Could serum thrombocyte/lymphocyte (TLR), neutrophil/lymphocyte (NLR) and neutro-phil/albumin (NAR) ratios be indicators of hospitalization and mortality in COVID-19?
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Abstract
Background and Objectives: Neutrophil / lymphocyte (NLR) and thrombocyte / lymphocyte ratios (TLR) are also a guiding factors in the prognostic evaluation of infectious diseases. Another parameter to determine inflammation and prognosis is albumin. This study was aimed to determine whether TLR, NLR and neutrophil / albumin ratios (NAR) are effective in predicting the severity and course of Corona Virus Disease-2019 (COVID-19).
Materials and Methods: In this retrospective and cross-sectional study, a total of 1597 patients who were admitted to our hospital between 15.03.2020- 1.06.2020, diagnosed with COVID-19 were evaluated.
Results: In the estimation of the decision for hospitalization, TLR, NLR and NAR AUROC values were 0.596, 0.634, 0.602 for cutoff values 123.7, 2.3 and 839.5, respectively. In predicting mortality, TLR, NLR and NAR AURO sample size can be specified C values were 0.674, 0.821, 0.787 for cutoff values 168.1, 5.2 and 1303.4, respectively (p <0.001 for all).
Conclusion: In our study, it was determined that TLR, NLR and NAR are independent predictors in making the decision of hospitalization and in determining the prognosis in patients who are decided to be hospitalized.
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16. Zhou P, Yang X-L, Wang X-G, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associ-ated with a new coronavirus of probable bat origin. Nature 2020; 579: 270-273.
17. Wang K, Chen W, Zhang Z, Deng Y, Lian J-Q, Du P, et al. CD147-spike protein is a novel route for SARS-CoV-2 infection to host cells. Signal Transduct Target Ther 2020; 5: 283.
18. Han Q, Wen X, Wang L, Han X, Shen Y, Cao J, et al. Role of hematological parameters in the diagnosis of influenza virus infection in patients with respiratory tract infection symptoms. J Clin Lab Anal 2020; 34(5): e23191.
19. Yang A-P, Liu J-P, Tao W-Q, Li H-M. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol 2020; 84: 106504.
20. Xia X, Wen M, Zhan S, He J, Chen W. An increased neutrophil/lymphocyte ratio is an early warning signal of severe COVID-19. Nan Fang Yi Ke Da Xue Xue Bao 2020; 40: 333-336.
21. Faria SS, Fernandes PC Jr, Silva MJ, Lima VC, Fontes W, Freitas-Junior R, et al. The neutro-phil-to-lymphocyte ratio: a narrative review. Ecancermedicalscience 2016; 10: 702.
22. Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al. Neutrophil-to-lymphocyte ratio predicts crit-ical illness patients with 2019 coronavirus disease in the early stage. J Transl Med 2020; 18: 206.
23. 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; 81(1): e6-e12.
24. Yan X, Li F, Wang X, Yan J, Zhu F, Tang S, et al. Neutrophil to lymphocyte ratio as prognos-tic and predictive factor in patients with coronavirus disease 2019: A retrospective cross-sectional study. J Med Virol 2020; 92: 2573-2581.
25. Chen R-F, Chang J-C, Yeh W-T, Lee C-H, Liu J-W, Eng H-L, et al. Role of vascular cell adhe-sion molecules and leukocyte apoptosis in the lymphopenia and thrombocytopenia of patients with severe acute respiratory syndrome (SARS). Microbes Infect 2006; 8: 122-127.
26. Behrens K, Alexander WS. Cytokine control of megakaryopoiesis. Growth Factors 2018; 36: 89-103.
27. Shen Y, Huang X, Zhang W. Platelet-to-lymphocyte ratio as a prognostic predictor of mortality for sepsis: interaction effect with disease severity-a retrospective study. BMJ Open 2019; 9(1): e022896.
28. Lee J-H, Song S, Yoon S-Y, Lim CS, Song J-W, Kim H-S. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as diagnostic markers for pneumonia severity. Br J Biomed Sci 2016; 73: 140-142.
29. Qu R, Ling Y, Zhang Y-H-Z, Wei L-Y, Chen X, Li X-M, et al. Platelet-to-lymphocyte ratio is associated with prognosis in patients with coronavirus disease-19. J Med Virol 2020; 92: 1533-1541.
30. Uyar E, Merdİn A, Yamanyar S, Ezgu MC, Artuk C, TaŞkin G, et al. Could serum albumin value and thrombocyte / lymphocyte ratio be an important prognostic factor in determining the severity of COVID 19? Turk J Med Sci 2021; 51: 939-946.
31. Akirov A, Masri-Iraqi H, Atamna A, Shimon I. Low albumin levels are associated with mortality risk in hospitalized patients. Am J Med 2017; 130(12): 1465.e11-1465.e19.
