Prognostic significance of C-reactive protein/albumin and neutrophil/lymphocyte ratios in patients with COVID-19
DOI:
https://doi.org/10.15584/ejcem.2024.2.14Keywords:
COVID-19, C-reactive protein/albumin, neutrophil/lymphocyteAbstract
Introduction and aim. COVID-19 causes an uncontrolled and generalized inflammatory response of the host immune system. Early recognition of the disease and early prediction of the clinical course are of great importance. The aim of this study was to evaluate the predictive role of the C-reactive protein/albumin ratio (CAR) and the neutrophil/lymphocyte ratio (NLR) for mortality in patients hospitalized with the diagnosis of COVID-19.
Material and methods. The patients, who were hospitalized for COVID-19 and whose CRP, albumin, neutrophil, and lymphocyte levels were documented within the first 24 hours after admission, were analyzed retrospectively. Patients were divided into survivors and non-survivors; the groups were compared. Univariate and multivariate Cox regression models were developed to evaluate the CAR and the NLR as risk factors for mortality in COVID-19 patients.
Results. One hundred and thirty patients were included in this study. The mean age of the survivor group (n=114) was 60±16 and 52% were male. The mean age of the non-survivor group (n=16) was 75±13 and 56% were male. In the non-survivor group, the CAR detected at the time of admission to the hospital was significantly higher compared to patients in the survivor group (p=0.026).
Conclusion. As a result, the CAR, the NLR and LDH are independent risk factor indicators of mortality in hospitalized patients
Downloads
References
Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-733. doi: 10.1056/NEJMoa2001017
Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020;382(18):1708-1720. doi: 10.1056/NEJMoa2002032
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi: 10.1016/S0140-6736(20)30183-5
Asrani P, Eapen MS, Chia C, et al. Diagnostic approaches in COVID-19: clinical updates. Expert Rev Respir Med. 2021;15(2):197-212. doi: 10.1080/17476348.2021.1823833
Liao D, Zhou F, Luo L, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study. Lancet Haematol. 2020;7(9):671-678. doi: 10.1016/S2352-3026(20)30217-9
Thompson S, Bohn MK, Mancini N, et al. IFCC interim guidelines on biochemical/hematological monitoring of COVID-19 patients. Clin Chem Lab Med. 2020;58(12):2009-2016. doi: 10.1515/cclm-2020-1414
Angkananard T, Anothaisintawee T, McEvoy M, et al. Neutrophil lymphocyte ratio and cardiovascular disease risk: a systematic review and meta-analysis. Biomed Res Int. 2018;2018:2703518. doi: 10.1155/2018/2703518
Huang Z, Fu Z, Huang W, et al. Prognostic value of neutrophil-to-lymphocyte ratio in sepsis: A meta-analysis. Am J Emerg Med. 2020;38(3):641-647. doi: 10.1016/j.ajem.2019.10.023
Aksu Y, Uslu AU, Tarhan G, et al. Predictive value of platelet to lymphocyte ratio and neutrophil to lymphocyte ratio in evaluating both lung involvement and severity of patients with coronavirus disease 2019. Saudi Med J. 2021;42(11):1223-1228. doi: 10.15537/smj.2021.42.11.20210485
Alkhatip AAAMM, Kamel MG, Hamza MK, et al. The diagnostic and prognostic role of neutrophil-to-lymphocyte ratio in COVID-19: a systematic review and meta-analysis. Expert Rev Mol Diagn. 2021;21(5):505-514. doi: 10.1080/14737159.2021.1915773
Henry BM, De Oliveira MHS, Benoit S, et al. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020;58(7):1021-1028. doi: 10.1515/cclm-2020-0369
Imran MM, Ahmad U, Usman U, Ali M, Shaukat A, Gul N. Neutrophil/lymphocyte ratio-A marker of COVID-19 pneumonia severity. Int J Clin Pract. 2021;75(4):13698. doi: 10.1111/ijcp.13698
Liu Y, Du X, Chen J, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020;81(1):6-12. doi: 10.1016/j.jinf.2020.04.002
Sarkar S, Khanna P, Singh AK. The Impact of Neutrophil-Lymphocyte Count Ratio in COVID-19: A Systematic Review and Meta-Analysis. J Intensive Care Med. 2022;37(7):857-869. doi: 10.1177/08850666211045626
Yang A-P, Liu J-P, Tao W-Q, et al. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504. doi: 10.1016/j.intimp.2020.106504
