Neutrophil-to-Lymphocyte ratio in moderate and severe COVID-19 among hospitalized adults: A retrospective study from a resource limited setting in Pakistan
DOI:
https://doi.org/10.47489/szmc.v40i3.955Keywords:
COVID-19, Neutrophil-to-Lymphocyte Ratio, Disease Severity, Biomarker, PakistanAbstract
Background: Coronavirus disease 2019 (COVID-19) has a broad clinical spectrum. Simple and inexpensive inflammatory markers may help characterize patients with more severe illness in resource-limited settings. The neutrophil-to-lymphocyte ratio (NLR), derived from a routine complete blood count, has been associated with COVID-19 severity in previous studies.
Methods: A retrospective study included 635 adults who were hospitalized with reverse-transcription polymerase chain reaction (RT-PCR)-confirmed COVID-19 in Lahore, Pakistan. Demographic, clinical, and laboratory information was reviewed. NLR was calculated from complete blood count parameters and is reported as median (interquartile range [IQR]). Categorical associations with disease severity were assessed from the retained aggregate counts using Pearson's chi-square test for age categories and two-sided Fisher's exact test for 2 x 2 comparisons.
Results: Severe disease was recorded in 490 (77.2%) patients and moderate disease in 145 (22.8%). Median NLR was 11.1 (IQR 12.7) in the severe group and 2.6 (IQR 2.4) in the moderate group. Sex was not associated with severity (two-sided Fisher's exact p=0.482). Obesity showed a borderline but non-significant association with severity (p=0.054). Overall, 200 (31.5%) patients died and 435 (68.5%) were discharged.
Conclusion: NLR was markedly higher in the severe group than in the moderate group and may be a simple marker associated with disease severity in hospitalized patients. Because patient-level data were unavailable for receiver operating characteristic (ROC) analysis, effect-Zize estimation, and multivariable adjustment, these findings do not establish NLR as an independent predictor or define its clinical discriminatory performance.
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