The prognostic role of NLR, PLR, and LMR in predicting mortality of COVID-19 patients in a rural area

Ade Ajeng Cempakadewi; Brigitta Marcia Budihardja; Carissa Cornelia  Chundiawan; Apolonia Berenika Badu; Anselmus Ake; Gusti Ayu Sri Bidani

doi:10.15562/ism.v14i1.1578

The prognostic role of NLR, PLR, and LMR in predicting mortality of COVID-19 patients in a rural area

Ade Ajeng Cempakadewi ,

Brigitta Marcia Budihardja ,

Carissa Cornelia Chundiawan ,

Apolonia Berenika Badu ,

Anselmus Ake ,

Gusti Ayu Sri Bidani ,

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DOI: https://doi.org/10.15562/ism.v14i1.1578 |
Published: 2023-03-07

Abstract

Introduction: COVID-19 has been a challenge worldwide. This infection can manifest in various characteristics, from asymptomatic to severe, leading to mortality. Predictive tools to predict mortality are highly important in better therapeutic strategies. Hematology ratios, including neutrophil, platelet, lymphocyte, and monocyte, have been suggested as a prognostic tool that is widely available. The study aimed to assess the prognostic significance of NLR, PLR, and LMR in predicting COVID-19 patients' mortality in a rural setting.

Methods: Hospitalized patients with COVID-19 at Bajawa Regional General Hospital were included in this retrospective cohort study. The patient's medical records from January 2021 to August 2021 were examined. The patients were separated into two groups; in-hospital death and discharged group. The routine blood examination during admission gave NLR, PLR, and LMR results. Data analysis was processed with SPSS 26. The Receiver Operating Characteristic (ROC) curve is used to determine whether NLR, PLR, and LMR may be used as prognostic indicators for hospitalized patients’ outcomes. The area under the curve (AUC) results were used to rate the accuracy.

Results: There were 91 patients in total. NLR, PLR, and LMR, AUCs were 0.689, 0.635, and 0.653, with cut-off values of 4.28, 184.12, and 2.69, respectively. Each indicator’s sensitivity and specificity remained poor. The cut-off value of PLR was the only indicator that had significant differences when compared between the two groups.

Conclusion: NLR, PLR, and LMR performed poor values as predictors of mortality in hospitalized patients with COVID-19.

References

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Citu, C. et al. The Predictive Role of NLR, d-NLR, MLR, and SIRI in COVID-19 Mortality. Diagnostics 12, (2022).
Açıksarı, G. et al. Prognostic Value of Inflammatory Biomarkers in Patients with Severe COVID-19: A Single-Center Retrospective Study. Biomark. Insights 16, (2021).
Sarkar, S., Kannan, S., Khanna, P. & Singh, A. K. Role of platelet-to-lymphocyte count ratio (PLR), as a prognostic indicator in COVID-19: A systematic review and meta-analysis. J. Med. Virol. 94, (2022).
Karimi, A., Shobeiri, P., Kulasinghe, A. & Rezaei, N. Novel Systemic Inflammation Markers to Predict COVID-19 Prognosis. Frontiers in Immunology vol. 12 (2021).
Charlson, M. E., Pompei, P., Ales, K. L. & MacKenzie, C. R. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J. Chronic Dis. 40, (1987).
Yang, S. & Berdine, G. The receiver operating characteristic (ROC) curve. Southwest Respir. Crit. Care Chronicles 5, (2017).
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Sunil, R., Ramesh, P. C., Nagaraj, A. H., & Kadarappa, K. Utility of Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) as A Predictor of Mortality in COVİD-19. Medical Laboratory Technology Journal, 2022:8(1), 35–41.
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[1] Zaman, M. S. & Sizemore, R. C. Diverse manifestations of covid-19: Some suggested mechanisms. International Journal of Environmental Research and Public Health vol. 18 (2021).

[2] Citu, C. et al. The Predictive Role of NLR, d-NLR, MLR, and SIRI in COVID-19 Mortality. Diagnostics 12, (2022).

