Brief Communication

Prognostic Value of Admission Neutrophil Count in Asthma Patients with COVID-19: A Comparative Analysis with other Systemic Inflammation Indices for In-Hospital Mortality Prediction

Neutrophil count predicting COVID-19 severity


Despite studies indicating that asthma patients do not exhibit a higher mortality rate or severity compared to the general population when infected with COVID-19, there have been few reports on predictive factors for mortality in this context. This study aimed to assess the predictive value of systemic inflammation indices including neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte (PLR), systemic inflammation response index (SIR-I), and systemic inflammation index (SII) in determining mortality rate among patients with COVID-19 and asthma.
In this prospective study, the laboratory parameters of 1792 COVID-19 patients were examined, with a subgroup consisting of 112 patients with asthma and 1680 patients without asthma. Receiver operating characteristic (ROC) analysis was employed to assess the potential of inflammatory indices in indicating COVID-19 severity, while Kaplan-Meier curves were utilized to analyze the survival probability with death as the outcome.
In deceased non-asthma patients, the levels of leukocyte and differential cell counts, and the values of PLR, NLR, MLR, SII, and SIR-I were higher than in survivors. In contrast, all the above values except PLR and MLR were significant in the asthma groups. The Kaplan–Meier survival curves were consistent with the ROC analysis. However, a multivariate Cox regression analysis revealed that neutrophil counts in non-asthma subjects and leukocyte and neutrophil counts in asthma patients remained significant for survival.
In conclusion, while numerous inflammatory indices were associated with mortality in COVID-19 patients without asthma, neutrophil counts could independently predict mortality risk in asthma COVID-19 patients.

