Prognostic Value of C-Reactive Protein to Lymphocyte Ratio (CLR) in Emergency Department Patients with SARS-CoV-2 Infection

(1) Introduction: According to recent studies, the ratio of C-reactive-protein to lymphocyte is more sensitive and specific than other biomarkers associated to systemic inflammatory processes. This study aimed to determine the prognostic value of CLR on COVID-19 severity and mortality at emergency department (ED) admission. (2) Methods: Between 1 March and 30 April 2020, we carried out a multicenter and retrospective study in six major hospitals of northeast France. The cohort was composed of patients hospitalized for a confirmed diagnosis of moderate to severe COVID-19. (3) Results: A total of 1,035 patients were included in this study. Factors associated with infection severity were the CLR (OR: 1.001, CI 95%: (1.000–1.002), p = 0.012), and the lymphocyte level (OR: 1.951, CI 95%: (1.024–3.717), p = 0.042). In multivariate analysis, the only biochemical factor significantly associated with mortality was lymphocyte rate (OR: 2.308, CI 95%: (1.286–4.141), p = 0.005). The best threshold of CLR to predict the severity of infection was 78.3 (sensitivity 79%; specificity 47%), and to predict mortality, was 159.5 (sensitivity 48%; specificity 70%). (4) Conclusion: The CLR at admission to the ED could be a helpful prognostic biomarker in the early screening and prediction of the severity and mortality associated with SARS-CoV-2 infection.

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Neutrophil-to-Lymphocyte Ratio and Early Variation of NLR to Predict In-Hospital Mortality and Severity in ED Patients with SARS-CoV-2 Infection

Journal of Clinical Medicine ◽

10.3390/jcm10122563 ◽

2021 ◽

Vol 10 (12) ◽

pp. 2563

Author(s):

Laure Abensur Vuillaume ◽

Pierrick Le Borgne ◽

Karine Alamé ◽

François Lefebvre ◽

Lise Bérard ◽

...

Keyword(s):

Retrospective Cohort ◽

Prognostic Value ◽

Inflammatory Diseases ◽

Predictive Marker ◽

Neutrophil To Lymphocyte Ratio ◽

C Reactive Protein ◽

Lymphocyte Ratio ◽

Factors Associated ◽

Reactive Protein ◽

Biochemical Factor

(1) Introduction: The neutrophil-to lymphocyte ratio is valued as a predictive marker in several inflammatory diseases. For example, an increasing NLR is a risk factor of mortality in sepsis. It also appears to be helpful in other settings such as cancer. The aim of our work was to study the prognostic value of NLR for disease severity and mortality in patients infected with SARS-CoV-2 upon their admission to the Emergency Department (ED) and its early variation (ΔNLR) in the first 24 h of management (H-24). (2) Methods: Between 1 March and 30 April 2020, we conducted a multicenter and retrospective cohort study of patients with moderate or severe coronavirus disease 19 (COVID-19), who were all hospitalized after presenting to the ED. (3) Results: A total of 1035 patients were included in our study. Factors associated with infection severity were C-reactive protein level (OR: 1.007, CI 95%: [1.005–1.010], p < 0.001), NLR at H-24 (OR: 1.117, CI 95%: [1.060–1.176], p < 0.001), and ΔNLR (OR: 1.877, CI 95%: [1.160–3.036], p: 0.01). The best threshold of ΔNLR to predict the severity of infection was 0.222 (sensitivity 56.1%, specificity 68.3%). In multivariate analysis, the only biochemical factor significantly associated with mortality was again ΔNLR (OR: 2.142, CI 95%: ([1.132–4.056], p: 0.019). The best threshold of ΔNLR to predict mortality was 0.411 (sensitivity 53.3%; specificity 67.3%). (4) Conclusion: The NLR and its early variation (ΔNLR) could help physicians predict both severity and mortality associated with SARS-CoV-2 infection, hence contributing to optimized patient management (accurate triage and treatment).

