Neutrophil to Lymphocyte Ratio (NLR) and Derived NLR Combination: A Cost-effective Predictor of Moderate to Severe COVID-19 Progression
-
Sussan Kaboudanian Ardestani
,
Mohammad Reza Salehi
,
Bahareh Attaran
,
Seyed Mahmoud Hashemi
,
Somayeh Sadeghi
,
Sara Ghaffarpour
,
Fatemeh Tuserkani
,
Tooba Ghazanfari
Abstract
Inflammation is an essential contributor to Coronavirus disease 2019 (COVID-19).
In this regard, finding a prognostic indicator is valuable because the treatment will be more effective if critical patients with high inflammation are diagnosed earlier. We aimed to evaluate some hematologic markers for COVID-19 and assess their association with the severity of the disease.
A total of 154 COVID-19 patients were laboratory-confirmed and admitted to Imam Khomeini Hospital Complex, Tehran, Iran, from February 12, 2020, to April 4, 2020, and 55 healthy individuals were enrolled in the study. The severity of the patients' illnesses was classified into three subgroups according to the types of oxygen therapies (moderate (61), severe (28), and critical (43)) and examined the different ratios of total white blood cell (WBC) count, neutrophil to lymphocyte ratio (NLR), platelet to monocyte ratio (PLR), macrophage to lymphocyte ratio (MLR), derived NLR ratio (dNLR), and some biochemical tests.
COVID-19 patients had higher levels of NLR, MLR, PLR, and dNLR than healthy subjects. receiver operating characteristic (ROC) analysis of the curve revealed that NLR and dNLR had a high diagnostic value to differentiate COVID-19 patients from healthy subjects (area under the curve [AUC]=0.923 and 0.910, respectively) and predict mortality (AUC=0.726 and 0.735, respectively).
NLR and dNLR may be reliable markers to evaluate the severity of COVID-19. NLR and dNLR had a high diagnostic value for differentiating COVID-19 patients from healthy subjects, and they could predict the severity and outcome of the disease.
1. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.
2. WHO. Clinical management of COVID-19: interim guidance. 2020( WHO/2019-nCoV/clinical/2020.5).
3. Lin L, Lu L, Cao W, Li T. Hypothesis for potential pathogenesis of SARS-CoV-2 infection–a review of immune changes in patients with viral pneumonia. Emerg Microbes Infect. 2020;9(1):727-32.
4. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
5. Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5-14.
6. Ying H-Q, Deng Q-W, He B-S, Pan Y-Q, Wang F, Sun H-L, et al. The prognostic value of preoperative NLR, d-NLR, PLR, and LMR for predicting clinical outcome in surgical colorectal cancer patients. Med Oncol. 2014;31(12):305-11.
7. Wynants L, Van Calster B, Bonten MM, Collins GS, Debray TP, De Vos M, et al. Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal. BMJ. 2020;369.
8. Sun S, Cai X, Wang H, He G, Lin Y, Lu B, et al. Abnormalities of peripheral blood system in patients with COVID-19 in Wenzhou, China. Clinica Chimica Acta. 2020.
9. Fu J, Kong J, Wang W, Wu M, Yao L, Wang Z, et al. The clinical implication of dynamic neutrophil to lymphocyte ratio and D-dimer in COVID-19: A retrospective study in Suzhou China. Thromb Res. 2020.
10. Cheng K, Wei M, Shen H. Clinical characteristics of 463 patients with common and severe type coronavirus disease 2019. Shanghai Med J. 2020;1:1-15.
11. Gao Y, Li T, Han M, Li X, Wu D, Xu Y, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID‐19. J Med Virol. 2020;92(7):791-6.
12. Mei Z, Shi L, Wang B, Yang J, Xiao Z, Du P, et al. Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors: a systematic review and meta-analysis of 66 cohort studies. Cancer Treat Rev. 2017;58:1-13.
13. Kerboua KE. NLR: A Cost-effective Nomogram to Guide Therapeutic Interventions in COVID-19. Immunol Investig. 2020:1-9.
14. Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med. 2012;5(1):2.
15. Yang A-P, Liu J, Tao W, Li H-m. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020:106504.
16. Thomas J, Pociute A, Kevalas R, Malinauskas M, Jankauskaite L. Blood biomarkers differentiating viral versus bacterial pneumonia aetiology: a literature review. Ital J Pediatr. 2020;46(1):4-9.
17. Organization WH. Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus ( MERS-CoV) infection is suspected: interim guidance. World Health Organization; 2019.
18. World Health O. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance, 28 January 2020. Geneva: World Health Organization; 2020 2020. Contract No.: WHO/nCoV/Clinical/2020.3.
