C-reactive protein and Neutrophil-Lymphocyte Ratio as predictors of clinical severity of COVID-19

Stefan Pandilov,Dejan Dokic,Sasho Stoleski,Suzana Klenkoski,Elena Jovanovska Janeva,Hristian Duma,Gazmend Mehmeti,Dragan Mijakoski

doi:10.3889/aph.2021.6006

Abstract

COVID-19 is an infectious disease that can manifest quite differently. In this study we examined the relationship between the value of serum CRP(C-reactive protein) andneutrophil-lymphocyte ratio (NLR) as predictor factors for the development of a severe clinical manifestation in COVID19 patients. Materials and methods: We followed 95 COVID-19 positive patients who were hospitalized at the University Clinic for Eye Diseases - COVID Center. We analyzed the initial laboratory parameters of white blood cells and CRP on admission of the patients and the results of laboratory analyses performed before they left the Clinic, or the last parameters before the lethal outcome in those patients who died. Several models of logistic regression were tested to analyze the predictive value of these markers of inflammation for lethal outcome in patients hospitalized for COVID-19. Results: Bivariate analysis demonstrated that the length of hospital stay was significantly shorter in patients with lethal outcome (p=0.001). The NLR was significantly higher in patients with lethal outcome at both times (p=0.005; and p=0.017). Leukocyte’s count (p=0.046, and p<0.001) and CRP (p=0.013,and p=0.005) were also significantly higher in patients with lethal outcome at both times. The increase on the NLR scale both at hospitalization and at discharge (or the last analysis before death) leads to increase in the odds of lethal outcome (T1:40.4% increased odds; T2:36% increased odds). Conclusion: CRP and NLR are laboratory parameters that can predict the severity of the clinical manifestation in patients with COVID-19.

Highlights

COVID-19 is a highly infectious disease that has spread throughout the world
In this study we examined the relationship between the value of serum CRP(C-reactive protein) andneutrophil-lymphocyte ratio (NLR) as predictor factors for the development of a severe clinical manifestation in COVID19 patients
The disease is caused by SARS-CoV-2, an RNA virus that has been known to science since 1937 when it was first isolated in chicken embryos.[1]

Summary

Introduction

COVID-19 is a highly infectious disease that has spread throughout the world. The disease is caused by SARS-CoV-2, an RNA virus that has been known to science since 1937 when it was first isolated in chicken embryos.[1]. The most common causes of death in COVID-19 patients are ARDS, thromboembolic events, acute renal failure, sepsis and septic shock, and acute liver failure.[2] the detection of biological markers in patients who will predict the severity of the clinical picture is crucial to timely indicate appropriate health care. For these reasons, monitoring of vital parameters and laboratory findings have been shown to be predictors of the possibility of developing a severe clinical picture in COVID-19 patients. A few laboratory markers are used as predictors of clinical severity in patients with COVID-19 and for fatal outcome including: CRP (C-reactive protein), the ratio between neutrophils and lymphocytes (NLR), LDH and elevated D-dimer values.[3,4]

Methods

Results

Conclusion