HAMANDI, O. (2025). Neutrophil / Lymphocyte Ratio as a Predictor of Diagnosis and Severity of COVID-19 Infection in The Emergency Department of Baghdad Teaching Hospital. , 24(1), 42-51. doi: 10.52573/ipmj.2025.140833
OMAR MOHAMMED-RIDHA HAMANDI. "Neutrophil / Lymphocyte Ratio as a Predictor of Diagnosis and Severity of COVID-19 Infection in The Emergency Department of Baghdad Teaching Hospital". , 24, 1, 2025, 42-51. doi: 10.52573/ipmj.2025.140833
HAMANDI, O. (2025). 'Neutrophil / Lymphocyte Ratio as a Predictor of Diagnosis and Severity of COVID-19 Infection in The Emergency Department of Baghdad Teaching Hospital', , 24(1), pp. 42-51. doi: 10.52573/ipmj.2025.140833
HAMANDI, O. Neutrophil / Lymphocyte Ratio as a Predictor of Diagnosis and Severity of COVID-19 Infection in The Emergency Department of Baghdad Teaching Hospital. , 2025; 24(1): 42-51. doi: 10.52573/ipmj.2025.140833

Neutrophil / Lymphocyte Ratio as a Predictor of Diagnosis and Severity of COVID-19 Infection in The Emergency Department of Baghdad Teaching Hospital

Iraqi Postgraduate Medical Journal
Article 7, Volume 24, Issue 1, January 2025, Pages 42-51    PDF (902.14 K)
Document Type: Research Paper
DOI: 10.52573/ipmj.2025.140833
Author
OMAR MOHAMMED-RIDHA HAMANDI*
Department of Operations and Emergency Medical Services Baghdad Al-Karkh
Abstract
Abstract
Background: getting infected with the Corona virus leads to corona virus disease, which has shown a rapid human to human transmission and different degrees of mortality, death occur because of acute respiratory distress syndrome, multi organ failure, and other serious complications. The neutrophil to lymphocyte ratio is a world-wide used marker for estimate the prognosis of patients with other infectious diseases like pneumonia and non-infectious like cancer.
Aim of the study: is to evaluate the Diagnostic and Severity predictive power of neutrophil/ lymphocyte ratio in Coronavirus disease patients.
Methods: A cross-sectional study done in the emergency department of Baghdad Teaching Hospital in Baghdad City-Iraq. Sample collected randomly and 528 patients who had symptoms of Corona virus disease were enrolled prospectively in the study.
Result: Patients with neutrophil-to-lymphocyte ratio ≥3.6 were 20.3 times more likely to have Corona virus disease compared to patients whose neutrophil-to-lymphocyte ratio was ≤3.6. Neutrophil-to-lymphocyte ratio was significantly high as the disease severity increase. The difference in the age of the patients was not statistically significant regarding the Diagnosis, but seems to play a significant role in the disease severity. The optimal threshold at 4.3 for neutrophil-to-lymphocyte ratio showed a superior predictive possibility of patient to had severe to critical disease, which had the highest of sensitivity and specificity When age ≥ 51.5 years old.
Conclusion: elevated Neutrophil-to-lymphocyte ratio is an independent Diagnostic and Severity predictive biomarker for Corona virus disease patients. Age and Neutrophil-to-Lymphocyte ratio are independent risk factors to the severity of the infection.
Keywords
Neutrophil,,; ,،Lymphocyte,,; ,،COVID-19,,; ,،Coronavirus
References
  1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, et al..Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395:497–506. 10.1016/S0140-6736(20)30183-5.
  2. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, Ren R, Leung KS, Lau EH, Wong JY, Xing X, Xiang N, Wu Y, et al..Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med.2020; 382:1199–207. 10.1056/NEJMoa2001316.
  3. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang L.Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395:507–13. 10.1016/S0140-6736(20)30211-7.
  4. Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, Xing F, Liu J, Yip CC, Poon RW, Tsoi HW, Lo SK, Chan KH, et al..A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020; 395:514–23. 10.1016/S0140-6736(20)30154-9.
  5. World Health Organization. Novel coronavirus : World Health Organization; 2020. [cited 2020 mars 11] https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020.
 