19. Ghazanfari T, Namaki S, Salehi M, Arabkheradmand J, Rostamian A, Rajabnia Chenary M, et al. Interpretation of hematological, biochemical and immunological findings of covid-19 disease: Biomarkers Associated with Severity and Mortality. Iran J Allergy Asthma Immunol (IJAAI). 2021;in press.
20. Rostamian A, Ghazanfari T, Arabkheradmand J, Edalatifard M, Ghaffarpour S, salehi mr, et al. Iran COVID-19 Immunological Study: Remarkable Level of Interleukin-6 in Iranian COVID-19 Hospitalized Patients. Lancet Respir. Med., 2020; 20(20).
21. Cao X. COVID-19: immunopathology and its implications for therapy. Nat Rev Immunol. 2020;20(5):269-70.
22. Vaninov N. In the eye of the COVID-19 cytokine storm. Nat Rev Immunol. 2020;20(5):277-9.
23. Kassir R. Risk of COVID‐19 for patients with obesity. Obes Rev. 2020;21(6):9-11.
24. Tiwari N, Nath D, Madan J, Singh S, Bajpai P, Madan U. The Neutrophil Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR) and routine hematological parameters of COVID-19 Patient: A perspective of the Indian scenario from a frontline pilot study of 32 COVID-19 cases in a Tertiary Care Institute of North India. medRxiv. 2020.
25. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HH, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020; 81(1):e6-e12.
26. Cheng B, Hu J, Zuo X, Chen J, Li X, Chen Y, et al. Predictors of progression from moderate to severe coronavirus disease 2019: a retrospective cohort. Clin Microbiol Infect. 2020;26(10):1400-5.
27. Lian J, Jin C, Hao S, Zhang X, Yang M, Jin X, et al. High neutrophil-to-lymphocyte ratio associated with progression to critical illness in older patients with COVID-19: a multicenter retrospective study. Aging. 2020;12(14):13849-59.
28. Li X, Liu C, Mao Z, Xiao M, Wang L, Qi S, et al. Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis. Crit Care. 2020;24(1):647-9.
29. Yan X, Li F, Wang X, Yan J, Zhu F, Tang S, et al. Neutrophil to lymphocyte ratio as prognostic and predictive factor in patients with coronavirus disease 2019: A retrospective cross‐sectional study. J Med Virol. 2020.
30. Gao F, Li X, Geng M, Ye X, Liu H, Liu Y, et al. Pretreatment neutrophil–lymphocyte ratio: an independent predictor of survival in patients with hepatocellular carcinoma. Medicine. 2015;94(11):7-14.
31. Nalbant A, Kaya T, Varim C, Yaylaci S, Tamer A, Cinemre H. Can the neutrophil/lymphocyte ratio (NLR) have a role in the diagnosis of coronavirus 2019 disease (COVID-19)? Rev Assoc Med Bras. 2020;66(6):746-51.
32. Taghavi-Farahabadi M, Mahmoudi M, Hashemi SM, Namaki S. Neutrophils to Lymphocytes Ratio and the Prognosisof the COVID-19 Patients. Immunoregulation. 2020;3(2):89-96.
33. Zhao Y, Yu C, Ni W, Shen H, Qiu M, Zhao Y. Peripheral blood inflammatory markers in predicting prognosis in patients with COVID‐19. Some differences with influenza A. J Clin Lab. Anal. 2020:e23657.
34. Sayah W, Berkane I, Guermache I, Sabri M, Lakhal FZ, Yasmine Rahali S, et al. Interleukin-6, procalcitonin and neutrophil-to-lymphocyte ratio: Potential immune-inflammatory parameters to identify severe and fatal forms of COVID-19. Cytokine. 2021;141(11):155428.
35. Zeng F, Huang Y, Guo Y, Yin M, Chen X, Xiao L, et al. Association of inflammatory markers with the severity of COVID-19: a meta-analysis. Int J Infect Dis. 2020;96:464-74.
36. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020;71(15):761-8.
37. Liu X, Shen Y, Wang H, Ge Q, Fei A, Pan S. Prognostic significance of neutrophil-to-lymphocyte ratio in patients with sepsis: a prospective observational study. Mediat Inflamm. 2016;2016:8191254.
38. Naymagon L, Zubizarreta N, Feld J, van Gerwen M, Alsen M, Thibaud S, et al. Admission D-dimer levels, D-dimer trends, and outcomes in COVID-19. Thromb Res. 2020;196(18):99-105.
39. Shang W, Dong J, Ren Y, Tian M, Li W, Hu J, et al. The value of clinical parameters in predicting the severity of COVID‐19. J Med Virol. 2020;92(10):2188-92.
