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