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Neutrophil/Lymphocyte Ratio – A Marker of COVID-19 Pneumonia Severity
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  • Mehar Muhammad Imran,
  • Umair Ahmed,
  • Umer Usman,
  • Majid Ali,
  • Aamir Shaukat,
  • Noor Gul
Mehar Muhammad Imran
District Headquarter Hospital
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Umair Ahmed
Allied Hospital
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Umer Usman
District Headquarter Hospital
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Majid Ali
Umm Al-Qura University College of Pharmacy
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Aamir Shaukat
District Headquarter Hospital
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Noor Gul
District Headquarter Hospital
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Abstract

Aim: To determine the efficacy of neutrophil/lymphocyte ratio (NLR) as a marker of the severity of COVID-19 pneumonia in the South-Asian population. Methods: This was a prospective, cross-sectional, analytic study conducted at HDU/ICU of District Headquarter Hospital, Faisalabad, Pakistan, from May through July 2020. Sixty-three eligible patients, admitted to the HDU/ICU, were prospectively enrolled in the study. Their NLR, C-reactive protein, serum albumin, and serum fibrinogen were measured. Patients’ demographic characteristics, comorbidities, clinical manifestations of COVID-19 infection, medication use, and history of lung malignancy were retrieved from their medical history. Patients were categorized into either a general group (with mild COVID-19) or a heavy group (with moderate to severe COVID-19). Results: There were significant differences between the two groups in diabetes prevalence, NLR, C-reactive protein, and serum albumin. NLR and C-reactive protein were positively correlated (P < 0.001, P = 0.04 respectively) whereas serum albumin was negatively correlated (P = 0.009) with severe COVID-19. NLR was found to be an independent risk factor for severe COVID-19 pneumonia in the heavy group (OR = 1.264, 95% CI: 1.046~1.526, P = 0.015). The calculated AUC using ROC for NLR was 0.831, with an optimal limit of 4.795, sensitivity of 0.83 and specificity of 0.75, which is highly suggestive of NLR being a marker for early detection of deteriorating severe COVID-19 infection. Conclusion: NLR can be used as an early warning signal for deteriorating severe COVID-19 infection and can provide an objective basis for early identification and management of severe COVID-19 pneumonia.

Peer review status:Published

29 Aug 2020Submitted to International Journal of Clinical Practice
31 Aug 2020Submission Checks Completed
31 Aug 2020Assigned to Editor
20 Sep 2020Reviewer(s) Assigned
12 Oct 2020Review(s) Completed, Editorial Evaluation Pending
24 Dec 20201st Revision Received
26 Dec 2020Reviewer(s) Assigned
26 Dec 2020Submission Checks Completed
26 Dec 2020Assigned to Editor
26 Jul 2021Review(s) Completed, Editorial Evaluation Pending
Apr 2021Published in International Journal of Clinical Practice volume 75 issue 4. 10.1111/ijcp.13698