An Emerging Marker Predicting The Severity of Covid-19: Neutrophil-Lymphocyte Count Ratio

Objective: To assess the efficacy of neutrophil-lymphocyte count ratio in predicting the severity of covid-19 Materials and Methods: The patients with positive results for COVID-19 were shifted to COVID ITC, CMH, Multan. The clinical histories of confirmed patients of COVID-19 during February 2020 to May 2021 were reviewed. The patients were divided into 4 classes, mild, common, severe, and fatal, according to guidelines of COVID-19 i.e., trial version 7. Data was collected regarding age, sex, smoking history, temperature, epidemiological history, clinical symptoms, and laboratory findings of all included patients including NLCR. Results: The mean NLCR of Mild and Severe Group was 2.77±1.23 and 20.31±4.45, respectively, (p=0.000). (Table. II). The area under the curves of NLCR was larger than neut, suggesting the optimal performance of NLCR with cut-off value 5.89. The sensitivity and specificity of NLCR was 85% and 95%, respectively. (Table. III). Conclusion: It can be concluded that an increase in NLCR levels can indicate that the covid-19 disease is moving towards exacerbation. NLCR can be recommended as a novel and highly sensitive and specific indicator for severity prediction in Covid-19 patients. Keywords: Emerging, Marker, Severity, Covid-19, Neutrophils, Lymphocytes, Ratio

223. The Value of Neutrophil to Lymphocyte Count Ratio for Predicting the Clinical Outcomes of Patients with Carbapenem-resistant Klebsiella pneumonia Blood Stream Infection

Background The neutrophil to lymphocyte count ratio (NLR) has been recognized as a useful marker of inflammation. But, the prognostic function of NLR in patients with Carbapenem-resistant Klebsiella pneumonia (CRKP) blood stream infection is still largely unknown. The aim of this study was to explore the relationship between postoperative NLR and mortality in those patients. Methods We performed a retrospective study based on the database from Computerized Patient Record System in Sir Run Run Shaw Hospital from 1/1/2017 to 31/10/2020. Logistic analysis was performed to assess the associations between NLR and 28-day mortality. Multivariate analyses were used to control for confounders. Results A total of 134 CRKP blood stream infection inpatients were included in this study, including 54 fatal cases and 80 survival cases on the 28-day after the onset of CRKP BSI, the overall 28-day mortality rate of patients with a CRKP BSI episode was 40.3% (54/134). We conducted a multivariate analysis on these 134 patients and found that APACHE II score on the 4th day (OR 1.379 95% CI 1.065- 1.785, p = 0.015), NLR on the 4th day (OR 1.134 95% CI 1.054- 1.221, p = 0.001) were significant risk factors for the 28-day mortality of CRKP BSI patients Conclusion Elevated NLR was significantly associated with increased 28-day mortality as well as APACHE II score on the 4th day after first positive culture.NLR is promising to be a readily available and independent prognostic biomarker for patients with CRKP blood stream infection. Disclosures All Authors: No reported disclosures

The Impact of Neutrophil-Lymphocyte Count Ratio in COVID-19: A Systematic Review and Meta-Analysis

Background: The neutrophil–lymphocyte count ratio (NLR) has emerged as a potential prognostic tool for different diseases. In the current coronavirus disease (COVID-19) pandemic, the NLR may be a useful tool for risk scarification and the optimal utilization of limited healthcare resources. However, there is no consensus regarding the optimal value of NLR, and the association with disease severity and mortality. Thus, this study aims to systematically analyze the current evidence of the utility of baseline NLR as a predictive tool for mortality, disease severity in COVID-19 patients. Methods: A compendious screening of electronic databases up to June 15, 2021, was done after enlisting the protocol in PROSPERO (CRD42020202659). Studies evaluating the utility of baseline NLR in COVID-19 are included for this review as per the PRISMA statement. Results: We retrieved a total of 13112 and 12986 COVID-19 patients for survivability and severity over 90 studies. The expired and critically sick patients had elevated baseline NLR on admission, in comparison to survivors and noncritical patients. (SMD = 3.82; 95% CI: 2.79-4.85; I2 = 100% and SMD = 1.42; 95% CI: 1.22-1.63; I2 = 95%, respectively). The summary receiver operating curve analysis for mortality (AUC = 0.87; 95% CI: 0.86-0.87; I2 = 94.7%), and severity (AUC = 0.82; 95% CI: 0.80-0.84; I2 = 79.7%) were also suggestive of its significant predictive value. Conclusions: The elevated NLR on admission in COVID-19 patients is associated with poor outcomes.