40. Zahorec R, Hulin I, Zahorec P. Rationale Use of Neutrophil-to-lymphocyte ratio for early diagnosis and stratification of COVID-19. Bratisl Lek Listy. 2020;121(7):466-70.
41. Tan C, Huang Y, Shi F, Tan K, Ma Q, Chen Y, et al. C‐reactive protein correlates with computed tomographic findings and predicts severe COVID‐19 early. J Med Virol. 2020; 92(7):856-62.
42. Lagadinou M, Solomou EE, Zareifopoulos N, Marangos M, Gogos C, Velissaris D. Prognosis of COVID-19: Changes in laboratory parameters. Age (yrs). 2020;62(13.4):47-16.2.
43. Phua J, Weng L, Ling L, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations, Lancet Respir Med. 2020;8(5):506-517.
44. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42.
45. Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al. Neutrophil-to-lymphocyte ratio predicts severe illness patients with 2019 novel coronavirus in the early stage. J Transl Med. 2020 May 20;18(1):206.
46. Sakurai K, Chubachi S, Irie H, Tsutsumi A, Kameyama N, Kamatani T, et al. Clinical utility of blood neutrophil-lymphocyte ratio in Japanese COPD patients. BMC Pulm Med. 2018;18(1):65-9.
47. Aaron SD, Angel JB, Lunau M, Wright K, Fex C, LE SAUX N, et al. Granulocyte inflammatory markers and airway infection during acute exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;163(2):349-55.
48. Torun S, Tunc BD, Suvak B, Yildiz H, Tas A, Sayilir A, et al. Assessment of neutrophil-lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity. Clin Res Hepatol Gastroenterol. 2012;36(5):491-7.
49. Azab B, Jaglall N, Atallah JP, Lamet A, Raja-Surya V, Farah B, et al. Neutrophil-lymphocyte ratio as a predictor of adverse outcomes of acute pancreatitis. Pancreatology. 2011;11(4):445-52.
50. Paliogiannis P, Fois AG, Sotgia S, Mangoni AA, Zinellu E, Pirina P, et al. The neutrophil‐to‐lymphocyte ratio as a marker of chronic obstructive pulmonary disease and its exacerbations: A systematic review and meta‐analysis. Eur J Clin Invest. 2018;48(8):e12984.
51. Teng F, Ye H, Xue T. Predictive value of neutrophil to lymphocyte ratio in patients with acute exacerbation of chronic obstructive pulmonary disease. PloS one. 2018;13(9):12-8.
52. Wang Y, Ju M, Chen C, Yang D, Hou D, Tang X, et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in acute respiratory distress syndrome patients: a retrospective study. J Thorac Dis. 2018;10(1):273-5.
53. Ye Z, Ai X, Liao Z, You C, Cheng Y. The prognostic values of neutrophil to lymphocyte ratio for outcomes in chronic obstructive pulmonary disease. Medicine. 2019;98(28):12-6.
2. WHO. Clinical management of COVID-19: interim guidance. 2020( WHO/2019-nCoV/clinical/2020.5).
3. Lin L, Lu L, Cao W, Li T. Hypothesis for potential pathogenesis of SARS-CoV-2 infection–a review of immune changes in patients with viral pneumonia. Emerg Microbes Infect. 2020;9(1):727-32.
4. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
5. Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102(1):5-14.
6. Ying H-Q, Deng Q-W, He B-S, Pan Y-Q, Wang F, Sun H-L, et al. The prognostic value of preoperative NLR, d-NLR, PLR, and LMR for predicting clinical outcome in surgical colorectal cancer patients. Med Oncol. 2014;31(12):305-11.
7. Wynants L, Van Calster B, Bonten MM, Collins GS, Debray TP, De Vos M, et al. Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal. BMJ. 2020;369.
8. Sun S, Cai X, Wang H, He G, Lin Y, Lu B, et al. Abnormalities of peripheral blood system in patients with COVID-19 in Wenzhou, China. Clinica Chimica Acta. 2020.
9. Fu J, Kong J, Wang W, Wu M, Yao L, Wang Z, et al. The clinical implication of dynamic neutrophil to lymphocyte ratio and D-dimer in COVID-19: A retrospective study in Suzhou China. Thromb Res. 2020.
10. Cheng K, Wei M, Shen H. Clinical characteristics of 463 patients with common and severe type coronavirus disease 2019. Shanghai Med J. 2020;1:1-15.
11. Gao Y, Li T, Han M, Li X, Wu D, Xu Y, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID‐19. J Med Virol. 2020;92(7):791-6.
