Neutrophil-to-Lymphocyte Ratios Are Closely Associated With the Severity and Course of Non-mild COVID-19

Abstract

<sec><title>Background</title> Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is spreading worldwide. Measuring the prevention and control of the disease has become a matter requiring urgent focus. </sec><sec><title>Objective</title> Based on coronavirus disease 2019 (COVID-19) clinical data from Wuhan, we conducted an in-depth analysis to clarify some of the pathological mechanisms of the disease and identify simple measures to predict its severity early on. </sec><sec><title>Methods</title> A total of 230 patients with non-mild COVID-19 were recruited, and information on their clinical characteristics, inflammatory cytokines, and T lymphocyte subsets was collected. Risk factors for severity were analyzed by binary logistic regression, and the associations of neutrophil-to-lymphocyte ratios (N/LRs) with illness severity, disease course, CT grading, inflammatory cytokines, and T lymphocyte subsets were evaluated. </sec><sec><title>Results</title> Our results showed that the N/LRs were closely related to interleukin (IL)-6 and IL-10 (<italic>P</italic> &lt; 0.001, <italic>P</italic> = 0.024) and to CD3⁺ and CD8⁺ T lymphocytes (<italic>P</italic> &lt; 0.001, <italic>P</italic> = 0.046). In particular, the N/LRs were positively correlated with the severity and course of the disease (<italic>P</italic> = 0.021, <italic>P</italic> &lt; 0.001). Compared to the values at the first test after admission, IL-6 and IL-10 were significantly decreased and increased, respectively, as of the last test before discharge (<italic>P</italic> = 0.006, <italic>P</italic> &lt; 0.001). More importantly, through binary logistic regression, we found that male sex, underlying diseases (such as cardiovascular disease), pulse, and N/LRs were all closely related to the severity of the disease (<italic>P</italic> = 0.004, <italic>P</italic> = 0.012, <italic>P</italic> = 0.013, <italic>P</italic> = 0.028). </sec><sec><title>Conclusions</title> As a quick and convenient marker of inflammation, N/LRs may predict the disease course and severity level of non-mild COVID-19; male sex, cardiovascular disease, and pulse are also risk factors for the severity of non-mild COVID-19. </sec>