Neutrophil to lymphocyte ratio and in-hospital mortality among patients with SARS-CoV-2: A retrospective study

Maryam Salah Al-Mazedi; Rajesh Rajan; Mohammed Al-Jarallah; Raja Dashti; Ahmad Al Saber; Jiazhu Pan; Kobalava D Zhanna; Hassan Abdelnaby; Wael Aboelhassan; Farah Almutairi; Naser Alotaibi; Mohammad Al Saleh; Noor AlNasrallah; Bader Al-Bader; Haya Malhas; Maryam Ramadhan; Peter A Brady; Ibrahim Al-Zakwani; Parul Setiya; Mohammed Abdullah; Moudhi Alroomi; Gary Tse

doi:10.1016/j.amsu.2022.104748

Neutrophil to lymphocyte ratio and in-hospital mortality among patients with SARS-CoV-2: A retrospective study

Ann Med Surg (Lond). 2022 Oct:82:104748. doi: 10.1016/j.amsu.2022.104748. Epub 2022 Oct 1.

Authors

Maryam Salah Al-Mazedi¹, Rajesh Rajan², Mohammed Al-Jarallah², Raja Dashti², Ahmad Al Saber³, Jiazhu Pan³, Kobalava D Zhanna⁴, Hassan Abdelnaby⁵, Wael Aboelhassan⁶, Farah Almutairi⁷, Naser Alotaibi⁸, Mohammad Al Saleh⁷, Noor AlNasrallah⁸, Bader Al-Bader⁷, Haya Malhas⁹, Maryam Ramadhan¹⁰, Peter A Brady¹¹, Ibrahim Al-Zakwani¹², Parul Setiya¹³, Mohammed Abdullah¹⁴, Moudhi Alroomi¹⁴, Gary Tse¹⁵

Affiliations

¹ Dept. of Medical Laboratory Technology, Public Authority for Applied Education and Training, Kuwait.
² Department of Cardiology, Sabah Al Ahmed Cardiac Centre, Al Amiri Hospital, Kuwait City, Kuwait.
³ Department of Mathematics and Statistics, University of Strathclyde, Glasgow, G1 1XH, UK.
⁴ Department of Internal Medicine with the Subspecialty of Cardiology and Functional Diagnostics Named After V.S. Moiseev, Institute of Medicine, Peoples' Friendship University of Russia (RUDN University), Moscow, Russian Federation.
⁵ Department of Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt. Department of Medicine, Division of Gastroenterology, Al Sabah Hospital, Kuwait.
⁶ Department of Medicine, Division of Gastroenterology, Jaber Al Ahmed Hospital, South Surra, Kuwait.
⁷ Department of Medicine, Farwaniya Hospital, Farwaniya, Kuwait.
⁸ Department of Medicine, Al Adan Hospital, Hadiya, Kuwait.
⁹ Department of Emergency Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait.
¹⁰ Department of Obstetrics and Gynaecology, Maternity Hospital, Shuwaikh Medical Area, Kuwait.
¹¹ Department of Cardiology, Illinois Masonic Medical Center, Chicago, IL, USA.
¹² Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman & Gulf Health Research, Muscat, Oman.
¹³ Department of Agrometeorology, College of Agriculture, G.B.Pant University of Agriculture & Technology, Pantnagar, Uttarakhand, India.
¹⁴ Department of Infectious Diseases, Infectious Diseases Hospital, Shuwaikh Medical Area, Kuwait.
¹⁵ Cardiovascular Analytics Group, Hong Kong, China; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, 300211, China.

Abstract

The goal of this study was to investigate in-hospital mortality in patients suffering from acute respiratory syndrome coronavirus 2 (SARS-CoV-2) relative to the neutrophil to lymphocyte ratio (NLR) and to determine if there are gender disparities in outcome. Between February 26 and September 8, 2020, patients having SARS-CoV-2 infection were enrolled in this retrospective cohort research, which was categorized by NLR levels ≥9 and < 9. In total, 6893 patients were involved included of whom6591 had NLR <9, and 302 had NLR ≥9. The age of most of the patients in the NLR<9 group was 50 years, on the other hand, the age of most of the NLR ≥9 group patients was between 50 and 70 years. The majority of patients in both groups were male 2211 (66.1%). The ICU admission time and mortality rate for the patients with NLR ≥9 was significantly higher compared to patients with NLR <9. Logistic regression's outcome indicated that NLR ≥9 (odds ratio (OR), 24.9; 95% confidence interval (CI): 15.5-40.0; p < 0.001), male sex (OR, 3.5; 95% CI: 2.0-5.9; p < 0.001) and haemoglobin (HB) (OR, 0.95; 95% CI; 0.94-0.96; p < 0.001) predicted in-hospital mortality significantly. Additionally, Cox proportional hazards analysis (B = 4.04, SE = 0.18, HR = 56.89, p < 0.001) and Kaplan-Meier survival probability plots also indicated that NLR>9 had a significant effect on mortality. NLR ≥9 is an independent predictor of mortality(in-hospital) among SARS-CoV-2 patients.

Keywords: AОR, аdjusted Odds Rаtiо; COVID-19; ICU, Intensive Care Unit; In-hospital mortality; NLR; NLR, Neutrophil to lymphocyte ratio; RT–PCR, Reverse Transcription Polymerase Chain Reaction; SARS-CoV-2; SАRS-СоV-2, severe асute resрirаtоry syndrоme соrоnаvirus 2; СI, Cоnfidenсe Intervаl; СRF, Cаse Reсоrd Fоrm.