Association of Neutrophil-Lymphocytes Ratio (NLR) and D-Dimer Levels with COVID-19 Mortality
DOI:
https://doi.org/10.30872/j.kes.pasmi.kal.v5i2.7697Abstract
Coronavirus Disease 2019 (COVID-19) is a disease caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Due to the severity and transmission of SARS-CoV-2, exploration of risk factors for mortality in COVID-19 patients as early as possible becomes very important for appropriate actions and interventions and to improve the cure and quality of prognosis of COVID-19 patients. This study aimed to determine association of NLR and D-dimer with COVID-19 patient mortality. An analytical observational study with a cross-sectional study approached using 90 data from medical records of adult COVID-19 patients who were hospitalized at Abdoel Wahab Sjahranie Hospital Samarinda from July to December 2021. Statistical analysis using Spearman’s correlation, p <0,05 was significant. The results showed male patients = 51 and female patients = 39. The mean age of survived patients = 52 years and deceased patients = 50 years. Median neutrophil count of survived patients = 5.5 x 103/μl and deceased patients = 6.95 x 103/μl. Median lymphocyte count of survived patients = 1.11 x 103/μl and deceased patients = 1.03 x 103/μl. Median NLR of survived patients = 4.99 and deceased patients = 6.14. The median of D-dimer level of survived patients = 1.08 μg/ml and deceased patients = 1.83 μg/ml. The association of NLR with COVID-19 mortality showed p = 0.031; r = 0.228. The association of D-dimer levels with COVID-19 mortality showed p < 0.001; r = 0.416. It was concluded that NLR and D-dimer levels each had a significant relationship with mortality in COVID-19 patients.
References
Park SE. Epidemiology , virology , and clinical features of severe acute respiratory syndrome -coronavirus-2 ( SARS-CoV-2 ; Coronavirus Disease-19 ). CEP [Internet]. 2020;63(4):119–24. Available from: www.e-cep.org
Asakura H, Ogawa H. COVID-19-associated coagulopathy and disseminated intravascular coagulation. Int J Hematol [Internet]. 2021;113(1):45–57. Available from: https://doi.org/10.1007/s12185-020-03029-y
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet [Internet]. 2020;395(10223):507–13. Available from: http://dx.doi.org/10.1016/S0140-6736(20)30211-7
Ye W, Chen G, Li X, Lan X, Ji C, Hou M, et al. Dynamic changes of D-dimer and neutrophil-lymphocyte count ratio as prognostic biomarkers in COVID-19. Respir Res. 2020;21(1):1–7.
Mathew D, Giles JR, Baxter AE, Oldridge DA, Greenplate AR, Wu JE, et al. Deep immune profiling of COVID-19 patients reveals distinct immunotypes with therapeutic implications. Science (80- ). 2020;369(6508).
Yang A-P, Liu J, Tao W, Li H. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol [Internet]. 2020 Jul;84(January):106504. Available from: https://linkinghub.elsevier.com/retrieve/pii/S156757692030494X
Efrina D, Priyanto H, Andayani N, Arliny Y, Yanti B. Neutrophil To Lymphocyte Ratio as A Marker of Covid-19 Disease Severity in Banda Aceh, Indonesia. J Respirologi Indones. 2021;41(4):1–7.
Favresse J, Lippi G, Roy PM, Chatelain B, Jacqmin H, ten Cate H, et al. D-dimer: Preanalytical, analytical, postanalytical variables, and clinical applications. Crit Rev Clin Lab Sci [Internet]. 2018;55(8):548–77. Available from: https://doi.org/10.1080/10408363.2018.1529734
Ge YL, Liu CH, Wang N, Xu J, Zhu XY, Su CS, et al. Elevated Plasma D-Dimer in Adult Community-Acquired Pneumonia Patients is Associated with an Increased Inflammatory Reaction and Lower Survival. Clin Lab. 2019 Jan;65(1).
Zhang N, Xu X, Zhou LY, Chen G, Li Y, Yin H, et al. Clinical characteristics and chest CT imaging features of critically ill COVID-19 patients. Eur Radiol. 2020;30(11):6151–60.
Selanno Y, Widaningsih Y, Esa T, Arif M. Analysis of Neutrophil Lymphocyte Ratio and Absolute Lymphocyte Count as Predictors of Severity of COVID-19 Patients. 2021;27(2):184–9.
Damar Çakırca T, Torun A, Çakırca G, Portakal RD. Role of NLR, PLR, ELR and CLR in differentiating COVID-19 patients with and without pneumonia. Int J Clin Pract. 2021;75(11):2–7.
Sukrisman L, Sinto R, Priantono D. Hematologic profiles and correlation between absolute lymphocyte count and neutrophil/ lymphocyte ratio with markers of inflammation of covid-19 in an indonesian national referral hospital. Int J Gen Med. 2021;14:6919–24.
Tatum D, Taghavi S, Houghton A, Stover J, Toraih E, Duchesne J. Neutrophil-to-Lymphocyte Ratio and Outcomes in Louisiana COVID-19 Patients. Shock. 2020;54(5):652–8.
Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of Immune Response in Patients with COVID-19 in Wuhan, China. SSRN Electron J. 2020;
Mubarak AR, Esa T, Widaningsih Y, Bahrun U. D-Dimer Analysis in COVID-19 Patients. Indones J Clin Pathol Med Lab. 2021;28(1):5–9.
Wang Z, Gao X, Miao H, Ma X, Ding R. Understanding COVID-19-associated coagulopathy: From PIC to SIC or DIC. J Intensive Med [Internet]. 2021;1(1):35–41. Available from: https://doi.org/10.1016/j.jointm.2021.03.002
McGonagle D, O’Donnell JS, Sharif K, Emery P, Bridgewood C. Immune mechanisms of pulmonary intravascular coagulopathy in COVID-19 pneumonia. Lancet Rheumatol [Internet]. 2020;2(7):e437–45. Available from: http://dx.doi.org/10.1016/S2665-9913(20)30121-1
Becker RC. COVID-19 update: Covid-19-associated coagulopathy. J Thromb Thrombolysis [Internet]. 2020;50(1):54–67. Available from: https://doi.org/10.1007/s11239-020-02134-3
Poudel A, Poudel Y, Adhikari A, Aryal BB, Dangol D, Bajracharya T, et al. D-dimer as a biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19. PLoS One [Internet]. 2021;16(8 August 2021):1–13. Available from: http://dx.doi.org/10.1371/journal.pone.0256744
Gupta N, Zhao YY, Evans CE. The stimulation of thrombosis by hypoxia. Thromb Res [Internet]. 2019;181:77–83. Available from: https://doi.org/10.1016/j.thromres.2019.07.013
Joly BS, Siguret V, Veyradier A. Understanding pathophysiology of hemostasis disorders in critically ill patients with COVID ‑ 19. Intensive Care Med [Internet]. 2020;1–4. Available from: https://doi.org/10.1007/s00134-020-06088-1
Downloads
Published
Issue
Section
License
Authors retain copyright and grant the Jurnal Kesehatan Andalas right of first publication with the work simultaneously licensed under a Creative Commons Attribution License (CC BY-SA 4.0) that allows others to share (copy and redistribute the material in any medium or format) and adapt (remix, transform, and build upon the material) the work for any purpose, even commercially with an acknowledgment of the work's authorship and initial publication in Jurnal Kesehatan Pasak Bumi Kalimantan.Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in Jurnal Kesehatan Pasak Bumi Kalimantan.
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).
