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Vol 15, Issue 6, 2022
Online - 2455-3891
Print - 0974-2441
THE RELATIONS BETWEEN NEUTROPHIL-LYMPHOCYTIC RATIO AND DIFFERENT
COMORBIDITIES IN CORONAVIRUS-INFECTED PATIENTS
NIKHIL AGRAWAL1*, AKASH BHARTI2, SHAAVI MITTAL2
1Department of General Medicine, University College of Medical Sciences and Guru Teg Bahadur Hospital, Delhi, India. 2Department of
General Medicine, School of Medical Science and Research, Greater Noida, Uttar Pradesh, India. Email: Nikhil.agrawal2107@icloud.com
Received: 02 March 2022, Revised and Accepted: 05 April 2022
ABSTARCT
Methods: A total of 51 patients with COVID-19 infection with laboratory-confirmed reports were enrolled in this study: Age, neutrophil-to-lymphocyte
(LYMLYM) ratio (NLR), an examination, and comparison. Data analysis, compilation, and report writing were completed based on the acquired data.
Using SPSS.ver-23, standard statistical procedures were used to analyze the mean and standard deviation, as well as the Pearson correlation. If p<0.05,
it is deemed significant.
Results: The mean hemoglobin level was 12.44±3.55%, the mean platelet count was 1.95±0.65 cumm, the mean white blood cell count was 17400
±6455.22 cumm, and the mean NLR was 5.72±1.24. When we looked at people who had hypertension, diabetes mellitus, and high cholesterol, we
found that the NLR value was significantly higher in people with these diseases (p=0.05).
Conclusion: We found that NLR is an excellent way to predict COVID-19-infected patients who are likely to get a lot of other illnesses and have a lot
of problems early on.
Keywords: Covid-19, Neutrophil-to-lymphocyte ratio, Diabetes mellitus, Hypertension, Hyperlipidemia.
INTRODUCTION
Coronaviruses are a type of virus that can be found all over the world.
Members of this family have been linked to common colds as well
as serious disorders such as the Middle-East respiratory syndrome
and severe acute respiratory syndrome. In December 2019, the 2019
coronavirus disease (COVID-19) was determined to be the cause of
unexplained viral pneumonia in Wuhan, China, and the World Health
Organization acknowledged this virus on January 12, 2020. COVID-19
was claimed to have spread throughout Hubei Province, China, and
even to other countries the following month [2].
The majority of people infected with the novel coronavirus had mild-
to-moderate sickness, with severe illness frequently leading to dyspnea
after 1 week. Acute disease patients rapidly progressed to acute
respiratory failure, acute respiratory distress syndrome, metabolic
acidosis, coagulopathy, and septic shock. The early identification of
critical disease risk factors facilitated proper supportive care and quick
access to the intensive care unit (ICU) when necessary. Patients with
mild-to-moderate illness require general seclusion and ICU care. Unless
the condition advances, no treatment is required. As a result, an early
prognostic prediction may aid in reducing mortality and alleviating
medical resource shortages. Huang et al. [3] found that lymphopenia was
common in COVID-19 patients. Furthermore, the baseline neutrophil-to-
lymphocyte ratio (NLR) has been demonstrated to be an accurate short-
term predictor of people’s health. We performed correlation analysis
to see how different variables linked with one another, such as NLR,
epidemiological history, comorbidity, and other laboratory tests.
METHODS
It was a study that was carried out in the future – a study conducted at
MGM Medical College and Hospital’s Department of General Medicine.
A total of 51 patients with laboratory-confirmed COVID-19 infection
were enrolled in the study. Age, NLR, inspection, and comparison the
study were conducted and followed up for 6 months (January 2020–
June 2021) at the in-patient department of general medicine. Data
analysis, compilation, and report writing were accomplished using the
acquired data. Using SPSS.ver-23, standard statistical procedures were
employed to calculate the mean and standard deviation, as well as the
correlation. It is considered significant if p<0.05.
A general survey, systemic evaluation, and other pertinent systemic
inquiries were all part of the clinical examinations. A laboratory
investigation, primarily a complete blood count, is performed.
Variables to consider
Men and women were different in terms of their ages, gender,
education, occupation, religion, and place of residence. Other risk
factors (hypertension [HTN], hyperlipidemia, and type 2 diabetes) and
hematological abnormalities are also present.
