Can hematologic inflammatory parameters predict the severity of coronavirus disease 2019 at hospital admission?

Abstract

Background
The ability to forecast the progression and severity of coronavirus disease 2019 (COVID-19) disease is critical for effective management.


Objective
To determine whether hematological parameters can predict severe COVID-19 at the time of hospital admission.


Patients and methods
The study was conducted on 298 admitted COVID-19 patients. They were categorized into severe or nonsevere groups. Blood picture was done with analysis of red-cell distribution width (RDW), neutrophil–lymphocyte ratio (NLR), RDW-to-platelet ratio, and platelet–lymphocyte ratio (PLR). Other investigations like D-dimer, ferritin, C-reactive protein, kidney, and liver functions were assessed and compared between the groups.


Results
Males were predominant in the severe group (65.7%). Compared with the nonsevere group, the severe group had a higher median age (59 vs. 37 years). The severe group showed significantly lower counts for lymphocytes and platelets (P=0.000), while the total leukocytic count and neutrophils were significantly higher compared with the nonsevere group. Also, the severe group showed significantly higher ratios regarding NLR and PLR (P=0.021 and 0.000, respectively). RDW and RDW-to-platelet ratio values were not significantly different between both groups. While assessing the risk factors for severe COVID-19, the highest odds ratio was observed for NLR, odds ratio: 1.954 (confidence interval: 1.404–2.718). A cut-off point of NLR more than 1.67 had high sensitivity 81.3 and 60.2% specificity with high accuracy; area under the curve=0.780. PLR at a cutoff more than 176 showed 70.5% sensitivity and 62% specificity with high accuracy area under the curve=0.760.


Conclusion
NLR and PLR could be used as simple, readily available, and cost-effective biomarkers predicting the severity of cases of COVID-19. Hematologic parameter values mostly alter amid the course of the illness.