32. Mani Mishra P, Uversky VN, Nandi CK. Serum albumin-mediated strategy for the effective targeting of SARS-CoV-2. Med Hypotheses 2020; 140: 109790.
33. Rod JE, Oviedo-Trespalacios O, Cortes-Ramirez J. A brief-review of the risk factors for covid-19 severity. Rev Saude Publica 2020; 54: 60.
34. Li J, Li M, Zheng S, Li M, Zhang M, Sun M, et al. Plasma albumin levels predict risk for non-survivors in critically ill patients with COVID-19. Biomark Med 2020; 14: 827-837.
35. Wang H, Zhang Y, Mo P, Liu J, Wang H, Wang F, et al. Neutrophil to CD4+ lymphocyte ratio as a potential biomarker in predicting virus negative conversion time in COVID-19. Int Immunopharmacol 2020; 85: 106683.
36. Tingle SJ, Severs GR, Goodfellow M, Moir JA, White SA. NARCA: A novel prognostic scor-ing system using neutrophil-albumin ratio and Ca19-9 to predict overall survival in palliative pan-creatic cancer. J Surg Oncol 2018; 118: 680-686.
37. Wang B, Li D, Cheng B, Ying B, Gong Y. The neutrophil percentage-to-albumin ratio us associated with all-cause mortality in critically Ill patients with acute kidney injury. Biomed Res Int 2020; 2020: 5687672.
2. World Health Organization (WHO) and others. Report of the WHO-China joint mission on coronavirus disease 2019 (COVID-19). Geneva: WHO; 2020. Available from https://www.who.int/publications-detail/report-of-the-who-china-joint-mission-on-coronavirus-disease-2019-(covid-19)
3. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus-infected Pneumonia in Wuhan, China. JAMA 2020; 323: 1061-1069.
4. Zhang MQ, Wang XH, Chen YL, Zhao KL, Cai YQ, An CL, et al. Clinical features of 2019 nov-el coronavirus pneumonia in the early stage from a fever clinic in Beijing. Zhonghua Jie He He Hu Xi Za Zhi 2020; 43: 215-218.
5. Zahorec R. Ratio of neutrophil to lymphocyte counts--rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy 2001; 102: 5-14.
6. Liu X, Shen Y, Wang H, Ge Q, Fei A, Pan S. Prognostic significance of neutrophil-to-lymphocyte ratio in patients with sepsis: a prospective observational study. Mediators Inflamm 2016; 2016: 8191254.
7. Curbelo J, Luquero Bueno S, Galván-Román JM, Ortega-Gómez M, Rajas O, Fernández-Jiménez G, et al. Inflammation biomarkers in blood as mortality predictors in community-acquired pneumonia admitted patients: Importance of comparison with neutrophil count percent-age or neutrophil-lymphcyte ratio. PLoS One 2017; 12(3): e0173947.
8. Koh YW, Lee HW. Prognostic impact of C-reactive protein/albumin ratio on the overall surviv-al of patients with advanced nonsmall cell lung cancers receiving palliative chemotherapy. Medicine (Baltimore) 2017; 96(19): e6848.
9. Varim C, Yaylaci S, Demirci T, Kaya T, Nalbant A, Dheir H, et al. Neutrophil count to albumin ratio as a new predictor of mortality in patients with COVID-19 ınfection. Rev Assoc Med Bras (1992) 2020; 66Suppl 2(Suppl 2): 77-81.
10. Ciccullo A, Borghetti A, Zileri Dal Verme L, Tosoni A, Lombardi F, Garcovich M, et al. Neu-trophil-to-lymphocyte ratio and clinical outcome in COVID-19: a report from the Italian front line. Int J Antimicrob Agents 2020; 56: 106017.
11. Chan AS, Rout A. Use of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in COVID-19. J Clin Med Res 2020; 12: 448-453.
12. Lagunas-Rangel FA. Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. J Med Virol 2020; 92: 1733-1734.
13. Henry BM, De Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus dis-ease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med 2020; 58: 1021-1028.
14. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respira-tory distress syndrome and death in patients with Coronavirus disease 2019 Pneumonia in Wu-han, China. JAMA Intern Med 2020; 180: 934-943.
15. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497-506.
16. Zhou P, Yang X-L, Wang X-G, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associ-ated with a new coronavirus of probable bat origin. Nature 2020; 579: 270-273.
17. Wang K, Chen W, Zhang Z, Deng Y, Lian J-Q, Du P, et al. CD147-spike protein is a novel route for SARS-CoV-2 infection to host cells. Signal Transduct Target Ther 2020; 5: 283.
18. Han Q, Wen X, Wang L, Han X, Shen Y, Cao J, et al. Role of hematological parameters in the diagnosis of influenza virus infection in patients with respiratory tract infection symptoms. J Clin Lab Anal 2020; 34(5): e23191.
