Comparison of hemoglobin level and neutrophil to lymphocyte ratio as prognostic markers in patients with COVID-19
Shaimaa Hani Fouad (1),
Mohamed Farouk Allam (2), Sara Ibrahim Taha (3), Ahmed Ashraf Okba (4), Amr
Hosny (5), Mayada Moneer (1) and Sylvia Wefky Roman (1)
1. Departments of
Internal Medicine and Allergy and Clinical Immunology, Faculty of Medicine, Ain
Shams University, Cairo, Egypt.
2. Department of Family
Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
3. Department of Clinical
Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
4. Department of
Radiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
5. Department of
Anesthesiology and Intensive Care, Faculty of Medicine, Ain Shams University,
Cairo, Egypt.
Journal of International
Medical Research 2021;49(7):1-15.
DOI: 10.1177/03000605211030124
Abstract
Background.
Anemia can negatively affect the outcome
of many diseases, including infections and inflammatory conditions.
Aim. To compare the prognostic value of hemoglobin level
and the neutrophil/lymphocyte ratio (NLR) for prediction of coronavirus disease
2019 (COVID-19) severity.
Methods.
In this retrospective cohort study,
clinical data from patients with laboratory-confirmed COVID-19 were collected
from hospital records from 10 April 2020 to 30 July 2020.
Results.
The proportions of patients with mild,
moderate, and severe COVID-19 differed significantly in association with
hemoglobin levels, neutrophil counts, lymphocyte counts, NLR, and total
leukocyte counts. Patients with severe COVID-19 had significantly lower
hemoglobin levels than those with moderate or mild COVID-19. There were
statistically significant negative associations between hemoglobin and D-dimer,
age, and creatinine. The optimal hemoglobin cut-off value for prediction of
disease severity was 11.6 g/dL. Using this cut-off value, hemoglobin had higher
negative predictive value and sensitivity than NLR (92.4% and 51.3%,
respectively). The specificity of hemoglobin as a prognostic marker was 79.3%.
Conclusion.
Both NLR and hemoglobin level are of
prognostic value for predicting severity of COVID-19. However, hemoglobin level
displayed higher sensitivity than NLR. Hemoglobin level should be assessed upon
admission in all patients and closely monitored throughout the disease course.
Keywords. Coronavirus disease 2019, hospital, anemia, neutrophil/lymphocyte
ratio, patient stratification, hemoglobin, intensive care unit, severity.
Journal of International Medical Research 2021;49(7):1-15.
https://journals.sagepub.com/doi/full/10.1177/03000605211030124
