Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19

Abstract Since the outbreak of COVID-19 several studies conducted to identify predictive factors which are associated with prognosis of COVID-19. In this study we aimed to determine whether the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) could help the clinicians to predict intensive care unit (ICU) admission and mortality of COVID-19 patients. This retrospective cohort study involved examining the medical records of 311 Iranian COVID-19 patients from 22 July 2020 to 22 August 2020. All characteristic data and laboratory results were recorded. The receiver operating characteristic (ROC) curve was used to identify the predictive value of studied parameters for ICU admission and death. Comparison of data revealed that some factors were jointly higher in non-survivors and ICU admitted patients than survivors and non-ICU admitted patients, such as: age, hemoglobin (HB), NLR, derived neutrophil-to-lymphocyte ratio (dNLR), PLR, systemic inflammatory index (SII), lactate dehydrogenase (LDH), Respiratory diseases, ischemic heart disease (IHD). Multivariate logistic regression analysis showed that only hypertension (OR 3.18, P=0.02) is an independent risk factor of death in COVID-19 patients, and also PLR (OR 1.02, P=0.05), hypertension (OR 4.00, P=0.002) and IHD (OR 5.15, P=0.008) were independent risk factor of ICU admission in COVID-19 patients. This study revealed that the NLR, PLR, platelet-to-white blood Cell ratio (PWR), dNLR and SII are valuable factors for predicting ICU admission and mortality of COVID-19 patients.

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Neutrophil-to-Lymphocyte Ratio on Admission is an Independent Risk Factor for the Severity of Neurological Impairment at Disease Onset in Patients with a First Episode of Neuromyelitis Optica Spectrum Disorder

Neuropsychiatric Disease and Treatment ◽

10.2147/ndt.s311942 ◽

2021 ◽

Vol Volume 17 ◽

pp. 1493-1503

Author(s):

Yongyan Zhou ◽

Haojie Xie ◽

Yi Zhao ◽

Jinwei Zhang ◽

Yanfei Li ◽

...

Keyword(s):

Risk Factor ◽

Neuromyelitis Optica ◽

Independent Risk Factor ◽

Disease Onset ◽

Neurological Impairment ◽

Spectrum Disorder ◽

Neutrophil To Lymphocyte Ratio ◽

First Episode ◽

Neuromyelitis Optica Spectrum Disorder ◽

Lymphocyte Ratio

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Relation between neutrophil-to-lymphocyte ratio and mortality in patients with hypertrophic cardiomyopathy

Biomarkers in Medicine ◽

10.2217/bmm-2020-0463 ◽

2020 ◽

Vol 14 (18) ◽

pp. 1693-1701

Author(s):

Ziqiong Wang ◽

Liming Zhao ◽

Sen He

Keyword(s):

Risk Factor ◽

Hypertrophic Cardiomyopathy ◽

Mortality Rate ◽

Subgroup Analysis ◽

Prognostic Value ◽

Independent Risk Factor ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

The Third ◽

All Cause Mortality

Aim: We assessed the prognostic value of neutrophil-to-lymphocyte ratio (NLR) for all-cause mortality in patients with hypertrophic cardiomyopathy (HCM). Methods & results: A total of 354 HCM patients were enrolled. There were 44 all-cause mortality in total. Patients in the third tertile of NLR had the highest all-cause mortality rate of 5.2 per 100 person-years. Patients in tertile 3 had a significantly higher risk of all-cause mortality with adjusted hazard ratio of 2.4 (95% CI: 1.0–5.4; p = 0.040) when compared with that of patients in tertile 1. No significant interactions between NLR and other variables were observed during subgroup analysis. Conclusion: NLR was an independent risk factor for all-cause mortality in HCM patients.

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Associations of procalcitonin, C-reaction protein and neutrophil-to-lymphocyte ratio with mortality in hospitalized COVID-19 patients in China

Scientific Reports ◽

10.1038/s41598-020-72164-7 ◽

2020 ◽

Vol 10 (1) ◽

Cited By ~ 3

Author(s):

Jian-bo Xu ◽

Chao Xu ◽

Ru-bing Zhang ◽

Meng Wu ◽

Chang-kun Pan ◽

...

Keyword(s):

Risk Factor ◽

Retrospective Study ◽

Independent Risk Factor ◽

Neutrophil To Lymphocyte Ratio ◽

Age Group ◽

Lymphocyte Ratio ◽

Risk Of Mortality ◽

Increased Risk ◽

Increasing Risk ◽

Baseline Levels

Abstract Coronavirus disease 2019 (COVID-19) is an important and urgent threat to global health. Inflammation factors are important for COVID-19 mortality, and we aim to explore whether the baseline levels of procalcitonin (PCT), C-reaction protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) are associated with an increased risk of mortality in patients with COVID-19. A retrospective study was conducted and a total of 76 patients with confirmed COVID-19 were included between January 17, 2020 to March 2, 2020, of these cases, 17 patients were dead. After adjusting covariates, PCT (≥ 0.10 ng/mL) and CRP (≥ 52.14 mg/L) exhibited independent increasing risks of mortality were used hazard ratio (HR) of 52.68 (95% confidence interval [CI]: 1.77–1571.66) and 5.47 (95% CI: 1.04–28.72), respectively. However, NRL (≥ 3.59) was not found to be an independent risk factor for death in our study. Furthermore, the elevated PCT levels were still associated with increasing risk of mortality in the old age group (age ≥ 60 y), and in the critically severe and severe patients after adjustment for complications. Thu Baseline levels of PCT and CRP have been addressed as independent predictors of mortality in patients with COVID-19.

