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Research ArticleOriginal Article
Open Access

The use of neutrophil-to-lymphocyte ratio (NLR) as a marker for COVID-19 infection in Saudi Arabia

A case-control retrospective multicenter study

Anwar A. Sayed, Assem A. Allam, Ayman I. Sayed, Mohammed A. Alraey and Mercy V. Joseph
Saudi Medical Journal April 2021, 42 (4) 370-376; DOI: https://doi.org/10.15537/smj.2021.42.4.20200818
Anwar A. Sayed
From the Department of Medical Microbiology and Immunology (Sayed AA), Faculty of Medicine, Taibah University; from the Department of Internal Medicine (Sayed AI), Nojood Medical Center, Madinah; Department of Infection Control (Allam, Alraey, Joseph), King Abdullah Bin Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia; and form the Department of Surgery and Cancer (Sayed AA), Imperial College London, London, United Kingdom.
MBBS, PhD
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  • For correspondence: [email protected]
Assem A. Allam
From the Department of Medical Microbiology and Immunology (Sayed AA), Faculty of Medicine, Taibah University; from the Department of Internal Medicine (Sayed AI), Nojood Medical Center, Madinah; Department of Infection Control (Allam, Alraey, Joseph), King Abdullah Bin Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia; and form the Department of Surgery and Cancer (Sayed AA), Imperial College London, London, United Kingdom.
MBBS, MD
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Ayman I. Sayed
From the Department of Medical Microbiology and Immunology (Sayed AA), Faculty of Medicine, Taibah University; from the Department of Internal Medicine (Sayed AI), Nojood Medical Center, Madinah; Department of Infection Control (Allam, Alraey, Joseph), King Abdullah Bin Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia; and form the Department of Surgery and Cancer (Sayed AA), Imperial College London, London, United Kingdom.
MBBS
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Mohammed A. Alraey
From the Department of Medical Microbiology and Immunology (Sayed AA), Faculty of Medicine, Taibah University; from the Department of Internal Medicine (Sayed AI), Nojood Medical Center, Madinah; Department of Infection Control (Allam, Alraey, Joseph), King Abdullah Bin Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia; and form the Department of Surgery and Cancer (Sayed AA), Imperial College London, London, United Kingdom.
MBBS, MD
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Mercy V. Joseph
From the Department of Medical Microbiology and Immunology (Sayed AA), Faculty of Medicine, Taibah University; from the Department of Internal Medicine (Sayed AI), Nojood Medical Center, Madinah; Department of Infection Control (Allam, Alraey, Joseph), King Abdullah Bin Abdulaziz University Hospital, Riyadh, Kingdom of Saudi Arabia; and form the Department of Surgery and Cancer (Sayed AA), Imperial College London, London, United Kingdom.
BSN, CIC
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  • Figure 1
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    Figure 1

    - Comparisons of neutrophil-to-lymphocyte ratios (NLR) between the control and COVID-19 cohorts. The bar charts demonstrate the differences of the median NLR between the control group (blue) and of the COVID-19 patients (red) which is significantly higher in the latter. HC: healthy control, ****denotes a p<0.0001

  • Figure 2
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    Figure 2

    - Comparisons of neutrophil-to-lymphocyte ratios (NLR) between the different cohorts. The bar charts demonstrate the differences of the median NLR between the different cohorts. The chart shows that the control cohort (blue) which has the lowest NLR value compared to non-intensive patients (red), and the ICU patients (green). ICU patients have the highest NLR compared to the other cohorts. HC: healthy control; ICU: intensive care unit, **denotes a p<0.01, **** denotes a p<0.0001.

Tables

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    Table 1

    - Clinical characteristics and laboratory results of the control and Covid-19 cohorts.

    CharacteristicsControls (n=250) median (95% CI)COVID-19 cases (n=701) median (95% CI)P-value
    Gender, n (%)
    Male Female138 (55.2) 112 (44.8)317 (45.2) 384 (54.8)0.0079*
    Age (years)48 (44.58-48.13)35 (35.09-37.77)<0.0001*
    Red blood cell x106/L5.08 (5.02-5.11)4.75 (4.65-4.78)<0.0001*
    Hemoglobin g/dL14 (13.6-14.06)13.2 (11.79-12.52)<0.0001*
    Mean corpuscular volume fL90.35 (88.74-90.8)86.35 (84.98-86.33)<0.0001*
    Mean corpuscular hemoglobin pg29.55 (29.28-29.69)28.7 (27.96-28.49)<0.0001*
    Mean corpuscular hemoglobin concentration g/dL33 (32.91-33.14)33 (32.51-33.02)0.63
    Platelet count x103/μl309.5 (297.5-320.7)231.5 (242.2-260.8)<0.0001*
    White blood cell count x103/μl7.2 (6.92-7.37)5.5 (6.12-6.83)<0.0001*
    Neutrophil count x103/μl4.4 (4.28-4.64)3.48 (4.09-4.75)<0.0001*
    Neutrophil percentage58 (56.03-58.6)66.8 (63.35-66.47)<0.0001*
    Lymphocyte count x103/μl2.1 (1.95-2.1)0.9 (0.9-1.31)<0.0001*
    Lymphocyte percentage30.45 (29.8-31.31)22.6 (22.88-25.61)<0.0001*
    Monocyte count x103/μl0.6 (0.61-0.69)0.33 (0.33-0.61)<0.0001*
    Neutrophil-to-lymphocyte ratio2.18 (2.3-2.6)2.9 (4.24-5.31)<0.0001*
    • The table demonstrates the clinical characteristics and the complete blood results of both the control and patients’cohorts.

