Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio as Markers for Predicting the Severity in COVID-19 Patients: A Prospective Observational Study

Yudhyavir Singh; Abhishek Singh; Swetha Rudravaram; Kapil D Soni; Richa Aggarwal; Nishant Patel; Naveet Wig; Anjan Trikha

doi:10.5005/jp-journals-10071-23906

Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio as Markers for Predicting the Severity in COVID-19 Patients: A Prospective Observational Study

Indian J Crit Care Med. 2021 Aug;25(8):847-852. doi: 10.5005/jp-journals-10071-23906.

Authors

Yudhyavir Singh¹, Abhishek Singh², Swetha Rudravaram¹, Kapil D Soni³, Richa Aggarwal⁴, Nishant Patel¹, Naveet Wig⁵, Anjan Trikha⁶

Affiliations

¹ Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India.
² Department of Anaesthesiology, Critical Care and Pain Medicine, New Delhi, India.
³ Department of Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
⁴ Department of Critical Care, All India Institute of Medical Sciences, New Delhi, India.
⁵ Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.
⁶ Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India.

Abstract

Background: Coronavirus disease-2019 (COVID-19) pandemic has shown unpredictable course in individual patients. Few patients develop severe disease with progression after admission to a healthcare facility. Multiple parameters have been investigated to identify a marker to predict disease progression. Neutrophil-to-lymphocyte ratio (NLR) or platelet-to-lymphocyte (PLR) ratio has shown some promise. The current investigation explores the role of NLR and PLR to predict the disease progression. Materials and methods: After obtaining ethics committee approval, 608 patients were screened for inclusion in the prospective observational study, and 201 patients were included in the final analysis. The NLR and PLR were derived from routinely obtained complete blood count analysis. The patients were followed to determine the development of severity of the disease during the course. The NLR and PLR were analyzed in both univariate and multivariable models to assess the association and prediction. Results: In nonsevere (NS) group, the mean age of patients was 50.9 ± 16.3 years, and 66 (61.2%) were male, while in severe group (S), the mean age of patients was 53.7 ± 16.4 years, and 65 (69.89%) were male. NLR at day 1 and day 3 was significantly lower in survivors as compared to nonsurvivors, while the relation of PLR in both the groups was not statistically significant. The NLR is better in predicting the severity of disease as well as mortality than PLR. Conclusion: The NLR calculated at the time of admission has high predictive value for disease deterioration and adverse clinical outcome. How to cite this article: Singh Y, Singh A, Rudravaram S, Soni KD, Aggarwal R, Patel N, et al. Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio as Markers for Predicting the Severity in COVID-19 Patients: A Prospective Observational Study. Indian J Crit Care Med 2021;25(8):847-852.

Keywords: COVID-19; COVID-19 infection; COVID-19 mortality; Mortality; Mortality prediction.