The Neutrophil to Lymphocyte Ratio and In-Hospital All-Cause Mortality in Patients with COVID-19

Objective: In December 2019, pneumonia associated with severe acute respiratory syndrome coronavirus 2 emerged in China, and has been spread worldwide eventuating the coronavirus disease 2019 (COVID-19) pandemic. As of June 27, 2020, 195,883 people have been diagnosed with COVID-19 in Turkey, among them 5082 are dead. Moreover, 9,999,606 people were infected worldwide. The neutrophil-to-lymphocyte ratio (NLR) has been reported as an inflammatory biomarker. This study aimed to evaluate the relationship between NLR on admission and in-hospital all-cause mortality in adult patients with COVID-19.

Methods: This retrospective cohort study included a total of 455 COVID-19 patients from Turkey. The diagnosis of COVID-19 was made according to the World Health Organization’s interim guidance and confirmed by RNA detection of SARS-CoV-2. The NLR was calculated for each patient.

Results: The NLR on admission was found to be significantly higher in nonsurvivor COVID-19 patients than survivors (12.3 [0.8–137.3] vs. 3.2 [0.6–79.0], p<0.001). Forward stepwise logistic regression analysis was carried out to determine the independent predictors of in-hospital all-cause mortality of patients with COVID-19. The analysis demonstrated that age [odds ratio (OR)=1.203, 95% confidence interval (CI): 1.027–1.408, p=0.022], NLR (OR=1.261, 95% CI: 1.054–1.509, p=0.011), lactate dehydrogenase level (OR=1.013, 95% CI: 1.004–1.022, p=0.005), glomerular filtration rate (OR=0.920, 95% CI: 0.853–0.992, p=0.030), alanine transaminase level (OR=1.107, 95% CI: 1.011–1.212, p=0.028), and aspartate transaminase level on admission (OR=0.939, 95% CI: 0.888–0.993, p=0.027) were independent predictors of in-hospital all-cause mortality of patients with COVID-19. In the receiver operating characteristic curve analysis, the sensitivity and specificity of the NLR for predicting in-hospital all-cause mortality were found to be 92% and 53%, respectively, at the cut-off value of 3.

Conclusion: The NLR on admission predicts in-hospital all-cause mortality of patients with COVID-19.

How to cite: Allahverdiyev S, Quisi A, Harbalıoğlu H, Alıcı G, Genç Ö, Yıldırım A, et al. The Neutrophil to Lymphocyte Ratio and in Hospital All-Cause Mortality in Patients with COVID-19. Eur J Ther 2020; 26(3): 251-6.