    • Laboratory results are stated as median values with 95% confidence intervals between brackets, unless stated otherwise.

    • ↵*Statistical significance. CI: confidence intervals

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    Table 2

    - Clinical characteristics and laboratory results of the control and both patients’ cohorts (non-intensive and intensive care unit [ICU]-admitted) Covid-19 patients.

    CharacteristicsControls (n=250)Non-intensive COVID-19 cases (n=660)ICU-admitted COVID-19 patients (n=41)P-value (Kruskal Wallis)P -value (between non-intensive and ICU)
    Gender, n (%)
    Male138 (55.2) 112295 (44.7) 36522 (53.66)0.013*0.12
    Female(44.8)(55.3)19 (46.34)
    Age, years48 (44.58-48.13)35 (34.6-37.26)45 (36.51-52.47)<0.0001*0.0062*
    Red blood cell count x106/L5.08 (5.02-5.11)4.72 (4.63-4.76)4.6 (4.27-4.8)<0.0001*0.37
    Hemoglobin: g/dL14 (13.65-14.06)13.6 (13.01-14.25)13.2 (12.09-13.35)0.0012*0.067
    Mean corpuscular fL90.35 (88.74-90.8)86.4 (84.9-86.34)86.3 (83.35-88.14)<0.0001*0.91
    Mean corpuscular hemoglobin pg29.55 (29.28-29.69)28.8 (27.93-28.51)28.6 (27.58-28.94)<0.0001*0.63
    Mean corpuscular hemoglobinconcentration g/dL33 (32.91-33.14)33 (32.62-33.06)32.8 (32.54-33.22)0.720.5
    Platelet count x103/μl309.5 (297.5-320.7)230 (238.9-258.3)249 (245.5-309.9)<0.0001*0.046*
    White blood cell count x103/μl7.2 (6.92-7.37)5.37 (5.9-6.58)6.96 (6.96-10.29)<0.0001*0.0008*
    Neutrophil count x103/μl4.4 (4.28-4.64)3.39 (3.92-4.56)4.6 (4.47-7.57)<0.0001*0.0043*
    Neutrophil percentage58 (56.03-58.6)66.1 (62.82-65.98)76.05 (68.12-78.53)<0.0001*0.0005*
    Lymphocyte count x103/μl2.1 (1.95-2.1)1.2 (1.25-1.46)1 (0.92-1.63)<0.0001*0.05
    Lymphocyte percentage30.45 (29.8-31.31)23.05 (23.3-26.13)14.2 (13.29-21.34)<0.0001*0.0007*
    Monocyte count x103/μl0.6 (0.61-0.69)0.32 (0.31-0.62)0.38 (0.37-0.62)<0.0001*0.17
    Neutrophil-to-lymphocyte ratio2.18 (2.3-2.6)2.85 (3.89-4.9)5.5 (5.87-11.66)<0.0001*0.0014*
    • Laboratory results are stated asmedian values with 95% confidence intervals between brackets, unless stated otherwise.

    • ↵* Statistical significance

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Saudi Medical Journal: 42 (4)
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1 Apr 2021
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The use of neutrophil-to-lymphocyte ratio (NLR) as a marker for COVID-19 infection in Saudi Arabia
Anwar A. Sayed, Assem A. Allam, Ayman I. Sayed, Mohammed A. Alraey, Mercy V. Joseph
Saudi Medical Journal Apr 2021, 42 (4) 370-376; DOI: 10.15537/smj.2021.42.4.20200818

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The use of neutrophil-to-lymphocyte ratio (NLR) as a marker for COVID-19 infection in Saudi Arabia
Anwar A. Sayed, Assem A. Allam, Ayman I. Sayed, Mohammed A. Alraey, Mercy V. Joseph
Saudi Medical Journal Apr 2021, 42 (4) 370-376; DOI: 10.15537/smj.2021.42.4.20200818
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Keywords

  • complete blood count
  • COVID-19
  • NLR
  • prognosis
  • Saudi Arabia

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