Published April 5, 2025 | Version v1
Journal article Open

Neutrophil/lymphocyte ratio and C-reactive protein in patients with COVID-19: correlations in deceased and surviving patients

Authors/Creators

  • 1. Universidad Regional Amazónica Ikiam Tena. Napo-Ecuador.
  • 2. Universidad Simón Bolívar, Facultad de Ciencias de la Salud, Barranquilla, Colombia
  • 3. Universidad de la Costa, Departamento de Productividad e Innovación, Barranquilla, Atlántico, Colombia
  • 4. Universidad Simón Bolívar, Facultad de Ciencias de la Salud, Centro de Investigaciones en Ciencias de la Vida, Barranquilla, Colombia
  • 5. Universidad del Zulia. Escuela de Bioanálisis, Facultad de Medicina, Departamento de Salud Pública y Social. Maracaibo, Venezuela

Description

Summary:

Introduction: COVID-19 is caused by SARS-CoV-2 associated with the activation of the inflammatory process. Various studies have determined the importance of the neutrophil/lymphocyte ratio (NLR) in different inflammatory processes. C-reactive protein (CRP) is involved in several infectious processes as a marker of inflammation. Objective: To determine the values of NLR and CRP in COVID-19 patients and controls and to determine these values in COVID-19 survivors and deceased patients. Method: This retrospective study was conducted in patients with suspected COVID-19 from various clinical institutions in Portoviejo, Manabí, Ecuador, from March to June 2021. A total of 41 SARS-CoV-2-positive COVID-19 patients were included and evaluated. Patients were classified into two groups according to their results (survivors: 22 and deceased: 19). Result: Overall, lymphocyte counts, NLR, and CRP values increased significantly during COVID-19. It was observed that during the disease, there were more positive correlations between the different inflammatory parameters studied than between the controls. The results show that surviving patients had increased lymphocyte counts and CRP content compared to deceased patients; however, the latter presented the highest NLR values and the lowest lymphocyte values, establishing a prognostic value of severe evolution. The number of significant correlations observed in surviving and deceased patients was similar. Conclusion: This study suggests the importance of leukocytes and CRP in COVID-19 and a possible predictive value for the severe evolution of NLR in the disease.

