Prognostic implications of neutrophil-lymphocyte ratio inCOVID-19

Abstract

Background: The clinical presentation of COVID-19 ranges from a mild, self-lim-iting disease, to multiple organ failure and death. Most severe COVID-19 cases pre-sent low lymphocytes counts and high leukocytes counts, and accumulated evidencesuggests that in a subgroup of patients presenting severe COVID-19, there may bea hyperinflammatory response driving a severe hypercytokinaemia which may be,at least in part, signalling the presence of an underlying endothelial dysfunction. Inthis context, available data suggest a prognostic role of neutrophil-lymphocyte ratio(NLR) in various inflammatory diseases and oncological processes. Following thisrationale, we hypothesized that NLR, as a marker of endothelial dysfunction, may beuseful in identifying patients with a poor prognosis in hospitalized COVID-19 cases.Design: A retrospective observational study performed at Hospital Universitario HMPuerta del Sur, Madrid, Spain, which included 119 patients with COVID-19 from 1March to 31 March 2020. Patients were categorized according to WHO R&D ExpertGroup.Results: Forty-five (12.1%) patients experienced severe acute respiratory failure re-quiring respiratory support. Forty-seven (12.6%) patients died. Those with worseoutcomes were older (P = .002) and presented significantly higher NLR at admission(P = .001), greater increase in Peak NLR (P < .001) and higher increasing speed ofNLR (P = .003) compared with follow-up patients. In a multivariable logistic regres-sion, age, cardiovascular disease and C-reactive protein at admission and Peak NLRwere significantly associated with death.Conclusions: NLR is an easily measurable, available, cost-effective and reliable pa-rameter, which continuous monitoring could be useful for the diagnosis and treat-ment of COVID-19.K E Y W O R D SCOVID-19, endothelial dysfunction, hyperinflammatory response, Neutrophil¿lymphocyte ratio