Prognostic Significance Association of Neutrophil-To- Lymphocyte Ratio and Platelets-To-Lymphocyte Ratio with Mortality in COVID19 Patients
Keywords:coronavirus, inflammation, mortality, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio.
Background: Inflammation is a key factor in COVID-19 progression and is potentially an important
predictive factor. The ratios of neutrophils to lymphocytes and platelets to lymphocytes may show
significant inflammatory progression, which may contribute to the development of some major
complications and mortality problems as observed in COVID-19. Objective: To examine and investigate
the correlation of neutrophil lymphocytic ratio (NLR) and platelets to lymphocytes ratio (PLR) with
increased mortality risk.
Methods: 124 patients admitted to King Abdulaziz hospital with confirmed COVID-19 were enrolled in
our study. The blood cell count was used to obtain NLR and PLR. The receiver operating characteristic
(ROC) curve was used to determine the sensitivity and specificity of NLR and PLR for severity and
mortality of admitted patients with COVID-19. The logistic regression model was used to explore the
risk factors associated with mortality and severity.
Results: The mortality rate was 23.4%. Among non-survivors’ patients’ lymphocyte significantly
declined with 96.5%, while neutrophil counts increased. The Empirical optimal cut point of NLR
correlated with mortality is 4.647, with a sensitivity of 93% and a specificity of 61% (AUC: 0.847, 95%
CI 0.774-0.921; P = 0.001). Moreover, the optimal cut point of PLR associated mortality is 17.358,
with a sensitivity of 90% and a specificity of 64% (AUC: 0.791, 95% CI 0.703-0.878; P = 0.005).
Conclusions: NLR and PLR variables were significantly correlated with severity and mortality. NLR
and PLR can be considered independent biomarkers in COVID-19 patients which play a significant role
to predict mortality cases.
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