Statistical analysis
On the basis of the acquired data, data analysis, compilation, and report
writing were completed. Standard statistical methods were used to
analyze the mean and SDSD, as well as the Pearson correlation, using
SPSS.ver-23. If p<0.05, it is deemed significant.
RESULTS
Age distribution among the study population
Age in Year Number of Cases Percentage
40–50 6 11.8
51–60 19 37.3
61–70 17 33.3
71–80 09 17.6
Total 51 100
Mean and SD value 57.39±6.28
© 2022 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons.org/
licenses/by/4.0/) DOI: http://dx.doi.org/10.22159/ajpcr.2022v15i6.44779. Journal homepage: https://innovareacademics.in/journals/index.php/ajpcr
Research Article
Objective: The study’s aim was to determine the neutrophil-to-lymphocyte ratio (NLR) is most helpful predictor factor for COVID-19-related serious
illness.
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Agrawal et al.
The majority of the patients were in the age group of 51–60 years
(37.3%), followed by 61–70 years (33.3%), and 71–80 years (17.6%).
The least common age group was 40–50 years, involving only 11.8% of
patients. The mean age of study subjects was 57.39±6.28 years.
Sex distribution among the study population
Sex Number of Cases Percentage
Male 38 74.5
Female 13 25.5
Total 51 100
M: F 2.92:1
Male cases were predominantly higher than females. About 74.5% of
cases were male, while 25.5% were female. The male-to-female ratio
was 2.92:1.
Sociodemographical profile among the study population
??? Number of Cases Percentage
Educational Status
Primary 2 3.9
Upper primary 3 5.9
Madhyamik 20 39.2
Higher secondary 8 15.7
Graduate 10 19.6
Higher education 8 15.7
Occupational Status
Worker 4 7.9
Farmer 1 2.0
Businessmen 9 17.6
Service 25 49.0
Housewife 12 23.5
Religion
Hindu 44 86.3
Muslim 7 13.7
Residence
Rural 09 17.6
Urban 42 82.4
The patients studied have sociodemographic statuses, such as
educational status, occupational status, religion, and residential
status. Regarding the academic level, the majority of the patients
were educated with Madhyamik education (39.2%), followed by
primary (3.9%), graduation (19.6%), and higher education (15.7%).
In terms of occupational status, the majority of the patients were
servicemen (17.6%), housewives (23.5%), workers (7.9%), and
farmers (7.3%). About 2.0% were business people, and 17.66% were
farmers. 86.3% were Hindus among all the participants, and 13.7%
were Muslims. About 82.4% lived in urban areas, while 17.6% were
from rural areas.
Risk factors among the study population
Comorbidities Number of cases Percentage
Hypertension
Present 28 54.9
Absent 23 45.1
Diabetes mellitus
Present 39 76.5
Absent 12 23.5
Hyperlipidemia
Present 18 35.3
Absent 33 64.7
In this study, 54.9% of the people who took part in it had high
blood pressure, diabetes, or hyperlipidemia. About 45.1 (76.5%)
of the people who took part in this study also had diabetes or
hyperlipidemia.
Hematological parameters include the
neutrophil‑to‑Lymphocyte ratio levels in study participants
Hematological parameters Mean±SD
Hemoglobin (%) 12.44±3.55
Platelet Count (cumm) 1.95±0.65
WBC (Cumm) 17400±6455.22
Neutrophil and lymphocyte ratio 5.72±1.24
WBC: White blood cell
The mean hemoglobin level was 12.44%, the mean platelet count
was 1.95±0.65 cumm, the mean white blood cell (WBC) count was
17400±6455.22 cumm, and the mean NLR was 5.72±1.24.
Comparisons of neutrophil‑lymphocyte ratio among patients
with presence or absence of different risk factors
Comorbidities Number of cases NLR Mean SD p‑value
Hypertension
Present 28 5.213±0.68 0.0001
Absent 23 3.112±0.41
Diabetes mellitus
Present 39 5.426±0.77 0.003
Absent 12 3.254±0.59
Hyperlipidemia
Present 18 5.821±0.62 0.001
Absent 33 3.321±0.44
NLR: Neutrophil-lymphocyte ratio
People who have HTN, diabetes, and high cholesterol have a significantly
higher NLR value (p=0.05) when compared to people who don’t have
these diseases.
