High neutrophil-to-lymphocyte ratio associated with progression to critical illness in older patients with COVID-19: a multicenter retrospective study.

Jiangshan Lian,Jianhua Hu,Huan Cai,Lin Zheng,Yida Yang,Xi Jin,Shanyan Zhang,Yimin Zhang,Shaorui Hao,Xiaoli Zhang,Xiaopeng Yu,Xiaoyan Wang,Jifang Sheng,Guodong Yu,Hongyu Jia,Meifang Yang,Yingfeng Lu,Chanyuan Ye,Jianfeng Gu ,Gao J ,Chentao Jin

doi:10.18632/aging.103582

Abstract

This retrospective cohort study aimed to investigate the correlation of the neutrophil-to-lymphocyte ratio (NLR) with critical illness in older patients with COVID-19, and evaluate the prognostic power of the NLR at admission. We enrolled 232 patients with COVID-19, aged ≥60 y, in Zhejiang province from January 17 to March 3, 2020. Primary outcomes were evaluated until April 13. Cox regression was performed for prognostic factors. Twenty-nine (12.5%) patients progressed to critical illness. Age, shortness of breath, comorbidities including hypertension, heart disease, and chronic obstructive pulmonary disease, higher NLR, lower albumin levels, and multiple mottling and ground-glass opacity were associated with progression. In the multivariate analysis, older age (hazard ratio [HR] 1.121, confidence interval [CI] 1.070-1.174, P<0.001), heart disease (HR 2.587, CI 1.156-5.787, P=0.021), higher NLR (HR 1.136, CI 1.094-1.180, P < 0.001), and multiple mottling and ground-glass opacity (HR 4.518, CI 1.906-10.712, P<0.001) remained critical illness predictors. The NLR was independently associated with progression to critical illness; the relationship was significant and graded (HR: 1.16 per unit; 95% CI: 1.10-1.22; P for trend < 0.001). Therefore, NLR can be adopted as a prognostic tool to assist healthcare providers predict the clinical outcomes of older patients suffering from COVID-19.

Highlights

In December 2019, a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in Wuhan, China [1,2,3]
We found that older patients with COVID-19 had significantly greater disease severities, as well as higher rates of critical-type disease and intensive care unit (ICU) admission than their younger counterparts outside Wuhan [6]
We investigated the correlation of the neutrophil-to-lymphocyte ratio (NLR) with critical illness in older patients with COVID-19, to evaluate the prognostic power of the NLR at admission in the prediction of progression to critical illness

Summary

Introduction

In December 2019, a novel coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in Wuhan, China [1,2,3]. Infection with the virus leads to coronavirus disease (COVID-19), which is characterized by rapid human-to-human transmission and varied degrees of fatality, due to acute respiratory distress syndrome, multi-organ failure, and other serious complications [4, 5]. We found that older patients with COVID-19 had significantly greater disease severities, as well as higher rates of critical-type disease and intensive care unit (ICU) admission than their younger counterparts outside Wuhan [6]. In Italy, a majority of critically ill patients with laboratory-confirmed COVID-19 who were admitted to ICUs were older men, and a large proportion of them required mechanical ventilation and high levels of positive end-expiratory pressure; the associated ICUrelated mortality was 26% [9]

Methods

Results

Conclusion