The importance of Neutrophil-Lymphocyte Ratio, Monocyte-Lymphocyte Ratio, and Thrombocyte-Lymphocyte ratio in addition to abnormal laboratory parameters in COVID-19 pneumonia

Nermin Keni Begendi; Fatma Kacar; Mikail Dağ; Arzu Tarakçı; Şule Özdemir Armağan; Fatih Saçkan; Muhammet Cemal Kızılarslanoğlu

TR EN

Anormal laboratuvar parametrelerine ilave olarak, Nötrofil-Lenfosit, Monosit-Lenfosit ve Trombosit-Lenfosit oranlarının COVID-19 pnömonisindeki önemi

Öz

Amaç: COVID-19 pnömonisi olan ve olmayan hastalar arasındaki klinik ve hematolojik parametrelerdeki farklılıkların irdelenmesi, yatış ve taburculuk değerlerinin kıyaslanması, laboratuvar parametrelerinin yanında nötrofil-lenfosit oranı (NLO), monosit-lenfosit oranı (MLO) ve trombosit-lenfosit oranı (TLO)’ nın pnömoni açısından öneminin karşılaştırılması amaçlandı. Hastalar ve Yöntem: Retrospektif yaptığımız çalışmada Enfeksiyon Hastalıkları servisinde Nisan 2020-Temmuz 2020 tarihleri arasında yatarak tedavi alan COVID-19 tanılı 506 hasta dahil edildi. Hastaların 256’sı pnömoni tablosu olan (%50,6), 250’si pnömoni tablosu olmayan (%49,4) COVID-19 tanılı olgular idi. Her iki hasta grubunda dosya bilgileri taranarak demografik veriler, yatış ve taburculuklarındaki laboratuvar parametreleri, NLO, MLO ve TLO irdelenip karşılaştırıldı. Bulgular: Hastaların medyan yaşı 44,5 (16-89) yıl olup, %55,5 (n= 281)’i erkek idi. Pnömonisi olan hastaların medyan yaşı pnömonisi olmayanlara göre daha yüksekti ve bu grupta kadın cinsiyet sıklığının daha fazla olduğu görüldü (her iki durumda p<0,05). Pnömonisi olanların hastanede ortanca kalış süresi pnömoni olmayanlara göre daha yüksekti (p:0,009). Pnömonisi olanlarda olmayanlara göre yatış ve taburculuk lenfosit sayısı anlamlı olarak daha düşük idi (p değeri sırasıyla: <0,001, 0,007). Pnömonisi olanlarda olmayanlara göre yatış eozinofil sayısı anlamlı olarak daha düşük gözlendi (p<0,001). Pnömonisi olan hastaların yatış ve taburculuk NLO pnömonisi olmayan hastalara göre anlamlı olarak daha yüksek gözlendi (p sırasıyla <0,008, <0,007). Her iki grupta taburculuk NLO değeri yatış değerine göre düşük saptandı (her iki durumda p; <0.001). TLO pnömonisi olanlarda olmayanlara göre hem yatış hem de taburculukta daha yüksek görüldü (her iki durumda p <0,001). MLO incelendiğinde taburculuk MLO değerleri pnömonisi olanlarda daha yüksek gözlendi (p=0,001). Pnömoniyi öngörme açısından yapılan ROC analizinde; yatış eozinofil değerinin ≤0,02/µL olmasının AUC:0,668, %56,3 sensitivite, %71,2 spesifiteye, monosit değerinin ≤0,5/µL olmasının AUC:0,631, %55,1 sensitivite, %67,6 spesifiteye, TLO değerinin >105,7 olmasının AUC:0,611, %75,4 sensitivite, %46,0 spesifiteye sahip olduğu gözlendi. Sonuç: Bu çalışmada özellikle monosit, eozinofil sayıları ve TLO oranlarının COVID-19 pnömonisindeki önemi gösterilmiş oldu.