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References

  • 1. Mohamadian M, Chiti H, Shoghli A, Biglari S, Parsamanesh N, Esmaeilzadeh A. COVID-19: Virology, biology and novel laboratory diagnosis. J Gene Med. 2021;23(2): e3303
  • 2. Mosquera-Sulbaran JA, Pedreañez A, Carrero Y, Callejas D. C-reactive protein as an effector molecule in Covid-19 pathogenesis. Rev Med Virol. 2021;31(6): e2221.
  • 3. Bourgonje AR, Abdulle AE, Timens W, Hillebrands JL, Navis GJ, Gordijn SJ, et al. Angiotensin converting enzyme 2 (ACE2), SARS-CoV-2 and the pathophysiology of coronavirus disease 2019 (COVID-19). Vol. 251, Journal of Pathology. 2020. p. 228–48.
  • 4. Cheng H, Wang Y, Wang GQ. Organ-protective effect of angiotensin-converting enzyme 2 and its effect on the prognosis of COVID-19. Vol. 92, Journal of Medical Virology. 2020. p. 726–30.
  • 5. Kai H, Kai M. Interactions of coronaviruses with ACE2, angiotensin II, and RAS inhibitors-lessons from available evidence and insights into COVID-19. Hypertens Res. 2020;43(7):648–54.
  • 6. Bannaga AS, Tabuso M, Farrugia A, Subashini Chandrapalan S, Karenjit Somal K, Voon Kune Lim VK, Shahd Mohamed S, et al. C‐reactive protein and albumin association with mortality of hospitalised SARS‐CoV‐2 patients: a tertiary hospital experience. Clin Med. 2020;20: 463‐467.
  • 7. Cillóniz C, Torres A, Garcia‐Vidal C, Estela Moreno-Garcia E, Rosanel Amaro R, Nestor Soler N, et al. The value of C‐reactiv protein‐to‐lymphocyte ratio in predicting the severity of SARSCoV‐2 pneumonia. Arch Bronconeumol. 2020; S0300‐ 2896:30277‐30285.
  • 8. Torzewski J, Heigl F, Zimmermann O. First‐in‐Man: case report of selective C‐ reactive protein apheresis in a patient with SARS‐CoV‐2 infection. Am J Case Rep. 2020;21: e925020
  • 9. Baumeister D, Akhtar R, Ciufolini S, Pariante CM, Mondelli V. Childhood trauma and adulthood inflammation: a meta‐analysis of peripheral C‐reactive protein, inetleukin‐ 6 and tumour necrosis factor‐α. Mol Psychiatry. 2016; 21:642‐649.
  • 10. Mosquera-Sulbaran J, Pedreañez A, Carrero Y, Callejas D. C-reactive protein as an effector molecule in the COVID-19 pathogenesis. Reviews in Medical Virology. 2021; 1-8, e2221. Disponible en: https://doi.org/10.1002/rmv.2221.
  • 11. RodOviedo‐ Trespalacios JEO, Cortes‐Ramirez J. A brief‐review of the risk factors for covid‐19 severity. Rev Saude Publica. 2020; 54:60.
  • 12. Luo X, Zhou W, Yan X, Tangxi Guo T, Benchao Wang B, Hongxia Xia H, et al. Prognostic value of C‐reactive protein in patients with COVID‐19. Clin Infect Dis. 2020: ciaa641. https://doi.org/10.1093/cid/ciaa641.
  • 13. Wang L. C‐reactive protein levels in the early stage of COVID‐19. Med Mal Infect. 2020; 50:332‐334.
  • 14. Shiny A, Bibin YS, Shanthirani CS, Regin BS, Anjana RM, Balasubramanyam M, et al. Association of neutrophil-lymphocyte ratio with glucose intolerance: an indicator of systemic inflammation in patients with type 2 diabetes. Diabetes Technol Ther. 2014;16(8):524–30.
  • 15. Balta S, Celik T, Mikhailidis DP, Ozturk C, Demirkol S, Aparci M, Iyisoy A. The Relation Between Atherosclerosis and the Neutrophil-Lymphocyte Ratio. Clin Appl Thromb Hemost. 2016; 22:405-411.
  • 16. Lagunas-Rangel FA. Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID-19): A meta- analysis. J Med Virol 2020; 10.1002/jmv.25819. doi:10.1002/ jmv.25819
  • 17. Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. J Transl Med. 2020;18: 206
  • 18. Chen X, Zhang SX, Jahanshahi AA, Alvarez-Risco A, Dai H, Li J, Ibarra VG. Belief in a COVID-19 Conspiracy Theory as a Predictor of Mental Health and Well-Being of Health Care Workers in Ecuador: Cross-Sectional Survey Study. JMIR Public Health Surveill. 2020;6(3): e20737. https://doi: 10.2196/20737
  • 19. Cañizares Fuentes R, Aroca R, Blasco Carlos M. Evaluation of COVID- 19 Surveillance Strategy in Ecuador. Disaster Med Public Health Prep. 2020; 9:1-4. https://doi: 10.1017/dmp.2020.326.
  • 20. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: im-plications for virus origins and receptor binding. Lancet (London, England). 2020;395(10224):565–74.
  • 21. Zhang J-J, Dong X, Cao Y-Y, Yuan Y-D, Yang Y-B, Yan Y-Q, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;75(7):1730–41.
  • 22. Zhu J, Ji P, Pang J, Zhong Z, Li H, He C, et al. Clinical characteristics of 3062 COVID-19 patients: A meta-analysis. J Med Virol. 2020;92(10):1902–14.
  • 23. Pedreáñez A, Mosquera-Sulbarán J, Robalino J, Tene D, Muñóz N. Elevación del índice neutrófilo/linfocito y su relación con la proteína C reactiva en pacientes con diabetes mellitus tipo 2. Rev la Soc Argentina Diabetes. 2021;55(3):77–83.
  • 24. Mousavi-Nasab SD, Mardani R, Nasr Azadani H, Zali F, Ahmadi Vasmehjani A, Sabeti S, et al. Neutrophil to lymphocyte ratio and C-reactive protein level as prognostic markers in mild versus severe COVID-19 patients. Gastroenterol Hepatol from bed to bench. 2020;13(4):361–6.
  • 25. Yufei Y, Mingli L, Xuejiao L, Xuemei D, Yiming J, Qin Q, et al. Utility of the neutrophil-to-lymphocyte ratio and C-reactive protein level for coronavirus disease 2019 (COVID-19). Scand J Clin Lab Invest. 2020;80(7):536–40.
  • 26. Liu Y, Liao W, Wan L, Xiang T, Zhang W. Correlation between relative nasopharyngeal virus RNA load and lymphocyte count disease severity in patients with COVID-19. Viral Immunol. 2021;34(5):330–5.
  • 27. Fathi N, Rezaei N. Lymphopenia in COVID-19: Therapeutic opportunities. Cell Biol Int. 2020;44(9):1792–7.
  • 28. Liu F, Li L, Xu M, Wu J, Luo D, Zhu Y, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol Off Publ Pan Am Soc Clin Virol. 2020; 127:104370.
  • 29. Han H, Ma Q, Li C, Liu R, Zhao L, Wang W, et al. Profiling serum cytokines in COVID-19 patients reveals IL-6 and IL-10 are disease severity predictors. Emerg Microbes Infect. 2020;9(1):1123–30.
  • 30. Gómez-de-Segura GD, González MO, Pedraza MA. Asociación de marcadores inflamatorios en COVID-19 severo al ingreso con mortalidad y disfunción orgánica. Med Crit. 2023;37(4):276-290. https://dx.doi.org/10.35366/11216
  • 31. Yamada T, Wakabayashi M, Yamaji T, Chopra N, Mikami T, Miyashita H, et al. Value of leukocytosis and elevated C-reactive protein in predicting severe coronavirus 2019 (COVID-19): A systematic review and meta-analysis. Clin Chim Acta. 2020; 509:235–43.
  • 32. Tatum D, Taghavi S, Houghton A, Stover J, Toraih E, Duchesne J. Neutrophil-to-Lymphocyte Ratio and Outcomes in Louisiana COVID-19 Patients. Shock. 2020 ;54(5):652–8.
  • 33. Sayed AA, Allam AA, Sayed AI, Alraey MA, Joseph M V. The use of neutrophil-to-lymphocyte ratio (NLR) as a marker for COVID-19 infection in Saudi Arabia: A case-control retrospective multicenter study. Saudi Med J. 2021;42(4):370–6.
  • 34. Bedel C, Korkut M, Armağan HH. Comment on '"Can the neutrophil/lymphocyte ratio (NLR) have a role in the diagnosis of coronavirus 2019 disease (COVID-19)?"' Rev Assoc Med Bras. 2021;67(Suppl 1):168–9.
  • 35. Bedel C, Korkut M. Neutrophil-to-Lymphocyte Ratio and Covid-19. Shock [Internet]. 2021;56(5):874. Available from: https://journals.lww.com/10.1097/SHK.0000000000001712