Neutrophil to Lymphocyte Ratio on Admission to Predict Mortality of COVID-19 Elderly Patients
DOI:
https://doi.org/10.24293/ijcpml.v30i2.2145Keywords:
NLR, elderly, COVID-19, mortalityAbstract
Severe Acute Respiratory Syndrome Corona Virus Disease-2 (SARS-COV-2) is the cause of COVID-19, which led to a global pandemic and high mortality rate, especially in elderly patients. The declining immune system in elderly patients and comorbid diseases lead to more severe symptoms and an increased mortality rate. Many studies have shown that a high Neutrophil-Lymphocyte Ratio (NLR) value can predict the severity and mortality of COVID-19. However, studies on NLR in elderly patients in Indonesia have rarely been conducted. This study aimed to determine the role of NLR on admission as a mortality predictor in COVID-19 elderly patients who underwent in-hospital treatment. This research is an analytical observational study with a retrospective cohort method conducted in Bethesda Hospital, Yogyakarta, Indonesia. The research subjects were selected from July 2020 to October 2021 according to inclusion and exclusion criteria. Inclusion criteria were all elderly COVID-19 patients with an age limit of > 60 years old who had complete hemogram data on admission, demographic data, diagnostic criteria, types of comorbid diseases, and patient outcomes (survivor or non-survivor). The exclusion criteria were elderly COVID-19 patients with incomplete Electronic Medical Records (EMR). This study found 122 elderly patients with COVID-19 with a mortality rate of 30.33%. The result showed that NLR on admission significantly increased significantly in the non-survivor group compared to the survivor group. Multivariate Cox regression analysis presented severity (RR: 5.181; CI 1.662-16.154; p=0.005), comorbid diabetes mellitus (RR: 2.829; CI: 1.115-7.178), NLR > 6.04 (RR: 6.356; CI: 2.428-16.639) and other comorbid, namely thyroid, autoimmune, cancer, and anemia (RR: 15.836; CI: 1.841-136.234; p=0.012) as factors of mortality in hospitalized elderly patients.
Downloads
References
World Health Organization. Diagnostic testing for SARS-CoV-2: interim guidance,
September 11, 2020. Geneva, World Health Organization, 2020 (WHO/2019-nCoV/laboratory/2020.6). Available from: https://apps.who.int/iris/handle/10665/334254 (accessed May 2, 2023).
World Health Organization. Coronavirus Disease (COVID-19) outbreak situation. 2023.
Available from: https://covid19.who.int/. (accessed January 26, 2023).
Kemenkes RI. 2023. Gugus tugas percepatan penanganan COVID-19. Available from:
https://www.covid19.go.id/. (accessed January 27, 2023).
Burhan E, Susanto AD, Nasution SA, Ginanjar E, Pitoyo CW, et al. Pedoman tatalaksana
COVID-19. Ed 3., Jakarta, PDPI, PERKI, PAPDI, PERDATIN, IDAI, 2022; 6-7.
Xia W, Tan Y, Hu S, Li C, Jiang T. Predictive value of systemic immune-inflammation
index and neutrophil-to-lymphocyte ratio in patients with severe COVID-19. Clinical and Applied Thrombosis/Hemostasis, 2022; 28: 107602962211113.
Jin A, Yan B, Hua W, Feng D, Xu B, et al. Clinical characteristics of patients diagnosed with COVID-19 in Beijing. Biosafety and Health, 2020; 2(2): 104–11.
Vera BT, Kramarow EA. COVID-19 mortality in adults aged 65 and over: United States, 2020 [Internet]. CDC: Centers for Disease Control and Prevention. U.S. Department of Health and Human Services, 2022. Available from: https://www.cdc.gov/nchs/data/databriefs/db446.pdf (accessed March 31, 2022).
Guan W-Jie, Liang W-hua, Zhao Y, Liang H-rui, Chen Z-sheng, et al. Comorbidity and its impact on 1,590 patients with COVID-19 in China: A nationwide analysis. Eur Respir J, 2020; 55(5): 2000547.
