The Severity of COVID-19 and its Correlation with Inflammation Biomarkers
DOI:
https://doi.org/10.3889/oamjms.2022.9639Keywords:
COVID-19, Neutrophil-to-lymphocyte ratio, Neutrophil-to-monocyte ratio, Lymphocyte-to-monocyte ratio, BiomarkersAbstract
Introduction: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Cov2) or Covid-19 has been spread quickly and caused 5 million deaths until February 2022. Severe symptoms of the infection may lead to death that prompt appropriate clinical diagnosis and adequate treatment going to be necessary. Covid-19 shows a severe inflammatory response which causes an imbalance in the immune response. Therefore, circulating biomarkers that can represent inflammation and immune status are potential predictors for the prognosis of COVID-19 patients. This study aims to know the role of Neutrophil-Lymphocyte Ratio (NLR), Neutrophil Monocyte Ratio (NMR), and Lymphocyte-monocyte Ratio (LMR) as inflammatory biomarkers for the severity of Covid-19.
Methodology: This study is a single-center retrospective cohort study. The sample of this study was taken by consecutive sampling with complete clinical data from 893 Covid-19 patients from Andalas University Teaching Hospital from April 2020 to September 2021. This study uses SPSS Version 25.0 for data management and analysis.
Result: Most of the degrees of Covid-19 infection were mild degrees as many as 597 people with an NLR average value of 2.07 (0.27-34.50), and NMR average value of 7.86 (3-46), an LMR average value of 3.67 (0.25-25), an ANC value of 3.990 (945-45). 14,608). Most of the degrees of infection in patients with negative PCR results were moderate degrees as many as 70 people with a mean NLR value of 9.0694 (0.51-47.50), a mean NMR value of 18.6199 (1.15-47.50), and a mean LMR was 3.0324 (0.29-19.50), the ANC value was 9769.73 (1.088-37,219). There was a relationship between the degree of Covid-19 infection and the NLR value (p=0.144), as well as the LMR (p=0.000), NMR(p=0.000), and ANC (p=0.000). There was no relationship between the degree of infection in the negative PCR patient group and the NLR value (p=0.000), as well as the LMR (p=0.700), NMR(p=0.120), and ANC (p=0.90).
Conclusion: The severity of Covid-19 symptoms could be predicted through inflammatory biomarkers such as NLR, LMR, and NMR.
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References
World Health Organizations. COVID-19-China. Geneva: World Health Organization; 2020. Available from: https://www.who.int/emergencies/disease-outbreak-news/item/2020-DON233 [Last accessed on 2022 Jan 22].
World Health Organizations. WHO Coronavirus (COVID-19) Dashboard. Geneva: World Health Organizations; 2022. Available from: https://www.covid19.who.int/table [Last accessed on 2022 Feb 25].
Djaharuddin I, Munawwarah S, Nurulita A, Ilyas M, Tabri NA, Lihawa N. Comorbidities and mortality in COVID-19 patients. Gac Sanit. 2021;35:530-2. https://doi.org/10.1016/j.gaceta.2021.10.085 PMid:34929892 DOI: https://doi.org/10.1016/j.gaceta.2021.10.085
World Health Organizations. Living Guidance for Clinical Management of COVID-19. Geneva: World Health Organizastions; 2021. p. 63. Available from: https://www.who.int/publications/i/item/WHO-2019-nCoV-clinical-2021-1 [Last accessed on 2021 Nov 23].
Lee H, Kim I, Kang BH, Um SJ. Prognostic value of serial neutrophil-to-lymphocyte ratio measurements in hospitalized community-acquired pneumonia. PLoS One. 2021;16(4):0250067. https://doi.org/10.1371/journal.pone.0250067 PMid:33857241 DOI: https://doi.org/10.1371/journal.pone.0250067
Pan L, Du J, Li T, Liao H. Platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio associated with disease activity in patients with takayasu’s arteritis: A case-control study. BMJ Open. 2017;7(4):014451. https://doi.org/10.1136/bmjopen-2016-014451 PMid:28473512 DOI: https://doi.org/10.1136/bmjopen-2016-014451
Keskin H, Kaya Y, Cadirci K, Kucur C, Ziypak E, Simsek E, et al. Elevated neutrophil-lymphocyte ratio in patients with euthyroid chronic autoimmune thyreotidis. Endocr Regul. 2016;50(3):148-53. https://doi.org/10.1515/enr-2016-0017 PMid:27560798 DOI: https://doi.org/10.1515/enr-2016-0017
Fu L, Wang B, Yuan T, Chen X, Ao Y, Fitzpatrick T, et al. Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis. J Infect. 2020;80(6):656-65. https://doi.org/10.1016/j.jinf.2020.03.041 PMid:32283155 DOI: https://doi.org/10.1016/j.jinf.2020.03.041
Jordan RE, Adab P, Cheng KK. Covid-19: Risk factors for severe disease and death. BMJ. 2020;368:1198. https://doi.org/10.1136/bmj.m1198 PMid:32217618 DOI: https://doi.org/10.1136/bmj.m1198
Ministry of Health and Family Welfare. Clinical Management Protocol for COVID-19. Vol. 12. New Delhi: Ministry of Health and Family Welfare; 2016. p. 754-7.