[3] Açıksarı, G. et al. Prognostic Value of Inflammatory Biomarkers in Patients with Severe COVID-19: A Single-Center Retrospective Study. Biomark. Insights 16, (2021).

[4] Sarkar, S., Kannan, S., Khanna, P. & Singh, A. K. Role of platelet-to-lymphocyte count ratio (PLR), as a prognostic indicator in COVID-19: A systematic review and meta-analysis. J. Med. Virol. 94, (2022).

[5] Karimi, A., Shobeiri, P., Kulasinghe, A. & Rezaei, N. Novel Systemic Inflammation Markers to Predict COVID-19 Prognosis. Frontiers in Immunology vol. 12 (2021).

[6] Charlson, M. E., Pompei, P., Ales, K. L. & MacKenzie, C. R. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J. Chronic Dis. 40, (1987).

[7] Yang, S. & Berdine, G. The receiver operating characteristic (ROC) curve. Southwest Respir. Crit. Care Chronicles 5, (2017).

[8] Yan, X. et al. Neutrophil to lymphocyte ratio as a prognostic and predictive factor in patients with coronavirus disease 2019: A retrospective cross-sectional study. J. Med. Virol. 92, (2020).

[9] Fois, A. G. et al. The systemic inflammation index on admission predicts in-hospital mortality in COVID-19 patients. Molecules 25, (2020).

[10] Biswas, M., Rahaman, S., Biswas, T. K., Haque, Z. & Ibrahim, B. Association of Sex, Age, and Comorbidities with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis. Intervirology vol. 64 (2021).

[11] La Vignera, S. et al. Sex-specific SARS-CoV2 mortality: Among hormone-modulated ace2 expression, risk of venous thromboembolism and hypovitaminosis D. International Journal of Molecular Sciences vol. 21 (2020).

[12] Leng, J. & Goldstein, D. R. Impact of aging on viral infections. Microbes and Infection vol. 12 (2010).

[13] Asghar, M. S. et al. Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comparative analysis. J. Community Hosp. Intern. Med. Perspect. 10, (2020).

[14] Sunil, R., Ramesh, P. C., Nagaraj, A. H., & Kadarappa, K. Utility of Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) as A Predictor of Mortality in COVİD-19. Medical Laboratory Technology Journal, 2022:8(1), 35–41.

[15] Pedersen, S. F. & Ho, Y. C. SARS-CoV-2: A storm is raging. Journal of Clinical Investigation vol. 130 (2020).

[16] Turan, Demet. The relationship between SII, PLR, LCR, MPV / PLT indexes and prognosis in COVID-19. South. Clin. Istanbul Eurasia (2021)

[17] BG, S. et al. Neutrophil-to-Lymphocyte, Lymphocyte-to-Monocyte, and Platelet-to-Lymphocyte Ratios: Prognostic Significance in COVID-19. Cureus (2021)

[18] Bozan, O. et al. Prognostic value of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio for mortality in patients infected with SARS-CoV-2. Ukr. J. Nephrol. Dial. (2021)

[19] S., P. & Patil, N. Study correlating lymphocyte to monocyte ratio and platelet to lymphocyte ratio with the severity in COVID-19 patients: a cross sectional study. Int. J. Adv. Med. 8, (2021).

[20] Koval, D., Pertseva, T., Konopkina, L., Bielosludtseva, K. & Krykhtina, M. Lymphocyte-to-monocyte ratio (LMR) as a predictor of Covid-19 pneumonia progression. in (2021).

[21] Aly, M. M. et al. Can hematological ratios predict outcome of covid-19 patients? A multicentric study. J. Blood Med. 12, (2021).

[22] Syahrini H, Fadjari TH, Dalimoenthe NZ. Neutrophil-Lymphocyte Ratio (NLR) and Lymphocyte-Monocyte Ratio (LMR) as Covid-19 Screening Parameters. Indones J Med Lab Sci Technol. 2022 Apr 28;4(1):10–23.

The prognostic role of NLR, PLR, and LMR in predicting mortality of COVID-19 patients in a rural area

Abstract

References

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