Gibson DJ, Hartery K, Doherty J, et al. CRP/Albumin Ratio. J Clin Gastroenterol. 2018;52(6):48-52. doi: 10.1097/MCG.0000000000000884
Devran Ö, Karakurt Z, Adıgüzel N, et al. C-reactive protein as a predictor of mortality in patients affected with severe sepsis in intensive care unit. Multidiscip Respir Med. 2012;7(1):47. doi: 10.1186/2049-6958-7-47
Karabağ Y, Çağdaş M, Rencuzogullari I, et al. Relationship between C‐reactive protein/albumin ratio and coronary artery disease severity in patients with stable angina pectoris. J Clin Lab Anal. 2018;32(7):22457. doi: 10.1002/jcla.22457
Zhang J, Wang X, Jia X, et al. Risk factors for disease severity, unimprovement, and mortality in COVID-19 patients in Wuhan, China. Clin Microbiol Infect. 2020;26(6):767-772. doi: 10.1016/j.cmi.2020.04.012
Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020;71(15):762-768. doi: 10.1093/cid/ciaa248
Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest. 2003;111(12):1805-1812. doi: 10.1172/JCI18921
Luan YY, Yin CH, Yao YM. Update Advances on C-Reactive Protein in COVID-19 and Other Viral Infections. Front Immunol. 2021;12:720363. doi: 10.3389/fimmu.2021.720363
Yap F, Joynt G, Buckley T, et al. Association of serum albumin concentration and mortality risk in critically ill patients. Anaesth Intensive Care. 2002;30(2):202-207. doi: 10.1177/0310057X0203000213
Aziz M, Fatima R, Lee-Smith W, et al. The association of low serum albumin level with severe COVID-19: a systematic review and meta-analysis. Crit Care. 2020;24(1):255. doi: 10.1186/s13054-020-02995-3
Torun A, Çakırca TD, Çakırca G, et al. The value of C-reactive protein/albumin, fibrinogen/albumin, and neutrophil/lymphocyte ratios in predicting the severity of CoVID-19. Rev Assoc Med Bras (1992). 2021;67(3):431-436. doi: 10.1590/1806-9282.20200883
Karakoyun I, Colak A, Turken M, et al. Diagnostic utility of C-reactive protein to albumin ratio as an early warning sign in hospitalized severe COVID-19 patients. Int Immunopharmacol. 2021;91:107285. doi: 10.1016/j.intimp.2020.107285
Saylik F, Akbulut T, Kaya S. Can C-Reactive Protein to Albumin Ratio Predict In-Hospital Death Rate Due to COVID-19 in Patients With Hypertension? Angiology. 2021;72(10):947-952. doi: 10.1177/00033197211012145
Lucijanić M, Stojić J, Atić A, et al. Clinical and prognostic significance of C-reactive protein to albumin ratio in hospitalized coronavirus disease 2019 (COVID-19) patients : Data on 2309 patients from a tertiary center and validation in an independent cohort. Wien Klin Wochenschr. 2022;134(9-10):377-384. doi: 10.1007/s00508-021-01999-5
Özdemir S, Altunok İ. Comparison of the Predictive Ability of the Blood Urea Nitrogen/Albumin, C-Reactive Protein/Albumin, and Lactate/Albumin Ratios for Short-Term Mortality in SARS-CoV-2-Infected Patients. Avicenna J Med. 2023;13(1):43-48. doi: 10.1055/s-0043-1761471
Kalabin A, Mani VR, Valdivieso SC, et al. Does C reactive protein/Albumin ratio have prognostic value in patients with COVID-19. J Infect Dev Ctries. 2021;15(8):1086-1093. doi: 10.3855/jidc.14826
Howard R, Scheiner A, Kanetsky PA, et al. Sociodemographic and lifestyle factors associated with the neutrophil-to-lymphocyte ratio. Ann Epidemiol. 2019;38:11-21.e6. doi: 10.1016/j.annepidem.2019.07.015
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 European Journal of Clinical and Experimental Medicine
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our open access policy is in accordance with the Budapest Open Access Initiative (BOAI) definition: this means that articles have free availability on the public Internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from having access to the Internet itself.
All articles are published with free open access under the CC-BY Creative Commons attribution license (the current version is CC-BY, version 4.0). If you submit your paper for publication by the Eur J Clin Exp Med, you agree to have the CC-BY license applied to your work. Under this Open Access license, you, as the author, agree that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. This facilitates freedom in re-use and also ensures that Eur J Clin Exp Med content can be mined without barriers for the research needs.