Putra IM, Fenty F. Hubungan komorbiditas terhadap derajat keparahan admisi dan outcome pasien COVID-19. Journal of Health Promotion and Service Management, 2022; 1(1): 11–8.
Dadras O, Seyed-Alinaghi S, Karimi A, Shamsabadi A, Qaderi K, Ramezani M. COVID-
Mortality and its predictors in the elderly: A systematic review. Health Science Reports, 2022; 5(3): e657.
Mehraeen E, Karimi A, Barzegary A, Vahedi F, Afsahi AM, Dadras O. Predictors of
mortality in patients with COVID-19: A systematic review. European Journal of Integrative Medicine, 2020; 40: 101226.
Astuti AD, Aridamayanti BG. Penyebab mortalitas lansia selama masa perawatan
rumah sakit COVID-19: A systematic Review. Jurnal Penelitian Kesehatan Suara Forikes, 2021; 12(4): 521-524.
Keski H. Hematological and inflammatory parameters to predict the prognosis in COVID-19. Indian Journal of Hematology and Blood Transfusion, 2021; 37(4): 534–542.
Han H, Yang L, Liu R, Liu F, Wu K, et al. Prominent changes in blood coagulation of
patients with SARS-CoV-2 infection. Clinical Chemistry and Laboratory Medicine (CCLM), 2020; 58(7): 1116-1120.
Panigrahy D, Gilligan MM, Huang S, Gartung A, Cortés-Puch I, et al. Inflammation
resolution: A dual-pronged approach to averting cytokine storms in COVID-19? Cancer Metastasis Rev, 2020; 39(2): 337-340.
Tay MZ, Poh CM, Rénia L, MacAry PA, Ng LFP. The trinity of COVID-19: Immunity,
inflammation and intervention. Nat Rev Immunol, 2020; 20(6): 363-374.
Wang L, He W, Yu X, Hu D, Bao M, et al. Coronavirus disease 2019 in elderly patients:
Characteristics and prognostic factors based on 4-week follow-up. J Infect, 2020;
: 639–45.
Wang C, Deng R, Gou L, Fu Z, Zhang X, et al. Preliminary study to identify severe from
moderate cases of COVID-19 using combined hematology parameters. Annals of Translational Medicine, 2020; 8(9): 593.
Lian J, Jin C, Hao S, Zhang X, Yang M, et al. High neutrophil-to-lymphocyte ratio associated with progression to critical illness in older patients with COVID-19: A multicenter retrospective study. Aging (Albany, NY), 2020; 12(14): 13849-13859.
Erdogan A, Can FE, Gönüllü H. Evaluation of the prognostic role of NLR, LMR, PLR, and
LCR ratio in COVID-19 patients. Journal of Medical Virology, 2021; 93(9): 5555–
Soni M, Gopalakrishnan R. Significance of RDW in predicting mortality in COVID-19:
An analysis of 622 cases. International Journal of Laboratory Hematology, 2021; 43(4): O221–O223.
Wang Y, Zhao J, Yang L, Hu J, Yao Y. Value of the neutrophil-lymphocyte ratio in
predicting COVID-19 severity: A meta-analysis. Dis Markers, 2021; 1: 2571912.
Qu R, Ling Y, Zhang YH, Wei LY, Chen X, Li XM, et al. Platelet-to-lymphocyte ratio is
associated with prognosis in patients with Coronavirus disease-19. Journal of
Medical Virology, 2020; 92(9): 1533–1541.
Awale RB, Singh A, Mishra P, Bais PS, Vansh K, et al. Routine hematology parameters
in COVID-19: A predictor of disease severity and mortality. Journal of Family Medicine and Primary Care, 2022; 11(7): 3423–3429.
