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Can Hematological Ratios Predict Outcome of COVID-19 Patients? Egyptian Multicentric Study

Coronaviruses belong to a large family of viruses that lead to respiratory infection of various severity. Hematological ratios are indicators of the inflammatory response that are widely used in viral pneumonia with affordability in developing countries. Aim: Study the role of the Neutrophil Lymphocyte ratio(NLR), derived NLR ratio(d-NLR), Platelet Lymphocyte ratio(PL/LR), and Lymphocyte Monocyte ratio(LMR) in predicting the outcome of COVID-19 Egyptian patients. Methods: A retrospective study on 496 COVID-19 Egyptian patients, managed in four tertiary centers; grouped into non-severe, severe, and critical. Results: Critical group of patients had the highest Total leucocyte count(TLC), absolute neutrophil count(ANC), absolute monocyte count(AMC), NLR, d-NLR and, PL/LR (pl0.001 for all except AMC p=0.03) in addition to the least absolute lymphocyte count(ALC) and LMR (p=0.04 and l0.001 respectively). We calculated the optimal cut-off values of the hematological ratio; NLR(3.5), d-NLR(2.86), PL/LR(192), and LMR(3). D-NLR had the highest specificity(89.2%) while NLR had the highest sensitivity(71.4%). By univariate logistic regression; age, DM, HTN, cardiovascular diseases, COPD, NLR, d-NLR, LMR and PL/LR, CRP, steroid, oxygen aids, and mechanical ventilation were associated with severity of COVID-19 but only age, NLR, CRP, and oxygen aid were independent predictors in multivariate logistic regression. Conclusion: NLR is a predictor for severity in COVID-19. LMR, d-NLR, and PL/LR may assist in risk stratification.