Role of Neutrophil-Lymphocyte Ratio in Predicting Severity of COVID-19

Md. Saroar Jahan Rajib(1), Md. Raiq Raihan Chowdhury(2), Md. Samim Reza(3), Mily Dey(4), Nasrin Akhter(5), Md. Maruf Reza Kabir(6), Md. Mosharaf Hossain(7), Md. Abdul Bari Khandakar(8), Md. Salahuddin Shah(9)
(1) National Institute of Cancer Research and Hospital, Dhaka, Bangladesh
(2) Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
(3) Dhaka Medical College, Dhaka, Bangladesh
(4) Sir Salimullah Medical College, Dhaka, Bangladesh
(5) Dhaka Medical College, Dhaka, Bangladesh
(6) Dhaka Medical College, Dhaka, Bangladesh
(7) National Institute of Cancer Research and Hospital, Dhaka, Bangladesh
(8) Rajshahi Medical College, Rajshahi, Bangladesh
(9) Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Abstract

Background: Higher neutrophil-lymphocyte ratio (NLR) is considered as cardinal findings with prognostic potentials in identification of severe COVID-19 cases. However, whether baseline NLR could be a predictor of disease severity and outcome remained to be investigated. Hence, this study was conducted with an aim to evaluate the relation of NLR (on admission) with disease severity. Objective: The objective of the study was to estimate the neutrophil-lymphocyte ratio among COVID-19 patients and its role in predicting disease severity. Method: This cross-sectional study was conducted in Bangabandhu Sheikh Mujib Medical University (BSMMU) from July 2020 to June 2021. Ninety-four COVID-19 admitted patients were enrolled following inclusion & exclusion criteria. Informed consent was taken from the subjects. Ethical clearance was obtained from institutional review board (IRB) of BSMMU. Complete blood count for N-L ratio was done by standard procedure on admission by SYSMEX XN-2000 haematology analyser. Clinical and laboratory information were recorded with a semi-structured questionnaire. After collection of all the required data, analysis was done by SPSS 24.0. Results: Mean age of the patients was 56.59±12.25 years, wherein maximum patients were male (67%), non-smoker (80.9%), and retired/current service holder (51.1%). Maximum patients were hypertensive (61.7%) and diabetic (56.4%). Besides, maximum study patients (64.9%) were in severe category of COVID-19, followed by moderate (20.2%) and mild (14.9%) category according to National Guidelines on Clinical Management of COVID-19 criteria. Mean NLR was 5.40±4.35 (SD), wherein on admission NLR was significantly higher among severe COVID-19 patients compared to mild/moderate category (6.90±4.64 vs 2.61±1.53, p <0.05). 28-days hospital mortality was found to be significantly associated with NLR (p<0.05). Receiver operator curve analysis found highly significant cut-off value for NLR (3.42) with 75.4% sensitivity and 75.8% specificity in predicting severe COVID-19 patients (AUC= 0.841, p value <0.001). Multivariate logistic regression analysis found NLR as an independent predictor for severe COVID-19 (OR=4.68, 95% CI: 1.29-16.81, P=0.019). Pearson correlation analysis showed that NLR had significant positive correlation with CRP and D-dimer as p value <0.05. Conclusion: NLR can predict the disease severity and outcome of hospitalized COVID-19 patients. However, further larger study is recommended.

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Authors

Md. Saroar Jahan Rajib
jahan1639@gmail.com (Primary Contact)
Md. Raiq Raihan Chowdhury
Md. Samim Reza
Mily Dey
Nasrin Akhter
Md. Maruf Reza Kabir
Md. Mosharaf Hossain
Md. Abdul Bari Khandakar
Md. Salahuddin Shah
Author Biographies

Md. Saroar Jahan Rajib, National Institute of Cancer Research and Hospital, Dhaka

Assistant registrar, National Institute of Cancer Research & Hospital, Mohakhali, Dhaka

Md. Raiq Raihan Chowdhury, Bangabandhu Sheikh Mujib Medical University, Dhaka

Assistant Professor of Haematology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka

Md. Samim Reza, Dhaka Medical College, Dhaka

Department of Haematology, Dhaka Medical College Hospital, Dhaka, Bangladesh

Mily Dey, Sir Salimullah Medical College, Dhaka

Department of Haematology, Sir Salimullah Medical College, Dhaka , Bangladesh

Nasrin Akhter, Dhaka Medical College, Dhaka

Department of Haematology, Dhaka Medical College, Dhaka

Md. Maruf Reza Kabir, Dhaka Medical College, Dhaka

Department of Haematology, Dhaka Medical College, Dhaka

Md. Mosharaf Hossain, National Institute of Cancer Research and Hospital, Dhaka

Anaesthesiologist, Department of Anesthesia, Analgesia and ICU, National Institute of Cancer Research Hospital, Mohakhali, Dhaka

Md. Abdul Bari Khandakar, Rajshahi Medical College, Rajshahi

Assistant Professor, Department of Plastic Surgery, Rajshahi Medical College, Rajshahi

Md. Salahuddin Shah, Bangabandhu Sheikh Mujib Medical University, Dhaka

Professor of Haematology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka

1.
Rajib MSJ, Chowdhury MRR, Reza MS, Dey M, Akhter N, Kabir MMR, et al. Role of Neutrophil-Lymphocyte Ratio in Predicting Severity of COVID-19. Haematol J Bangladesh [Internet]. 2024 Feb. 20 [cited 2024 Apr. 17];8(1):21-7. Available from: https://journal.hematologybd.org/index.php/haematoljbd/article/view/120

Article Details

How to Cite

1.
Rajib MSJ, Chowdhury MRR, Reza MS, Dey M, Akhter N, Kabir MMR, et al. Role of Neutrophil-Lymphocyte Ratio in Predicting Severity of COVID-19. Haematol J Bangladesh [Internet]. 2024 Feb. 20 [cited 2024 Apr. 17];8(1):21-7. Available from: https://journal.hematologybd.org/index.php/haematoljbd/article/view/120