key: cord-281984-en9825p9
authors: Wang, Shijie; Fu, Lingli; Huang, Kejie; Han, Jianglong; Zhang, Rui; Fu, Zhenming
title: Neutrophil-to-lymphocyte ratio at admission is an independent risk factors for the severity and mortality in patients with coronavirus disease 2019
date: 2020-09-24
journal: J Infect
DOI: 10.1016/j.jinf.2020.09.022
sha: 
doc_id: 281984
cord_uid: en9825p9

• The level of NLR at admission could be independent risk factors for the severe disease and the mortality of COVID-19. • The predictive value of NLR for poor prognosis was more significant in patients without other potential risk factors. • NLR could help physicians rapidly identify high-risk patients and adopt timely intervention.

 The level of NLR at admission could be independent risk factors for the severe disease and the mortality of COVID-19.  The predictive value of NLR for poor prognosis was more significant in patients without other potential risk factors.  NLR could help physicians rapidly identify high-risk patients and adopt timely intervention.

The study by Liu et al. have been published in your journal and reported that the neutrophil-to-lymphocyte ratio (NLR) is an independent risk factor for the mortality of the COVID-19 patients. 1 Based on it, we reported the association between levels of NLR at admission and the disease severity in COVID-19, and further explored the predictive role of NLR for mortality of the COVID-19 patients in more subgroups.

Key epidemiological, clinical, laboratory, radiological and outcomes data were obtained through detailed medical chart review from January 1st to February 10th, 2020 at the Renmin Hospital of Wuhan University. All the peripheral venous blood samples were collected on admission and examined at the laboratory following standard procedures.

Multivariable logistic regression analyses with stepwise procedure were used to estimate odds ratios (OR) and 95% confidence intervals (CI 3 Previous studies of coronavirus suggested that the lymphocyte loss might be associated with the immune-escape mechanism of the virus. 3 Nowadays, it has also been suggested that lymphocyte loss might be associated hypertension. They only found that the male had a more significant association with the risk of mortality than the female. Interestingly, we further found that NLR was of greater value in predicting severity and mortality for patients with no other clinical risk factors (i.e., those with a theoretically better prognosis), such as patients with younger age, or without comorbidities.

In conclusion, we found that the level of NLR at admission could be independent risk factors for the prognosis of COVID-19, not only for the mortality but also for the disease severity. And the predictive value was more significant in patients without other potential risk factors. NLR could help physicians rapidly identify high-risk patients and adopt timely intervention, so as to reduce the rates of severe disease and mortality.

The authors state that they have no conflicts of interest to disclosure.

There was no funding source for this study. At admission, liver and renal function tests were all found to be within normal range, and thus excluded from the data collection. 

Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19

Longitudinal characteristics of lymphocyte responses and cytokine profiles in the peripheral blood of SARS-CoV-2 infected patients

Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology

SnapShot: COVID-19

Cytokine storm and leukocyte changes in mild versus severe SARS-CoV-2 infection: Review of 3939 COVID-19 patients in China and emerging pathogenesis and therapy concepts

Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory medicine 2020

Immune System and Chronic Diseases

Abbreviation: COVID-19, coronavirus disease

Derived from multivariate stepwise analysis of logistic regression models. 2 Final model 1: for disease severity, retained in this model after stepwise selection was age (as continuous variable), fever (yes, no), dyspnoea (yes

Final model 2: for disease severity, retained in the final model were fever (yes, no), dyspnoea (yes, no), NLR, and CRPR

for survival status, retained in the final model were hypertension (yes, no), cancer (yes

COPD (yes, no), cancer (yes, no), fever (yes, no), dyspnoea (yes, no), and NLR tertile group; for survival, retained in the final model were age group (<60, ≧60), hypertension (yes, no), dyspnoea (yes, no), CRPR, NLR tertile group

No acknowledgements.
