pneumonia (COVID-19): a multicenter study using the risk nomogram in Wuhan and Guangdong, China. medRxiv. 2020. doi: https://doi.org/10.1101/2020.03.17.20037515.J.