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Systematic Review

The Role of Neutrophil-to-Lymphocyte Ratio in Risk Stratification and Prognostication of COVID-19: A Systematic Review and Meta-Analysis

1
Allergy, Asthma, and Chest Centre, Krishnamurthypuram, Mysore 570004, India
2
Yenepoya Medical College, Yenepoya University, Mangalore 575018, India
3
Department of Respiratory Medicine, JSS Medical College, JSSAHER, Mysore 570015, India
4
University Hospitals Birmingham NHS Foundation Trust, Institute of Immunology Immunotherapy, University of Birmingham, Birmingham B15 2GW, UK
5
Unit of Integrative Toxicology, Institute of Environmental Medicine (IMM), Karolinska Institutet, 17177 Stockholm, Sweden
*
Authors to whom correspondence should be addressed.
These authors contributed equally to this work.
Academic Editors: Jose Moisés Laparra and Juan Antonio Giménez-Bastida
Vaccines 2022, 10(8), 1233; https://doi.org/10.3390/vaccines10081233
Received: 26 June 2022 / Revised: 27 July 2022 / Accepted: 28 July 2022 / Published: 1 August 2022
(This article belongs to the Special Issue Research in Innate and Adaptive Immunity)
Several studies have proposed that the neutrophil–lymphocyte ratio (NLR) is one of the various biomarkers that can be useful in assessing COVID-19 disease-related outcomes. Our systematic review analyzes the relationship between on-admission NLR values and COVID-19 severity and mortality. Six different severity criteria were used. A search of the literature in various databases was conducted from 1 January 2020 to 1 May 2021. We calculated the pooled standardized mean difference (SMD) for the collected NLR values. A meta-regression analysis was performed, looking at the length of hospitalization and other probable confounders, such as age, gender, and comorbidities. A total of sixty-four studies were considered, which included a total of 15,683 patients. The meta-analysis showed an SMD of 3.12 (95% CI: 2.64–3.59) in NLR values between severe and non-severe patients. A difference of 3.93 (95% CI: 2.35–5.50) was found between survivors and non-survivors of the disease. Upon summary receiver operating characteristics analysis, NLR showed 80.2% (95% CI: 74.0–85.2%) sensitivity and 75.8% (95% CI: 71.3–79.9%) specificity for the prediction of severity and 78.8% (95% CI: 73.5–83.2%) sensitivity and 73.0% (95% CI: 68.4–77.1%) specificity for mortality, and was not influenced by age, gender, or co-morbid conditions. Conclusion: On admission, NLR predicts both severity and mortality in COVID-19 patients, and an NLR > 6.5 is associated with significantly greater the odds of mortality. View Full-Text
Keywords: COVID-19; neutrophil-to-lymphocyte ratio; systematic review; COVID-19 mortality; COVID-19 severity; COVID-19 outcomes; NLR COVID-19; neutrophil-to-lymphocyte ratio; systematic review; COVID-19 mortality; COVID-19 severity; COVID-19 outcomes; NLR
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MDPI and ACS Style

Parthasarathi, A.; Padukudru, S.; Arunachal, S.; Basavaraj, C.K.; Krishna, M.T.; Ganguly, K.; Upadhyay, S.; Anand, M.P. The Role of Neutrophil-to-Lymphocyte Ratio in Risk Stratification and Prognostication of COVID-19: A Systematic Review and Meta-Analysis. Vaccines 2022, 10, 1233. https://doi.org/10.3390/vaccines10081233

AMA Style

Parthasarathi A, Padukudru S, Arunachal S, Basavaraj CK, Krishna MT, Ganguly K, Upadhyay S, Anand MP. The Role of Neutrophil-to-Lymphocyte Ratio in Risk Stratification and Prognostication of COVID-19: A Systematic Review and Meta-Analysis. Vaccines. 2022; 10(8):1233. https://doi.org/10.3390/vaccines10081233

Chicago/Turabian Style

Parthasarathi, Ashwaghosha, Sunag Padukudru, Sumalata Arunachal, Chetak Kadabasal Basavaraj, Mamidipudi Thirumala Krishna, Koustav Ganguly, Swapna Upadhyay, and Mahesh Padukudru Anand. 2022. "The Role of Neutrophil-to-Lymphocyte Ratio in Risk Stratification and Prognostication of COVID-19: A Systematic Review and Meta-Analysis" Vaccines 10, no. 8: 1233. https://doi.org/10.3390/vaccines10081233

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