19. Yang A-P, Liu J-P, Tao W-Q, Li H-M. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol 2020; 84: 106504.
20. Xia X, Wen M, Zhan S, He J, Chen W. An increased neutrophil/lymphocyte ratio is an early warning signal of severe COVID-19. Nan Fang Yi Ke Da Xue Xue Bao 2020; 40: 333-336.
21. Faria SS, Fernandes PC Jr, Silva MJ, Lima VC, Fontes W, Freitas-Junior R, et al. The neutro-phil-to-lymphocyte ratio: a narrative review. Ecancermedicalscience 2016; 10: 702.
22. Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al. Neutrophil-to-lymphocyte ratio predicts crit-ical illness patients with 2019 coronavirus disease in the early stage. J Transl Med 2020; 18: 206.
23. 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; 81(1): e6-e12.
24. Yan X, Li F, Wang X, Yan J, Zhu F, Tang S, et al. Neutrophil to lymphocyte ratio as prognos-tic and predictive factor in patients with coronavirus disease 2019: A retrospective cross-sectional study. J Med Virol 2020; 92: 2573-2581.
25. Chen R-F, Chang J-C, Yeh W-T, Lee C-H, Liu J-W, Eng H-L, et al. Role of vascular cell adhe-sion molecules and leukocyte apoptosis in the lymphopenia and thrombocytopenia of patients with severe acute respiratory syndrome (SARS). Microbes Infect 2006; 8: 122-127.
26. Behrens K, Alexander WS. Cytokine control of megakaryopoiesis. Growth Factors 2018; 36: 89-103.
27. Shen Y, Huang X, Zhang W. Platelet-to-lymphocyte ratio as a prognostic predictor of mortality for sepsis: interaction effect with disease severity-a retrospective study. BMJ Open 2019; 9(1): e022896.
28. Lee J-H, Song S, Yoon S-Y, Lim CS, Song J-W, Kim H-S. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio as diagnostic markers for pneumonia severity. Br J Biomed Sci 2016; 73: 140-142.
29. Qu R, Ling Y, Zhang Y-H-Z, Wei L-Y, Chen X, Li X-M, et al. Platelet-to-lymphocyte ratio is associated with prognosis in patients with coronavirus disease-19. J Med Virol 2020; 92: 1533-1541.
30. Uyar E, Merdİn A, Yamanyar S, Ezgu MC, Artuk C, TaŞkin G, et al. Could serum albumin value and thrombocyte / lymphocyte ratio be an important prognostic factor in determining the severity of COVID 19? Turk J Med Sci 2021; 51: 939-946.
31. Akirov A, Masri-Iraqi H, Atamna A, Shimon I. Low albumin levels are associated with mortality risk in hospitalized patients. Am J Med 2017; 130(12): 1465.e11-1465.e19.
32. Mani Mishra P, Uversky VN, Nandi CK. Serum albumin-mediated strategy for the effective targeting of SARS-CoV-2. Med Hypotheses 2020; 140: 109790.
33. Rod JE, Oviedo-Trespalacios O, Cortes-Ramirez J. A brief-review of the risk factors for covid-19 severity. Rev Saude Publica 2020; 54: 60.
34. Li J, Li M, Zheng S, Li M, Zhang M, Sun M, et al. Plasma albumin levels predict risk for non-survivors in critically ill patients with COVID-19. Biomark Med 2020; 14: 827-837.
35. Wang H, Zhang Y, Mo P, Liu J, Wang H, Wang F, et al. Neutrophil to CD4+ lymphocyte ratio as a potential biomarker in predicting virus negative conversion time in COVID-19. Int Immunopharmacol 2020; 85: 106683.
36. Tingle SJ, Severs GR, Goodfellow M, Moir JA, White SA. NARCA: A novel prognostic scor-ing system using neutrophil-albumin ratio and Ca19-9 to predict overall survival in palliative pan-creatic cancer. J Surg Oncol 2018; 118: 680-686.
37. Wang B, Li D, Cheng B, Ying B, Gong Y. The neutrophil percentage-to-albumin ratio us associated with all-cause mortality in critically Ill patients with acute kidney injury. Biomed Res Int 2020; 2020: 5687672.
| Files | ||
| Issue | Vol 14 No 6 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v14i6.11266 | |
| Keywords | ||
| COVID-19; Neutrophil/lymphocyte ratio (NLR); Thrombocyte/lymphocyte ratio; Neutrophil/albumin (NAR); Prognosis; Hospitalization | ||
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How to Cite
1.
Sari N, Serin I, Bakir A, Alacam S. Could serum thrombocyte/lymphocyte (TLR), neutrophil/lymphocyte (NLR) and neutro-phil/albumin (NAR) ratios be indicators of hospitalization and mortality in COVID-19?. Iran J Microbiol. 2022;14(6):913-920.