Correlation between Neutrophil‑Lymphocyte ratio versus
different risk factors
Correlations NLR Hyperlipidemia Hypertension Diabetes
Mellitus
NLR
Pearson
Correlation
1−0.729** −0.745** −0.722**
p-value 0.0001 0.0001 0.0001
No of
sample
51 51 51 51
**p=0.01, correlation is significant (HS), NLR: Neutrophil‑lymphocyte ratio
The Pearson correlation was established between HTN, diabetes
mellitus, and hyperlipidemia with a NLR. It shows that all the
parameters are negatively correlated with the NLR (p=0.001).
Final Outcome
Outcome Number
of Cases
Percentage
No death within 7 days 07 13.7
Recovery 35 68.6
No, follow-up (Due to communication gap) 09 17.7
The final outcome of the present study shows that 68.6% (35) patients
were recovered, while the mortality rate was 13.7% (7), and nine
(17.7%) were unavailable for follow-up due to communication gaps.
DISCUSSION
Since the COVID-19 pneumonia outbreak in December 2019, there have
been 2,000–4,000 new confirmed cases of infection every day in India,
with the number of severe cases and deaths growing daily. According to
a recent study, 26% of patients needed ICUICU. Care died, with a death
rate of 4.3%. The number of patients in Wuhan and other areas is rapidly
increasing[4,5]. The current issue is the scarcity of medical resources,
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Agrawal et al.
particularly critical care resources. The early detection of severe illness
and risk stratification management will aid in the alleviation of a few
medical help and may reduce mortality. Recent research has linked low
lymphocyte-to-C-reactive protein ratios [6], platelet-to-lymphocyte
ratios [7], and thrombocytopenia [8] to severe disease. Furthermore,
smoking and chronic obstructive pulmonary disease (COPD) have been
linked to COVID-19 [9]. Due to the small number of respondents, this
may not have had an impact on the current study’s findings (a total of
ten smoking and six COPD patients).
The COVID-19 pneumonia is not severe in the early stages, but
critical individuals deteriorate after 7–14 days and develop a state
of severe pneumonia and acute respiratory failure. The patients who
died as a result of COVID-19 infection were generally elderly and had
comorbidities [10]. The critically ill individuals in the trial were all
over the age of 50. The disease’s progression was linked to a drop in
lymphocyte count. It is unknown why lymphopenia is linked to severe
illness. COVID-19 has been postulated to act on T lymphocytes, and
T lymphocyte destruction is a major factor in the patient’s condition
deteriorating [11]. In addition, people who are very sick usually have
a lot of leukocytes, because damaged cells cause a lot of inflammation
in the lungs, which is mostly caused by pro-inflammatory macrophages
and granulocytes [12]. The NLR was a common way to figure out how
bad bacterial infections were and how well patients with pneumonia
and other illnesses were going to do [11].
This study looked at the data of 51 people who had COVID-19
pneumonia, and it looked at their baseline characteristics, as well as
how their laboratory and imaging features changed over time as they
got sick. The independent risk factors influencing the occurrence of
critical illness were investigated. According to the findings, NLR was
the most important predictive factor for progression. The average
hemoglobin level was 12.44±3.55%, the average platelet count
was 1.95±0.65 cumm, the average WBC count was 17400±6455.22
cumm, and the average NLR was 5.72±1.24. The Pearson association
between HTN, diabetes, hyperlipidemia, and NLR was established.
It demonstrates that all metrics are inversely linked with the
NLR (p=0.001). It was discovered that 68.6% (35) of the patients
were recovered, while the mortality rate was 13.7% (7), and nine
(17.7%) were unable to be followed up on due to a communication
breakdown.
The previous research has shown that the MuLBSTA score, which
includes six signs, can provide an early warning about the mortality of
viral pneumonia [13]. This score includes age, smoking history, HTN,
bacterial coinfection, lymphopenia, and multilobular infiltration. The
CURB-65 score was frequently utilized to assess 30-day mortality
in community-acquired pneumonia patients [14]. Furthermore, the
prediction effects of the NLR-CURB-65 models were found to be
superior to those of the original models. However, NLR was a simple
predictive index.
CONCLUSION
Our results suggest that the NLR value may be a paraclinical marker and
that NLR is a predictive factor for the early-stage prediction of COVID-
19-infected patients who are likely to acquire various comorbidities
and severe illnesses.
AUTHORS’ CONTRIBUTIONS
Contribute equally.
CONFLICTS OF INTEREST
At own interest.
AUTHORS’ FUNDING
None.
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