Published: 2022-02-23

Evaluation of simple cost-effective immuno-haematological markers to predict outcome in hospitalized COVID-19 patients during second wave

Golla Anmol Manaswini Yadav, Chegowni Venkateshwarlu, Varsha Reddy, P. Raghuveer, B. S. V. Manjula


Background: COVID-19 pandemic has strained the health infrastructure globally, hence the importance of cost-effective biomarkers. We aimed to identify simple haematological prognostic markers in hospitalized COVID-19 patients to differentiate between milder and severe cases, thus predicting outcome.

Methods: A retrospective study of COVID-19 patients admitted at Malla Reddy institute of medical sciences was conducted from April to June 2021. Total leukocyte count (TLC), neutrophil-to-lymphocyte ratio (NLR), derived NLR ratio (dNLR) and platelet-to-lymphocyte ratio (PLR) were calculated and correlated with outcome. These parameters were compared with other inflammatory markers using ROC (receiver operator curve) analysis.

Results: 303 patients of 397 fulfilled the inclusion criteria (male-198, female-105). There was a significant higher mean of NLR in patients with death (14.46±5.84) compared to patients recovered (8.43±4.33), similarly the dNLR was higher in death (8.06±2.34) compared to recovered (4.97±1.49). A significant positive strength of association between the NLR and dNLR with the ESR, CRP, CORADS score and CT severity score in the patients. The ROC analysis showed the NLR (AUC=0.777) and dNLR (0.799) a better marker to predict the outcome.

Conclusions: In COVID-19, immuno-haematological markers like NLR, dNLR, PLR found to be a simple and cost-effective tool to prognosticate the clinical outcome among hospitalized patients and were in concordance with the other inflammatory markers. Hence, these markers serve as better indicators in risk stratification and better management.


COVID-19, Haematological markers, NLR, PLR, dNLR

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Martin A, Markhvida M, Hallegatte S, Walsh B. Socio-economic impacts of covid-19 on household consumption and poverty. Econ Disaster Clim Change. 2020;4:1-27.

Nicola M, Alsafi Z, Sohrabi C, Kerwan A, Al-Jabir A, Iosifidis C, et al. The socio-economic implications of the coronavirus pandemic (COVID-19): a review. Int J Surg. 2020;78:185-93.

Liao D, Zhou F, Luo L, Xu M, Wang H, Xia J, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective COHORT study. Lancet Haematol. 2020;7(9):671-8.

Seyit M, Avci E, Nar R, Senol H, Yilmaz A, Ozen M, et al. Neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio and platelet to lymphocyte ratio to predict the severity of COVID-19. Am J Emerg Med. 2021;40:110-4.

Wang C, Zhang H, Cao X, Deng R, Ye Y, Fu Z, et al. Red cell distribution width (RDW): a prognostic indicator of severe COVID-19. Ann Transl Med. 2020;8(19).

Li Y, Wang W, Yang F, Xu Y, Feng C, Zhao Y. The regulatory roles of neutrophils in adaptive immunity. Cell Commun Signal. 2019;17(1):147.

Henry B, Cheruiyot I, Vikse J, Mutua V, Kipkorir V, Benoit J, et al. Lymphopenia and neutrophilia at admission predicts severity and mortality in patients with COVID-19: a meta-analysis. Acta Biomed. 2020;91(3):2020008.

Yang H, Xu Y, Li Z, Yan L, Wang J, Liao P. The clinical implication of dynamic hematological parameters in COVID-19: a retrospective study in Chongqing. Int J Gen Med. 2021;14:4073-80.

Ramesh J, Reddy SLS, Rajesh M, Varghese J. Evaluation of simple and cost-effective immuno- haematological markers to predict outcome in hospitalized severe COVID-19 patients, with a focus on diabetes mellitus: a retrospective study in Andhra Pradesh, India. Diabetes Metab Syndr. 2021;15(3):739-45.