Yang AP, Liu JP Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504. https://doi.org/10.1016/j.intimp.2020.106504 PMid:32304994 DOI: https://doi.org/10.1016/j.intimp.2020.106504
Liu J, Li S, Liu J, Liang B, Wang X, Wang H, et al. Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients. EBioMedicine. 2020;55:102763. https://doi.org/10.1016/j.ebiom.2020.102763 PMid:32361250 DOI: https://doi.org/10.1016/j.ebiom.2020.102763
Wang Y, He Y, Tong J, Qin Y, Xie T, Li J, et al. Characterization of an asymptomatic cohort of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected individuals outside of Wuhan, China. Clin Infect Dis. 2020;71(16):2132-8. https://doi.org/10.1093/cid/ciaa629 PMid:32442265 DOI: https://doi.org/10.1093/cid/ciaa629
Zhao Q, Meng M, Kumar R, Wu Y, Huang J, Deng Y, et al. Lymphopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A systemic review and meta-analysis. Int J Infect Dis. 2020;96:131-5. https://doi.org/10.1016/j.ijid.2020.04.086 PMid:32376308 DOI: https://doi.org/10.1016/j.ijid.2020.04.086
Zhang L, Huang B, Xia H, Fan H, Zhu M, Zhu L, et al. Retrospective analysis of clinical features in 134 coronavirus disease 2019 cases. Epidemiol Infect. 2020;148:199. https://doi.org/10.1017/s0950268820002010 PMid:32878654 DOI: https://doi.org/10.1017/S0950268820002010
Sadigh S, Massoth LR, Christensen BB, Stefely JA, Keefe J, Sohani AR. Peripheral blood morphologic findings in patients with COVID-19. Int J Lab Hematol. 2020;42(6):248-51. https://doi.org/10.1111/ijlh.13300 PMid:32730694 DOI: https://doi.org/10.1111/ijlh.13300
Erdogan A, Can FE, Gönüllü H. Evaluation of the prognostic role of NLR, LMR, PLR, and LCR ratio in COVID-19 patients. J Med Virol. 2021;93(9):5555-9. https://doi.org/10.1002/jmv.27097 PMid:34019701 DOI: https://doi.org/10.1002/jmv.27097
Sun S, Cai X, Wang H, He G, Lin Y, Lu B, et al. Abnormalities of peripheral blood system in patients with COVID-19 in Wenzhou, China. Clin Chim Acta. 2020;507:174-80. https://doi.org/10.1016/j.cca.2020.04.024 PMid:32339487 DOI: https://doi.org/10.1016/j.cca.2020.04.024
Anurag A, Jha PK, Kumar A. Differential white blood cell count in the COVID-19: A cross-sectional study of 148 patients. Diabetes Metab Syndr Clin Res Rev. 2020;14(6):2099-102. https://doi.org/10.1016/j.dsx.2020.10.029 PMid:33160224 DOI: https://doi.org/10.1016/j.dsx.2020.10.029
Barnes BJ, Adrover JM, Baxter-Stoltzfus A, Borczuk A, Cools- Lartigue J, Crawford JM, et al. Targeting potential drivers of COVID-19: Neutrophil extracellular traps. J Exp Med. 2020;217(6):20200652. https://doi.org/10.1084/jem.20200652 PMid:32302401 DOI: https://doi.org/10.1084/jem.20200652
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Copyright (c) 2022 Beni Indra, Nur Indrawaty Lipoeto, Hardisman Hardisman, Andani Eka Putra, Djong Hon Tjong, Sukri Rahman, Elfira Yusri, Muhammad Ridho Bilhaq, Yusan Pratama, Yudha Risman (Author)
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