  1. Jiangshan Lian, Ciliangjin, Shaorui Hao, Xiaoli Zhang, Meifang Yang, Xi Jin,  Yingfeng Lu, Jianhua Hu, Shanyan Zhang, Lin Zheng, Hongyu JiaHuan Cai, Yimin Zhang,  Guodong Yu  Xiaoyan Wang,  Jueqing Gu, Chanyuan Ye, Xiaopeng Yu, Jianguo Gao, Yida Yang, and Jifang Sheng High neutrophil-to-lymphocyte ratio associated with progression to critical illness in older patients with COVID-19: a multicenter retrospective study, Published online 2020 Jul 30. Dio 18632/aging.103582
  2. Lian J, Jin X, Hao S, Cai H, Zhang S, Zheng L, Jia H, Hu J, Gao J, Zhang Y, Zhang X, Yu G, Wang X, et al..Analysis of epidemiological and clinical features in older patients with corona virus disease 2019 (COVID-19) out of Wuhan. Clin Infect Dis. 2020. [Epub ahead of print]. 10.1093/cid/ciaa242.
  3. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z.Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323:1061–69. 10.1001/jama.2020.1585.
  4. Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R, Prill M, Chai SJ, Kirley PD, Alden NB, Kawasaki B, Yousey-Hindes K, Niccolai L, et al..Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019 - COVID-NET, 14 states, March 1-30, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69:458–64. 10.15585/mmwr.mm6915e3.
  5. Giede-Jeppe A, Bobinger T, Gerner ST. Neutrophil-to-Lymphocyte Ratio Is an Independent Predictor for In-Hospital Mortality in Spontaneous Intracerebral Hemorrhage. Cerebrovasc Dis 2017;44:26–34.
  6. Ha YJ, Hur J, Go DJ. Baseline peripheral blood neutrophil-to-lymphocyte ratio could predict survival in patients with adult polymyositis and dermatomyositis: A retrospective observational study. Plos One 2018;13 :e190411.
  7. Yoon NB, Son C, Um SJ. Role of the neutrophil-lymphocyte count ratio in the differential diagnosis between pulmonary tuberculosis and bacterial community-acquired pneumonia. Ann Lab Med. 2013;33:105-10.
  8. Walsh SR, Cook EJ, Goulder F et al. Neutrophil-lymphocyte ratio as a prognostic factor in colorectal cancer. J Surg Oncol 2005;91:181–84.
  9. Liu, Y., Du, X., Chen, J., Jin, Y., Peng, L., Wang, H. H. X. Zhao, Y. (2020).Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. Journal of infection. doi:10.1016/j.jinf.2020.04.02
  10. Qin C, Zhou L, Hu Z. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 2020.
  11. H. Kusumanto, W.A. Dam, G.A.P. Hospers, C. Meijer, N.H. Mulder, Platelets and granulocytes, in particular the neutrophils, form important compartments for circulating vascular endothelial growth factor, Angiogenesis 2003;6:283–87.
  12. Hanrahan, M.J. Currie, S.P. Gunningham, H.R. Morrin, P.A.E. Scott, B.A. Robinson, S.B. Fox, The angiogenic switch for vascular endothelial growth factor (VEGF)-A, VEGF-B, VEGF-C, and VEGF-D in the adenoma-carcinoma sequence during colorectal cancer progression, J. Pathol. 2003; 200:183–94.
  13. Kuper, H.O. Adami, D. Trichopoulos, Infections as a major preventable cause of human cancer, J. Int. Med. 2000;248 :171–83.
  14. Shacter, S.A. Weitzman, Chronic inflammation and cancer, Oncology (Williston Park, N.Y.) 2002; 16:217–32.
  15. A. Lagunas-Rangel Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis J. Med. Virolo. (2020), 10.1002/jmv.25819.
  16. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological andclinical characteristics of 99 cases of 2019 novel coronavirus pneumonia inWuhan, China: a descriptive study. Lancet. 2020;395:507-13.
  17. Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COV ID-19 patients. Int Immunopharmacol.2020; 84:106504.
  18. POZDNYAKOVA, Olga, et al. Clinical significance of CBC and WBC morphology in the diagnosis and clinical course of COVID-19 infection. American journal of clinical pathology, 2021, 155.3: 364-375.‏Rajab Mardani,1 Abbas Ahmadi Vasmehjani,2 Fatemeh Zali,3 Alireza Gholami,4 Seyed Dawood Mousavi Nasab et al, Laboratory Parameters in Detection of COVID-19 Patients with Positive RT-PCR; a Diagnostic Accuracy Study, Published online 2020 Apr 4.
  19. MARDANI, Rajab, et al. Laboratory parameters in detection of COVID-19 patients with positive RT-PCR; a diagnostic accuracy study. Archives of academic emergency medicine, 2020, 8.1.‏
  20. Zhou Y, Zhang Z, Tian J, Xiong S. Risk factors associated with disease progression in a cohort of patients infected with the 2019 novel coronavirus. Ann Palliat Med. 2020;9:428-36.
  21. Kim ES, Chin BS, Kang CK, Kim NJ, Kang YM, Choi JP, et al; Korea National Committee for Clinical Management of COV ID-19. Clinical course and outcomes of patients with severe acute respiratory syndrome coronavirus 2 infection: a preliminary report of the first 28 patients from the Korean Cohort Study on COV ID-19. J Korean Med Sci. 2020;35 :e142.
  22. Raymond Pranata and Ian Huang , Lymphopenia in severe coronavirus disease (COVID-19): systematic review and meta-analysis, Huang and Pranata Journal of Intensive Care 2020;8:36 https://doi.org/10.1186/s40560-020-00453-4.
  23. Ahmet Nalbant, Tezcan Kaya, Ceyhun Varim1, Selçuk Yaylaci1, Ali Tamer, Hakan Cinemre, neutrophil/lymphocyte ratio (NLR) have a role in the diagnosis of coronavirus 2019 disease. Sakarya University School of Medicine Departments of Internal Medicine, http://dx.doi.org/10.1590/1806-9282.66.6.746.
 

  1. ElnazVafadar Moradi, Ali Teimouri, Ramin Rezaee, Negar Morovatdar, Mahdi Foroughian, Parvaneh Layeghe Behrang Rezvani Kakhkia Seyed Reza Ahmadi KoupaeiVahidehGhoranic, Increased age, neutrophil-to-lymphocyte ratio (NLR) and white blood cells count are associated with higher COVID-19 mortality. The American Journal of Emergency Medicine , February 2021.
TATUM, Danielle, et al. Neutrophil-to-lymphocyte ratio and outcomes in Louisiana COVID-19 patients. Shock, 2020, 54.5: 652-658.‏

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