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Prognostic inflammatory markers in metastatic renal cell carcinoma: Neutrophil-to-lymphocyte ratio and prognostic nutritional index

Medical Science and Discovery ◽

10.36472/msd.v7i4.370 ◽

2020 ◽

Vol 7 (4) ◽

pp. 459-465

Author(s):

Mahmut Büyükşimsek ◽

Ali Oğul

Keyword(s):

Renal Cell Carcinoma ◽

Risk Factor ◽

Cell Carcinoma ◽

Metastatic Renal Cell Carcinoma ◽

Renal Cell ◽

Independent Risk Factor ◽

Prognostic Nutritional Index ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Nutritional Index

Objective: According to metastatic renal cell carcinoma treatment protocol, after the use of tyrosine kinase inhibitors (TKI) has been achieved significant improvements for the treatment of metastatic renal cell carcinoma (mRCC). In this study, we aimed to investigate the effect of neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI) on survival in patients with mRCC treated with sunitinib or pazopanib. Material and Methods: Medical data for 38 patients with mRCC were reviewed retrospectively. NLR and PNI values were dichotomized based on receiver operating characteristic (ROC) curve analysis (cut-off values: 3 and 46, respectively). Univariate and multivariate analyses were performed to identify prognostic factors for progression free survival (PFS) and overall survival (OS) using a Cox proportional hazards model. Results: Median PFS and OS were 12 and 27 months, respectively. Median PFS was 10 months in patients with NLR ≥3 while 14 months in patients with NLR <3 (p: 0.008). Median OS was 18 months in patients with NLR ≥3 while 31 months in patients with NLR <3 (p: 0.003). In patients with PNI ≥ 46, PFS was 21 months and OS was 47 months whereas in patients with PNI < 46, PFS was 8 months and OS was 13 months (p values were <0.001, <0.001 respectively). In multivariate analysis, PNI was the independent risk factor for both PFS and OS, while NLR was the independent risk factor for OS only. Conclusion: In patients with mRCC that using sunitinib or pazopanib, NLR and PNI values can be used as easily accessible prognostic markers.

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Neutrophil-to-lymphocyte ratio on admission is an independent risk factor for the severity and mortality in patients with coronavirus disease 2019

Journal of Infection ◽

10.1016/j.jinf.2020.09.022 ◽

2020 ◽

Author(s):

Shijie Wang ◽

Lingli Fu ◽

Kejie Huang ◽

Jianglong Han ◽

Rui Zhang ◽

...

Keyword(s):

Risk Factor ◽

Independent Risk Factor ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio

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Neutrophil-to-Lymphocyte Ratio Associates Independently With Mortality in Hospitalized Patients With Cirrhosis

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2018.04.045 ◽

2018 ◽

Vol 16 (11) ◽

pp. 1786-1791.e1 ◽

Cited By ~ 11

Author(s):

Jonathan Rice ◽

Jennifer L. Dodge ◽

Kiran M. Bambha ◽

Jasmohan S. Bajaj ◽

K. Rajender Reddy ◽

...

Keyword(s):

Hospitalized Patients ◽

Neutrophil To Lymphocyte Ratio ◽

Lymphocyte Ratio

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Elevation of blood glucose level predicts worse outcomes in hospitalized patients with COVID-19: a retrospective cohort study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001476 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001476 ◽

Cited By ~ 24

Author(s):

Jianfeng Wu ◽

Jianqiang Huang ◽

Guochao Zhu ◽

Qiongya Wang ◽

Qingquan Lv ◽

...

Keyword(s):

Sensitivity Analysis ◽

Risk Factor ◽

Blood Glucose ◽

Hospital Mortality ◽

Blood Glucose Level ◽

Glucose Level ◽

Independent Risk Factor ◽

Cox Regression ◽

Hospitalized Patients ◽

Medical Resources

IntroductionWith intense deficiency of medical resources during COVID-19 pandemic, risk stratification is of strategic importance. Blood glucose level is an important risk factor for the prognosis of infection and critically ill patients. We aimed to investigate the prognostic value of blood glucose level in patients with COVID-19.Research design and methodsWe collected clinical and survival information of 2041 consecutive hospitalized patients with COVID-19 from two medical centers in Wuhan. Patients without available blood glucose level were excluded. We performed multivariable Cox regression to calculate HRs of blood glucose-associated indexes for the risk of progression to critical cases/mortality among non-critical cases, as well as in-hospital mortality in critical cases. Sensitivity analysis were conducted in patient without diabetes.ResultsElevation of admission blood glucose level was an independent risk factor for progression to critical cases/death among non-critical cases (HR=1.30, 95% CI 1.03 to 1.63, p=0.026). Elevation of initial blood glucose level of critical diagnosis was an independent risk factor for in-hospital mortality in critical cases (HR=1.84, 95% CI 1.14 to 2.98, p=0.013). Higher median glucose level during hospital stay or after critical diagnosis (≥6.1 mmol/L) was independently associated with increased risks of progression to critical cases/death among non-critical cases, as well as in-hospital mortality in critical cases. Above results were consistent in the sensitivity analysis in patients without diabetes.ConclusionsElevation of blood glucose level predicted worse outcomes in hospitalized patients with COVID-19. Our findings may provide a simple and practical way to risk stratify COVID-19 inpatients for hierarchical management, particularly where medical resources are in severe shortage during the pandemic.

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