Evaluation of individual and combined NLR, LMR and CLR ratio for prognosis disease severity and outcomes in patients with COVID-19

• Published in: International immunopharmacology Vol. 109; p. 108781
• Main Authors: Ben Jemaa, Awatef, Salhi, Noura, Ben Othmen, Meriam, Ben Ali, Hana, Guissouma, Jihene, Ghadhoune, Hatem, Oueslati, Ridha, Dhaouadi, Hamdi
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01-08-2022
• Subjects: CLR; Combined markers; COVID-19; NLR; Prognosis; SARS-CoV-2; COVID-19; CLR; SARS-CoV-2; Prognosis; NLR; Combined markers
• DOI: 10.1016/j.intimp.2022.108781
• EISSN: 1878-1705
• ISSN: 1567-5769

•The feasibility of inflammatory indices combinations to assess COVID-19 disease severity.•Combination indices are more valuable than individual markers in the discrimination of COVID 19 cases.•Among combination indices, NLR combined to CLR seems to be the most effective to predict COVID-19 outcome.•NLR combined to CLR could be a novel biomarker that aid to the anticipation of severe COVID-19 complications.•Combination NLR and CLR could improve the clinical and therapeutic management of COVID-19 patients.
The study aimed to utilize the peripheral blood immunological parameters and resulting individual and combined inflammatory indices [neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR) and C-reactive protein/lymphocyte ratio (CLR)] in predicting the prognosis and mortality in COVID-19 patients.
The measurements of individual and combined inflammatory indices (NLR, LMR and CLR) were performed at hospital admission and at last day of hospitalization for COVID-19 patients.
Prominent elevation of NLR and CLR among patients with refractory disease admitted to Intensive Care Unit (ICU) and deceased patients was found when compared with moderate ill patients and healthy controls. Interestingly, NLR and CLR typically returned to near normal value as patients recover from severe infection. By contrast, deceased patients had persistent increased NLR and CLR until last day of hospitalization in ICU. ROC obtained for the above parameters showed that NLR and CLR were the most associated immunological parameters with the severity of COVID-19 disease. Using multivariate logistic regression analysis, CLR > 69.46 is an independent prognostic factors in identifying critically ill COVID-19 cases. Study of the combined markers NLR and CLR showed that most of patients admitted in ICU were characterized with high NLR combined with high CLR, while most of healthy subjects and non-ICU group have low NLR combined with low CLR.
The combination of NLR and CLR could improve the predictive efficacy compared to individual markers to segregate patients who will develop a severe disease from those with a mild pathology.