The Role of Hemogram-derived Ratios in COVID-19 Severity Stratification in a Primary Healthcare Facility

Sabina Segalo; Emina Kiseljakovic; Emsel Papic; Anes Joguncic; Aleksandra Pasic; Mubera Sahinagic; Orhan Lepara; Lutvo Sporisevic

doi:10.5455/aim.2023.31.41-47

The Role of Hemogram-derived Ratios in COVID-19 Severity Stratification in a Primary Healthcare Facility

Acta Inform Med. 2023 Mar;31(1):41-47. doi: 10.5455/aim.2023.31.41-47.

Authors

Sabina Segalo¹, Emina Kiseljakovic², Emsel Papic¹, Anes Joguncic^{1

3}, Aleksandra Pasic^{1

4}, Mubera Sahinagic⁵, Orhan Lepara², Lutvo Sporisevic⁵

Affiliations

¹ University of Sarajevo, Faculty of Health Studies, Sarajevo, Bosnia and Herzegovina.
² University of Sarajevo, Faculty of Medicine, Sarajevo, Bosnia and Herzegovina.
³ Public Health Institute of Canton Sarajevo, Sarajevo, Bosnia and Herzegovina.
⁴ Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.
⁵ Public Institution Medical Center of Sarajevo Canton, Sarajevo, Bosnia and Herzegovina.

Abstract

Background: Coronavirus disease 2019 (COVID-19) can cause a wide clinical spectrum, ranging from asymptomatic to severe disease with a high mortality rate. In view of the current pandemic and the increasing influx of patients into healthcare facilities, there is a need to identify simple and reliable tools for stratifying patients.

Objective: Study aimed to analyze whether hemogram-derived ratios (HDRs) can be used to identify patients with a risk of developing a severe clinical form and admission to hospital.

Methods: This cross-sectional and observational study included 500 patients with a confirmed diagnosis of COVID-19. Data on clinical features and laboratory parameters were collected from medical records and 13 HDRs were calculated and analyzed. Descriptive and inferential statistics were included in the analysis.

Results: Of the 500 patients, 43.8% had a severe form of the disease. Lymphocytopenia, monocytopenia, higher C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were found in severe patients (p < 0.05). Significantly higher neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), neutrophil-to-platelet ratio (NPR), neutrophil-to-lymphocyte-to-platelet ratio (NLPR) and CRP-to-lymphocyte ratio (CRP/Ly) values were found in severe patients (p < 0.001). In addition, they have statistically significant prognostic potential (p < 0.001). The area under the curve (AUC) for CRP/Ly, dNLR, NLPR, NLR, and NPR were 0.693, 0.619, 0.619, 0.616, and 0.603, respectively. The sensitivity and specificity were 65.7% and 65.6% for CRP/Ly, 51.6% and 70.8 for dNLR, 61.6% and 57.3% for NLPR, 40.6% and 80.4% for NLR, and 48.8% and 69.1% for NPR.

Conclusion: The results of the study suggest that NLR, dNLR, CRP/Ly, NPR, and NLPR can be considered as potentially useful markers for stratifying patients with a severe form of the disease. HDRs derived from routine blood tests results should be included in common laboratory practice since they are readily available, easy to calculate, and inexpensive.

Keywords: COVID-19; hemogram-derived ratios; pandemic; severity; stratification.