Neutrophil-to-lymphocyte count ratio in predicting prognosis of septic shock patients

Background Septic shock is one of the most common causes of admission to the intensive care unit in the world and one of the most common causes of death among intensive care patients. Since the definition of sepsis and septic shock and many studies have been designed to understand everything about sepsis regarding mechanism, pathophysiology, complications, diagnosis, management and all other aspects. Objective To find the association between neutrophil to lymphocyte count ratio and the mortality from septic shock patients. The work aims also to determine if this ratio can be used as a prognostic marker of septic shock patients and to compare this ratio with other sepsis markers as C-reactive protein (CRP) and procalcitonin. Patients and Methods This study was conducted prospectively in critical care unit in Ain Shams Hospital, a university-affiliated, tertiary referral center in Cairo, Egypt. Study subjects included 125 patients between January 2018 to January 2019. The ethics committee of our institution approved the study protocol, and written informed consent was obtained from each patient’s family. Results In our study, the neutrophils count was significantly increased in survived patients compared with early and late mortality patients in day 1 while lymphocytes count was lower in survived patient than early and late mortality patients and the NLCR in our study was higher in survived patients than early and late mortality patients. In day 4, our results revealed significant increase in neutrophils count in patients of late mortality compared with its count in survived patients, while lymphocytes didn't show any significant difference compared with its count in survived patients with significant increase in NLCR in patients of late mortality compared with those of survived patients in day 4. Both CRP and procalcitonin are increased in patients of early and late mortality groups compared with its value in survived patients in day 1 and 4. Conclusion This study demonstrates a real relationship between the NLCR and the risk of death in septic shock patients. Septic shock patients at risk of early death presented a low NLCR at admission, although late death was associated with an increased NLCR during the first 5 days. Early and late death should be distinguished because they may involve different underlying mechanisms, and the NLCR might be considered as a discriminant indicator of early or late death. In addition, our findings provide more insight into biology. The circulating neutrophil and lymphocyte trends observed in this study offer an interesting mechanistic viewpoint. We observed that circulating lymphocytes and the NLCR behave in opposite ways in early- and late death patients, supporting the hypothesis that divergent mechanisms could be involved in these two groups.

Study of Absolute Neutrophil Absolute Lymphocyte count ratio in Community Acquired Pneumonia patients as a prognostic indicator at a tertiary care centre

Background: Community acquired pneumonia refers to pneumonia contracted by a person with little or no contact with health care system. Following endotoxemia the number of circulating neutrophils increases while lymphocyte counts decrease. Combining both parameters seems a logical step and the ratio of neutrophil and lymphocyte counts is increasingly used in several clinical circumstances. Initially, this so-called neutrophil-lymphocyte count ratio (NLCR) was studied as an infection marker in ICU patients and found to correlate well with disease severity and outcome, according to APACHE-II and SOFA scores. In the current study, we explored the value of the NLCR in patients admitted with Community acquired pneumonia. Aims and Objectives: 1) To find out the value of Neutrophil-Lymphocyte Count Ratio (NLCR)in Community Acquired Pneumonia (CAP). 2) To study Neutrophil-Lymphocyte Count Ratio (NLCR) as prognostic indicator in Community Acquired Pneumonia (CAP). Materials and Methods: This prospective study was conducted on minimum of 100 patients admitted to hospitals from November 2015 to September 2017 from Bangalore. After admission of cases based on CURB-65 scores, a detailed history and clinical examination was done along with chest x-ray to establish the diagnosis. Before taking into the study all patients had signed the informed consent. Routine haematological investigations done on day 1,3 & 7 were carried out. Serum c-reactive protein levels, Urea nitrogen levels, Sputum for culture and sensitivity and Acid-fast bacilli (AFB) was done on the same day of admission. ANC (Absolute neutrophil count), ALC (Absolute lymphocyte count) and NLCR were calculated. Results: Our study included age groups above 18yrs. Majority of the patients in the study were between 58-67 years (30%) followed by 48-57 years (27%). As the CURB-65 score increased from score 0 to score 4–5, the NLCR consistently increased, while the lymphocyte counts consistently decreased. In patients who died there was a significantly higher NLCR at presentation compared to patients that survived (15.18±3.55 versus 11.73±3.01, p-value,0.003). Conclusion: In our study increased NLCR carried poor prognosis which correlated with high CURB65 score and ICU admission. In patients who died there was a significantly higher NLCR at presentation compared to patients those survived.