Anahtar Kelimeler

The importance of Neutrophil-Lymphocyte Ratio, Monocyte-Lymphocyte Ratio, and Thrombocyte-Lymphocyte ratio in addition to abnormal laboratory parameters in COVID-19 pneumonia

Abstract

Objective: We aimed to examine the importance of the neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR) and thrombocyte-lymphocyte ratio (TLR) in addition to laboratory parameters in terms of pneumonia between patients with and without pneumonia diagnosed with COVID-19 infection. Material and Methods: In our retrospective study, 506 patients diagnosed with COVID-19 who were hospitalized and treated between April 2020 and July 2020 were included. While 50.6% (n:256) of the patients had pneumonia, 49.4% (n:250) did not have. File informations were scanned; the demographic data, hospitalization and discharge laboratory parameters were recorded. Results: The median age of the patients was 44.5 (16-89) years, 55.5% (n = 281) of them were male. The median age of patients with pneumonia was higher than those without pneumonia, and the frequency of female gender was higher (p <0.05 for both conditions). The lymphocyte count at hospitalization and discharge was significantly lower in patients with pneumonia (p <0.001, 0.007, respectively). The count of eosinophils at hospitalization was significantly lower in patients with pneumonia (p <0.001). NLR and TLR values were significantly higher in patients with pneumonia at admission and discharge (p <0.008, <0.007, respectively for NLR and p <0.001, p<0.001 respectively for TLR). MLR values at discharge were higher in patients with pneumonia (p = 0.001). In ROC analyzes made in terms of predicting pneumonia; hospitalization CRP level, eosinophil, monocyte counts and TLR values were found to be important variables. Conclusion: In this study, the importance of monocyte, eosinophil counts and TLR values in COVID-19 pneumonia was demonstrated.

Keywords

Supporting Institution

Sağlık Bilimleri Üniversitesi, Konya Şehir Hastanesi

Thanks

Firstly, I must say that this article has not been accepted for publication elsewhere and want to explain the absence of any conflict of interest. During the Covid outbreak many articles have been published about the disease and its complications during the COVID-19 outbreak. Since I did not see enough studies comparing patients diagnosed with Covid-19 with and without pneumonia, I planned to do this study, which I think can guide the follow-up and treatment with the analysis of both groups. In our study, it was observed that markers correlating with severe disease in covid-19 patients with pneumonia were significantly different in our patient group with pneumonia, in accordance with the literature. In the present study, in the course of disease and accompanying pneumonia the changes observed in the neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR) and thrombocyte lymphocyte ratio (TLR) which are important inflammation markers were tried to be evaluated. We also compared abnormalities in biochemistry and hemogram parameters between patients with and without pneumonia diagnosed with covid-19. We hope that the significant differences we found in the study will contribute to the literature. I hope that our study will be accepted. Dear editor and the entire work team, we thank you in advance for your interest and assistance.

References

1. Q. Ye, B.Wang, J. Mao. The pathogenesis and treatment of the ‘cytokine storm’ in COVID-19, J. Inf. Secur. 80 (2020): 607-613.
1. Q. Ye, B.Wang, J. Mao. The pathogenesis and treatment of the ‘cytokine storm’ in COVID-19, J. Inf. Secur. 80 (2020): 607-613.
2. H. Akbari, R. Tabrizi, K.B. Lankarani, H. Aria, S. Vakili, F. Asadian et al. The role of cytokine profile and lymphocyte subsets in the severity of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. ELSEVIER, Life Sciences 258 (2020): 118167
2. H. Akbari, R. Tabrizi, K.B. Lankarani, H. Aria, S. Vakili, F. Asadian et al. The role of cytokine profile and lymphocyte subsets in the severity of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. ELSEVIER, Life Sciences 258 (2020): 118167
3. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX. Neutrophil to lymphocyte ratio as an independent risk factor for mortalitiy in hospitalized patients with COVID-19. Journal of Infection 81 (2020): e6-e12.
3. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX. Neutrophil to lymphocyte ratio as an independent risk factor for mortalitiy in hospitalized patients with COVID-19. Journal of Infection 81 (2020): e6-e12.
4. M. S. Asghar, N.A. Khan, S.J.H. Kazmi, A. Ahmed, M. Hassan, R. Jawed et al. Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comperative analysis. medRxiv June 2020.
4. M. S. Asghar, N.A. Khan, S.J.H. Kazmi, A. Ahmed, M. Hassan, R. Jawed et al. Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comperative analysis. medRxiv June 2020.

5. Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR, PLR in COVID-19 patients. Int. Immunopharmacol 2020;84: 106504.
5. Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR, PLR in COVID-19 patients. Int. Immunopharmacol 2020;84: 106504.
6. X. Wang, X. Li, Yu Shang, J. Wang, X. Zhang, D. Su et al. Ratios of neutrophil to lymphocyte and platelet to lymphocyte predict all-cause mortality in inpatients with coronavirus disease 2019: a retrospective cohort study in a single madical centre. Epidemiology and Infection 2020: 148, e211, 1-8. https://doi.org/10.1017.
6. X. Wang, X. Li, Yu Shang, J. Wang, X. Zhang, D. Su et al. Ratios of neutrophil to lymphocyte and platelet to lymphocyte predict all-cause mortality in inpatients with coronavirus disease 2019: a retrospective cohort study in a single madical centre. Epidemiology and Infection 2020: 148, e211, 1-8. https://doi.org/10.1017.
7. Wannarat A. Pongpirul, Surasak Wiboonchutikul, Lantharita Charoenpong, Nayot Panitantum, Apichart Vachiraphan, Sumonmal Uttayamakul et al. Clinical course and potential predictive factors for pneumonia of adult patients with Coronavirus Disease 2019 (COVID-19): A retrospective observational analysis of 193 confirmed cases in Thailand. PLoS Negl Trop Dis. 2020: Oct; 14(10): e0008806: https://doi.org/10.1371/journal.pntd.0008806.
7. Wannarat A. Pongpirul, Surasak Wiboonchutikul, Lantharita Charoenpong, Nayot Panitantum, Apichart Vachiraphan, Sumonmal Uttayamakul et al. Clinical course and potential predictive factors for pneumonia of adult patients with Coronavirus Disease 2019 (COVID-19): A retrospective observational analysis of 193 confirmed cases in Thailand. PLoS Negl Trop Dis. 2020: Oct; 14(10): e0008806: https://doi.org/10.1371/journal.pntd.0008806.
8. WJ. Guan, ZY. Ni, Y. Hu, WH. Liang, CQ. Ou, JX. He. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020:1708-20.
8. WJ. Guan, ZY. Ni, Y. Hu, WH. Liang, CQ. Ou, JX. He. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020:1708-20.
9. R. Chen MD, L.S. MD, M.J. PhD, Z. Yang, N.Jia PhD, W. Fu PhD et al. Longitudinal hematologic and immunologic variations associated with the progression of COVID-19 patients in China. J Allergy Clin Immunol. 2020: Jul; 146(1): 89–100 doi: 10.1016/j.jaci.2020.05.003
9. R. Chen MD, L.S. MD, M.J. PhD, Z. Yang, N.Jia PhD, W. Fu PhD et al. Longitudinal hematologic and immunologic variations associated with the progression of COVID-19 patients in China. J Allergy Clin Immunol. 2020: Jul; 146(1): 89–100 doi: 10.1016/j.jaci.2020.05.003
10. Guan W-J, Ni Z-Y, Hu Y. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020: 382(18):1708-1713.
10. Guan W-J, Ni Z-Y, Hu Y. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020: 382(18):1708-1713.
11. T.A Khartabil, H. Russcher, AJAM vander Ven, Y.B de Rijke. A summary of the diagnostic and prognostic value of hemacytometry markers in COVID-19 patients. Critical Reviews In Clinical Laboratory Sciences. 2020: June: https://doi.org/10.1080/10408363.2020.1774736.
11. T.A Khartabil, H. Russcher, AJAM vander Ven, Y.B de Rijke. A summary of the diagnostic and prognostic value of hemacytometry markers in COVID-19 patients. Critical Reviews In Clinical Laboratory Sciences. 2020: June: https://doi.org/10.1080/10408363.2020.1774736.
12. G. Lu, J. Wang. Dynamic changes in routine blood parameters of a severe COVID-19 case. Clinica Chim Acta 508 (2020): 98-102 doi: 10.1016/j.cca.2020.04.034
12. G. Lu, J. Wang. Dynamic changes in routine blood parameters of a severe COVID-19 case. Clinica Chim Acta 508 (2020): 98-102 doi: 10.1016/j.cca.2020.04.034
13. Qin C, Zhou L, Hu Z. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020 Jul 28;71(15):762-768. doi: 10.1093/cid/ciaa248.
13. Qin C, Zhou L, Hu Z. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020 Jul 28;71(15):762-768. doi: 10.1093/cid/ciaa248.
14. Song C-Y, Xu J, He J-Q. COVID-19 early warning score: a multi-parameter screening tool to identify highly suspected patients. medRxiv. March 8, 2020: doi: https://doi.org/10.1101/2020.03.05.20031906.
14. Song C-Y, Xu J, He J-Q. COVID-19 early warning score: a multi-parameter screening tool to identify highly suspected patients. medRxiv. March 8, 2020: doi: https://doi.org/10.1101/2020.03.05.20031906.
15. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis Clin Chim Acta. 2020: 506:145-148.
15. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis Clin Chim Acta. 2020: 506:145-148.
16. Yang M, Li CK, Li K. Hematological findings in SARS patients and possible mechanisms (review). Int J Mol Med. 2004:14(2):311-315.
16. Yang M, Li CK, Li K. Hematological findings in SARS patients and possible mechanisms (review). Int J Mol Med. 2004:14(2):311-315.
17. Tian S, Zhu X, Sun X. Longitudinal analysis of laboratory findings during the process of recovery for patients with COVID-19. medRxiv. April 7, 2020: doi: https://doi.org/10.1101/2020.04.04.20053280.
17. Tian S, Zhu X, Sun X. Longitudinal analysis of laboratory findings during the process of recovery for patients with COVID-19. medRxiv. April 7, 2020: doi: https://doi.org/10.1101/2020.04.04.20053280.
18. Feng Z, Yu Q, Yao S. Early prediction of disease progression in 2019 novel coronavirus pneumonia patients outside Wuhan with CT and clinical characteristics. medRxiv. 2020. doi: https://doi.org/10.1101/2020.02.19.20025296.
18. Feng Z, Yu Q, Yao S. Early prediction of disease progression in 2019 novel coronavirus pneumonia patients outside Wuhan with CT and clinical characteristics. medRxiv. 2020. doi: https://doi.org/10.1101/2020.02.19.20025296.
19. P. Forget, C. Khalifa, J-P Defour, D. Latinne, M-C Van P, M.D. Kock. What is the normal value of the neutrophil to lymphocyte ratio? BMC Res Notes (2017):10:12 DOI 10.1186/s13104-016-2335-5.
19. P. Forget, C. Khalifa, J-P Defour, D. Latinne, M-C Van P, M.D. Kock. What is the normal value of the neutrophil to lymphocyte ratio? BMC Res Notes (2017):10:12 DOI 10.1186/s13104-016-2335-5.
20. Peng, D. Qi, G. Yuan, X. Deng, Y. Mei, L. Feng et al. Diagnostic value of peripheral hematologic markers for coronavirus disease 2019 (COVID-19): A multicenter, crosssectional study J Clin Lab Anal. 2020: 34: e23475.
20. Peng, D. Qi, G. Yuan, X. Deng, Y. Mei, L. Feng et al. Diagnostic value of peripheral hematologic markers for coronavirus disease 2019 (COVID-19): A multicenter, crosssectional study J Clin Lab Anal. 2020: 34: e23475.
21. Gong J, Ou J, Qiu X. A tool to early predict severe 2019-novel coronavirus pneumonia (COVID-19): a multicenter study using the risk nomogram in Wuhan and Guangdong, China. medRxiv. 2020. doi: https://doi.org/10.1101/2020.03.17.20037515.J.
21. Gong J, Ou J, Qiu X. A tool to early predict severe 2019-novel coronavirus pneumonia (COVID-19): a multicenter study using the risk nomogram in Wuhan and Guangdong, China. medRxiv. 2020. doi: https://doi.org/10.1101/2020.03.17.20037515.J.