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Serum Lactate Is a Better Predictor of Short-Term Mortality When Stratified by C-reactive Protein in Adult Emergency Department Patients Hospitalized for a Suspected Infection

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2010.10.016 ◽

2011 ◽

Vol 57 (3) ◽

pp. 291-295 ◽

Cited By ~ 23

Author(s):

Jeffrey P. Green ◽

Tony Berger ◽

Nidhi Garg ◽

Nathan I. Shapiro

Keyword(s):

Emergency Department ◽

Serum Lactate ◽

C Reactive Protein ◽

Short Term ◽

Suspected Infection ◽

Reactive Protein ◽

Short Term Mortality ◽

Emergency Department Patients

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Sensitivity of Erythrocyte Sedimentation Rate and C-reactive Protein in Emergency Department Patients with Septic Arthritis

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2009.06.059 ◽

2009 ◽

Vol 37 (2) ◽

pp. 231-232 ◽

Cited By ~ 1

Author(s):

P. Hariharan ◽

J.K. Takayesu ◽

C. Kabrhel

Keyword(s):

Emergency Department ◽

Septic Arthritis ◽

Erythrocyte Sedimentation Rate ◽

Sedimentation Rate ◽

C Reactive Protein ◽

Reactive Protein ◽

Erythrocyte Sedimentation ◽

Emergency Department Patients

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Diagnostic use of C-reactive protein in bacteraemic emergency department patients

Emergency Medicine Australasia ◽

10.1111/j.1742-6723.2005.00759.x ◽

2005 ◽

Vol 17 (4) ◽

pp. 371-375 ◽

Cited By ~ 9

Author(s):

Nicholas G Adams

Keyword(s):

Emergency Department ◽

C Reactive Protein ◽

Reactive Protein ◽

Diagnostic Use ◽

Emergency Department Patients

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Clinical Value of Whole Blood Procalcitonin Using Point of Care Testing, Quick Sequential Organ Failure Assessment Score, C-Reactive Protein and Lactate in Emergency Department Patients with Suspected Infection

Journal of Clinical Medicine ◽

10.3390/jcm8060833 ◽

2019 ◽

Vol 8 (6) ◽

pp. 833 ◽

Cited By ~ 1

Author(s):

Bo-Sun Shim ◽

Young-Hoon Yoon ◽

Jung-Youn Kim ◽

Young-Duck Cho ◽

Sung-Jun Park ◽

...

Keyword(s):

Emergency Department ◽

Whole Blood ◽

Predictive Value ◽

Point Of Care ◽

Point Of Care Testing ◽

C Reactive Protein ◽

Suspected Infection ◽

Reactive Protein ◽

Failure Assessment ◽

Emergency Department Patients

We investigated the clinical value of whole blood procalcitonin using point of care testing, quick sequential organ failure assessment score, C-reactive protein and lactate in emergency department patients with suspected infection and assessed the accuracy of the whole blood procalcitonin test by point-of-care testing. Participants were randomly selected from emergency department patients who complained of a febrile sense, had suspected infection and underwent serum procalcitonin testing. Whole blood procalcitonin levels by point-of-care testing were compared with serum procalcitonin test results from the laboratory. Participants were divided into two groups—those with bacteremia and those without bacteremia. Sensitivity, specificity, positive predictive value, negative predictive value of procalcitonin, lactate and Quick Sepsis-related Organ Failure Assessment scores were investigated in each group. Area under receiving operating curve of C-reactive protein, lactate and procalcitonin for predicting bacteremia and 28-day mortality were also evaluated. Whole blood procalcitonin had an excellent correlation with serum procalcitonin. The negative predictive value of procalcitonin and lactate was over 90%. Area under receiving operating curve results proved whole blood procalcitonin to be fair in predicting bacteremia or 28-day mortality. In the emergency department, point-of-care testing of whole blood procalcitonin is as accurate as laboratory testing. Moreover, procalcitonin is a complementing test together with lactate for predicting 28-days mortality and bacteremia for patients with suspected infection.

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