12. Mei Z, Shi L, Wang B, Yang J, Xiao Z, Du P, et al. Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors: a systematic review and meta-analysis of 66 cohort studies. Cancer Treat Rev. 2017;58:1-13.
13. Kerboua KE. NLR: A Cost-effective Nomogram to Guide Therapeutic Interventions in COVID-19. Immunol Investig. 2020:1-9.
14. Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med. 2012;5(1):2.
15. Yang A-P, Liu J, Tao W, Li H-m. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020:106504.
16. Thomas J, Pociute A, Kevalas R, Malinauskas M, Jankauskaite L. Blood biomarkers differentiating viral versus bacterial pneumonia aetiology: a literature review. Ital J Pediatr. 2020;46(1):4-9.
17. Organization WH. Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus ( MERS-CoV) infection is suspected: interim guidance. World Health Organization; 2019.
18. World Health O. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance, 28 January 2020. Geneva: World Health Organization; 2020 2020. Contract No.: WHO/nCoV/Clinical/2020.3.
19. Ghazanfari T, Namaki S, Salehi M, Arabkheradmand J, Rostamian A, Rajabnia Chenary M, et al. Interpretation of hematological, biochemical and immunological findings of covid-19 disease: Biomarkers Associated with Severity and Mortality. Iran J Allergy Asthma Immunol (IJAAI). 2021;in press.
20. Rostamian A, Ghazanfari T, Arabkheradmand J, Edalatifard M, Ghaffarpour S, salehi mr, et al. Iran COVID-19 Immunological Study: Remarkable Level of Interleukin-6 in Iranian COVID-19 Hospitalized Patients. Lancet Respir. Med., 2020; 20(20).
21. Cao X. COVID-19: immunopathology and its implications for therapy. Nat Rev Immunol. 2020;20(5):269-70.
22. Vaninov N. In the eye of the COVID-19 cytokine storm. Nat Rev Immunol. 2020;20(5):277-9.
23. Kassir R. Risk of COVID‐19 for patients with obesity. Obes Rev. 2020;21(6):9-11.
24. Tiwari N, Nath D, Madan J, Singh S, Bajpai P, Madan U. The Neutrophil Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR) and routine hematological parameters of COVID-19 Patient: A perspective of the Indian scenario from a frontline pilot study of 32 COVID-19 cases in a Tertiary Care Institute of North India. medRxiv. 2020.
25. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HH, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020; 81(1):e6-e12.
26. Cheng B, Hu J, Zuo X, Chen J, Li X, Chen Y, et al. Predictors of progression from moderate to severe coronavirus disease 2019: a retrospective cohort. Clin Microbiol Infect. 2020;26(10):1400-5.
27. Lian J, Jin C, Hao S, Zhang X, Yang M, Jin X, et al. High neutrophil-to-lymphocyte ratio associated with progression to critical illness in older patients with COVID-19: a multicenter retrospective study. Aging. 2020;12(14):13849-59.
28. Li X, Liu C, Mao Z, Xiao M, Wang L, Qi S, et al. Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis. Crit Care. 2020;24(1):647-9.
29. Yan X, Li F, Wang X, Yan J, Zhu F, Tang S, et al. Neutrophil to lymphocyte ratio as prognostic and predictive factor in patients with coronavirus disease 2019: A retrospective cross‐sectional study. J Med Virol. 2020.
30. Gao F, Li X, Geng M, Ye X, Liu H, Liu Y, et al. Pretreatment neutrophil–lymphocyte ratio: an independent predictor of survival in patients with hepatocellular carcinoma. Medicine. 2015;94(11):7-14.
31. Nalbant A, Kaya T, Varim C, Yaylaci S, Tamer A, Cinemre H. Can the neutrophil/lymphocyte ratio (NLR) have a role in the diagnosis of coronavirus 2019 disease (COVID-19)? Rev Assoc Med Bras. 2020;66(6):746-51.
32. Taghavi-Farahabadi M, Mahmoudi M, Hashemi SM, Namaki S. Neutrophils to Lymphocytes Ratio and the Prognosisof the COVID-19 Patients. Immunoregulation. 2020;3(2):89-96.
33. Zhao Y, Yu C, Ni W, Shen H, Qiu M, Zhao Y. Peripheral blood inflammatory markers in predicting prognosis in patients with COVID‐19. Some differences with influenza A. J Clin Lab. Anal. 2020:e23657.
34. Sayah W, Berkane I, Guermache I, Sabri M, Lakhal FZ, Yasmine Rahali S, et al. Interleukin-6, procalcitonin and neutrophil-to-lymphocyte ratio: Potential immune-inflammatory parameters to identify severe and fatal forms of COVID-19. Cytokine. 2021;141(11):155428.