Greatalya LAD, Ariningrum D, Aryoseto L. Neutrophil to lymphocyte ratio and comorbidities as mortality predictors for COVID-19 patient at Dr. Moewardi Hospital Surakarta. Indonesian Journal of Clinical Pathology and Medical Laboratory, 2022; 29(1): 54-58.
Bintoro SUY, Hadi U, Dwijayanti NMI, Pramudya D, Amrita PN, et al. Hematologic and
coagulopathy parameter as a survival predictor among moderate to severe COVID-19 patients in non-ICU ward: A single-center study at the main referral hospital in Surabaya, East Java, Indonesia. F1000 Research, 2021; 10: 791.
TNP2K, 2020. The situation of the elderly in Indonesia and access to social protection
programs: Secondary data analysis. Jakarta, Indonesia, 2020; 3-4. Available from: https://www.tnp2k.go.id/downloads/the-situation-of-the-elderly-in-indonesia-and-access-to-social-protection-programs-secondary-data-analysis (accessed January 29, 2023).
Peraturan Mentri Kesehatan Republik Indonesia (Permenkes), nomor 25, rencana aksi
nasional kesehatan lanjut usia tahun 2016-2019. 2016.
Infodatin 2022. Lansia berdaya, bangsa berjaya. Available from:
https://www.kemkes.go.id/downloads/resources/download/pusdatin/infodatin/Infodatin-Lansia-2022.pdf (accessed Jan 27, 2023).
Tam EMYY, Kwan YK, Ng YY, Yam PW. Clinical course and mortality in older patients
with COVID-19: A cluster-based study in Hong Kong. Hong Kong Med J, 2022; 28(3): 215-222.
Mostaza JM, García-Iglesias F, González-Alegre T, Blanco F, Varas M, et al. Clinical
course and prognostic factors of COVID-19 infection in an elderly hospitalized population. Arch Gerontol Geriatr, 2020; 91: 104204.
Chinnadurai, R., Ogedengbe, O., Agarwal, P. et al. Older age and frailty are the chief
predictors of mortality in COVID-19 patients admitted to an acute medical unit in a secondary care setting- a cohort study. BMC Geriatr, 2020; 20: 409.
Trecarichi EM, Mazzitelli M, Serapide F, Pelle MC, Tassone B, et al. Clinical
characteristics and predictors of mortality associated with COVID-19 in elderly patients from a long-term care facility. Sci Rep, 2020; 10(1): 20834.
Asrie F, Tekle E, Gelaw Y, Dagnew M, Gelaw A, et al. Baseline thrombocytopenia and disease severity among COVID-19 patients, Tibebe Ghion Specialized Hospital COVID-19 treatment center, Northwest Ethiopia. J Blood Med, 2022; 13: 315-325.
Liu Y, Du X, Chen J, Jin Y, Peng L, et al. Neutrophil-to-lymphocyte ratio as an
independent risk factor for mortality in hospitalized patients with COVID-19. J Infect, 2020; 81: e6–12.
Mousavi SA, Rad S, Rostami T, Rostami M, Mousavi SA, et al. Hematologic predictors of mortality in hospitalized patients with COVID-19: A comparative study. Hematology, 2020; 25(1): 383-388.
Al-Mazedi MS, Rajan R, Al-Jarallah M, Dashti R, Al Saber A, Pan J, et al. Neutrophil to lymphocyte ratio and in-hospital mortality among patients with SARS-COV-2: A retrospective study. Annals of Medicine & Surgery, 2022; 82: 104748.
Kilercik M, Demirelce Ö, Serdar MA, Mikailova P, Serteser M. A new haematocytometric index: Predicting severity and mortality risk value in COVID-19 patients. PLoS One, 2021; 16(8): e0254073.
Simadibrata DM, Calvin J, Wijaya AD, Ibrahim NAA. Neutrophil-to-lymphocyte ratio
on admission to predict the severity and mortality of COVID-19 patients: A meta-analysis. Am J Emerg Med, 2021; 42: 60-69.
Downloads
Submitted
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