1. Jain R, Gopal A, Pathak BK, et al. Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio and Their Role as Predictors of Disease Severity of Coronavirus Disease 2019 (COVID-19). J Lab Physicians. 2021;13(1):58-63.
2. Mohammadshahi J, Ghobadi H, Matinfar G, et al. Role of Lipid Profile and Its Relative Ratios (Cholesterol/HDL-C, Triglyceride/HDL-C, LDL-C/HDL-C, WBC/HDL-C, and FBG/HDL-C) on Admission Predicts In-Hospital Mortality COVID-19. J Lipids. 2023;2023:6329873.
3. Shahla F, Faranak S, Shahram H, et al. Laboratory and clinical findings in hospitalized pregnant women with Covid-19 based on disease outcome during the outbreak of Delta variant in Ardabil (summer and autumn 2021). Iranina J Obstetrics Gynecol Infertility. 2022;25(9):29-39.
4. García-Menaya JM, Cordobés-Durán C, Rangel-Mayoral JF, et al. Outcomes and Laboratory and Clinical Findings of Asthma and Allergic Patients Admitted With Covid-19 in a Spanish University Hospital. Front pharmacol. 2020;11:570721.
5. Terpos E, Ntanasis-Stathopoulos I, Elalamy I, et al. Hematological findings and complications of COVID-19. Am J Hematol. 2020;95(7):834-7.
6. Henry BM, de Oliveira MHS, Benoit S, et al. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020; 58(7):1021-8.
7. Chan AS, Rout A. Use of Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in COVID-19. J Clin Med Res. 2020;12(7):448-53.
8. Yang AP, Liu JP, Tao WQ, et al. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020; 84:106504.
9. Shang W, Dong J, Ren Y, et al. The value of clinical parameters in predicting the severity of COVID-19. J Med Virol. 2020;92(10):2188-92.
10. Hosseninia S, Ghobadi H, Garjani K, et al. Aggregate index of systemic inflammation (AISI) in admission as a reliable predictor of mortality in COPD patients with COVID-19. BMC Pulmonary Med. 2023;23(1):107.
11. Ghobadi H, Mohammadshahi J, Javaheri N, et al. Role of leukocytes and systemic inflammation indexes (NLR, PLR, MLP, dNLR, NLPR, AISI, SIR-I, and SII) on admission predicts in-hospital mortality in non-elderly and elderly COVID-19 patients. Front Med (Lausanne). 2022;9:916453.
12. Kim SH, Ji E, Won SH, et al. Association of asthma comorbidity with poor prognosis of coronavirus disease 2019. World Allergy Organ J. 2021; 14(8):100576.
13. Gao YD, Agache I, Akdis M, et al. The effect of allergy and asthma as a comorbidity on the susceptibility and outcomes of COVID-19. Int Immunol. 2022;34(4):177-88.
14. Lemus Calderon JA, Beneyto Martin P, Guzmán Rodriguez R, et al. Differentiating characteristics of patients with asthma in the severe acute respiratory syndrome coronavirus 2 infection. Ann Allergy Asthma Immunol. 2021;126(1):92-3.
15. Lee SC, Son KJ, Han CH, et al. Impact of comorbid asthma on severity of coronavirus disease (COVID-19). Sci Rep. 2020;10(1):21805.
16. Paliogiannis P, Zinellu A, Scano V, et al. Laboratory test alterations in patients with COVID-19 and non COVID-19 interstitial pneumonia: a preliminary report. J Infect Dev Ctries. 2020;14(7):685-90.
17. Tjendra Y, Al Mana AF, Espejo AP, et al. Predicting Disease Severity and Outcome in COVID-19 Patients: A Review of Multiple Biomarkers. Arch Pathol Lab Med. 2020;144(12):1465-74.
18. Waris A, Din M, Khalid A, et al. Evaluation of hematological parameters as an indicator of disease severity in Covid-19 patients: Pakistan’s experience. J Clin Lab Anal. 2021;35(6):e23809.
19. Gerotziafas GT, Sergentanis TN, Voiriot G, et al. Derivation and Validation of a Predictive Score for Disease Worsening in Patients with COVID-19. Thromb Haemost. 2020;120(12):1680-90.
20. Fois AG, Paliogiannis P, Scano V, Cau s, Babudieri S, Perra R, et al. The Systemic Inflammation Index on Admission Predicts In-Hospital Mortality in COVID-19 Patients. Molecules. 2020; 25(23):5725.
21. Veras FP, Pontelli MC, Silva CM, Toller-Kawahisa GE, de Lima M, Carvalho Nascimento D, et al. SARS-CoV-2-triggered neutrophil extracellular traps mediate COVID-19 pathology. J Exp Med. 2020; 217(12): e20201129.
22. Tomar B, Anders HJ, Desai J, Mulay SR. Neutrophils and Neutrophil Extracellular Traps Drive Necroinflammation in COVID-19. Cells.2020; 9(6):1383.
23. Urbanowicz T, Michalak M, Olasińska-Wiśniewska A, Rodzki M, Witkowska A, Gąsecka A, et al. Neutrophil counts, neutrophil-to-lymphocyte ratio, and Systemic Inflammatory Response Index (SIRI) predict mortality after off-pump coronary artery bypass surgery. Cells. 2022;11(7):1124.
24. Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy. 2021;122(7):474-88.
25. Urbanowicz T, Michalak M, Gąsecka A, et al. Postoperative Neutrophil to Lymphocyte Ratio as an Overall Mortality Midterm Prognostic Factor following OPCAB Procedures. Clin Practice. 2021;11(3):587-597.
26. Aly MM, Meshref TS, Abdelhameid MA, et al. Can hematological ratios predict outcome of COVID-19 patients? A multicentric study. J Blood Med. 2021:505-15.
27. Eissa M, Shaarawy S, Abdellateif MS. The role of different inflammatory indices in the diagnosis of COVID-19. Inte J General Med. 2021:7843-7853.
28. Ertekin B, Yortanlı M, Özelbaykal O, et al. The Relationship between Routine Blood Parameters and the Prognosis of COVID-19 Patients in the Emergency Department. Emergency Med Int. 2021;2021.
29. Citu C, Gorun F, Motoc A, et al. The predictive role of NLR, d-NLR, MLR, and SIRI in COVID-19 mortality. Diagnostics. 2022;12(1):122.
30. Simadibrata DM, Pandhita BAW, Ananta ME, et al. Platelet-to-lymphocyte ratio, a novel biomarker to predict the severity of COVID-19 patients: A systematic review and meta-analysis. Journal of the intensive Care Society. 2022;23(1):20-6.
31. Zhang Y, Xing Z, Zhou K, et al. The predictive role of systemic inflammation response index (SIRI) in the prognosis of stroke patients. Clinical interventions in aging. 2021:1997-2007.
32. Kim J-W, Jung J-Y, Suh C-H, et al. Systemic immune-inflammation index combined with ferritin can serve as a reliable assessment score for adult-onset Still’s disease. Clin Rheumatol. 2021;40:661-8.
IssueVol 22 No 4 (2023) QRcode
SectionBrief Communication
Asthma Coronavirus COVID-19 Neutrophils

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Ghobadi H, Mohammadshahi J, Tarighi A, Hosseini SAH, Garjani K, Aslani MR. Prognostic Value of Admission Neutrophil Count in Asthma Patients with COVID-19: A Comparative Analysis with other Systemic Inflammation Indices for In-Hospital Mortality Prediction. Iran J Allergy Asthma Immunol. 2023;22(4):390-397.