35. Zeng F, Huang Y, Guo Y, Yin M, Chen X, Xiao L, et al. Association of inflammatory markers with the severity of COVID-19: a meta-analysis. Int J Infect Dis. 2020;96:464-74.
36. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020;71(15):761-8.
37. Liu X, Shen Y, Wang H, Ge Q, Fei A, Pan S. Prognostic significance of neutrophil-to-lymphocyte ratio in patients with sepsis: a prospective observational study. Mediat Inflamm. 2016;2016:8191254.
38. Naymagon L, Zubizarreta N, Feld J, van Gerwen M, Alsen M, Thibaud S, et al. Admission D-dimer levels, D-dimer trends, and outcomes in COVID-19. Thromb Res. 2020;196(18):99-105.
39. Shang W, Dong J, Ren Y, Tian M, Li W, Hu J, et al. The value of clinical parameters in predicting the severity of COVID‐19. J Med Virol. 2020;92(10):2188-92.
40. Zahorec R, Hulin I, Zahorec P. Rationale Use of Neutrophil-to-lymphocyte ratio for early diagnosis and stratification of COVID-19. Bratisl Lek Listy. 2020;121(7):466-70.
41. Tan C, Huang Y, Shi F, Tan K, Ma Q, Chen Y, et al. C‐reactive protein correlates with computed tomographic findings and predicts severe COVID‐19 early. J Med Virol. 2020; 92(7):856-62.
42. Lagadinou M, Solomou EE, Zareifopoulos N, Marangos M, Gogos C, Velissaris D. Prognosis of COVID-19: Changes in laboratory parameters. Age (yrs). 2020;62(13.4):47-16.2.
43. Phua J, Weng L, Ling L, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations, Lancet Respir Med. 2020;8(5):506-517.
44. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42.
45. Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al. Neutrophil-to-lymphocyte ratio predicts severe illness patients with 2019 novel coronavirus in the early stage. J Transl Med. 2020 May 20;18(1):206.
46. Sakurai K, Chubachi S, Irie H, Tsutsumi A, Kameyama N, Kamatani T, et al. Clinical utility of blood neutrophil-lymphocyte ratio in Japanese COPD patients. BMC Pulm Med. 2018;18(1):65-9.
47. Aaron SD, Angel JB, Lunau M, Wright K, Fex C, LE SAUX N, et al. Granulocyte inflammatory markers and airway infection during acute exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2001;163(2):349-55.
48. Torun S, Tunc BD, Suvak B, Yildiz H, Tas A, Sayilir A, et al. Assessment of neutrophil-lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity. Clin Res Hepatol Gastroenterol. 2012;36(5):491-7.
49. Azab B, Jaglall N, Atallah JP, Lamet A, Raja-Surya V, Farah B, et al. Neutrophil-lymphocyte ratio as a predictor of adverse outcomes of acute pancreatitis. Pancreatology. 2011;11(4):445-52.
50. Paliogiannis P, Fois AG, Sotgia S, Mangoni AA, Zinellu E, Pirina P, et al. The neutrophil‐to‐lymphocyte ratio as a marker of chronic obstructive pulmonary disease and its exacerbations: A systematic review and meta‐analysis. Eur J Clin Invest. 2018;48(8):e12984.
51. Teng F, Ye H, Xue T. Predictive value of neutrophil to lymphocyte ratio in patients with acute exacerbation of chronic obstructive pulmonary disease. PloS one. 2018;13(9):12-8.
52. Wang Y, Ju M, Chen C, Yang D, Hou D, Tang X, et al. Neutrophil-to-lymphocyte ratio as a prognostic marker in acute respiratory distress syndrome patients: a retrospective study. J Thorac Dis. 2018;10(1):273-5.
53. Ye Z, Ai X, Liao Z, You C, Cheng Y. The prognostic values of neutrophil to lymphocyte ratio for outcomes in chronic obstructive pulmonary disease. Medicine. 2019;98(28):12-6.
| Files | ||
| Issue | Vol 21 No 3 (2022) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijaai.v21i3.9798 | |
| Keywords | ||
| COVID-19 Inflammation Prognosis SARS-CoV-2 | ||
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How to Cite
1.
Ardestani S, Salehi MR, Attaran B, Hashemi SM, Sadeghi S, Ghaffarpour S, Tuserkani F, Ghazanfari T. Neutrophil to Lymphocyte Ratio (NLR) and Derived NLR Combination: A Cost-effective Predictor of Moderate to Severe COVID-19 Progression. Iran J Allergy Asthma Immunol. 2022;21(3):241-253.