Details

Primary Language

English

Subjects

Health Care Administration

Journal Section

Research Article

Authors

Nermin Keni Begendi ^*
0000-0002-7570-1552
Türkiye

Fatma Kacar
0000-0001-7013-6403
Türkiye

Mikail Dağ
0000-0002-8039-9036
Türkiye

Arzu Tarakçı
0000-0002-1245-3221
Türkiye

Şule Özdemir Armağan
0000-0001-9137-7150
Türkiye

Fatih Saçkan
0000-0003-0257-8917
Türkiye

Muhammet Cemal Kızılarslanoğlu
0000-0002-7632-6811
Türkiye

Publication Date

December 22, 2021

Submission Date

April 25, 2021

Acceptance Date

June 11, 2021

Published in Issue

Year 2021 Volume: 60 Number: 4

IZ

https://izlik.org/JA73MF48UW

Cite

RIS / Bibtex

Vancouver

1.Nermin Keni Begendi, Fatma Kacar, Mikail Dağ, Arzu Tarakçı, Şule Özdemir Armağan, Fatih Saçkan, Muhammet Cemal Kızılarslanoğlu. The importance of Neutrophil-Lymphocyte Ratio, Monocyte-Lymphocyte Ratio, and Thrombocyte-Lymphocyte ratio in addition to abnormal laboratory parameters in COVID-19 pneumonia. EJM [Internet]. 2021 Dec. 1;60(4):394-401. Available from: https://izlik.org/JA73MF48UW