Use of the neutrophil-to-lymphocyte ratio and an oxygen requirement to predict disease severity in patients with COVID-19

Takuya Ozawa; Takanori Asakura; Shotaro Chubachi; Ho Namkoong; Hiromu Tanaka; Ko Lee; Takahiro Fukushima; Shiro Otake; Kensuke Nakagawara; Mayuko Watase; Katsunori Masaki; Hirofumi Kamata; Makoto Ishii; Naoki Hasegawa; Norihiro Harada; Tetsuya Ueda; Soichiro Ueda; Takashi Ishiguro; Ken Arimura; Fukuki Saito; Takashi Yoshiyama; Yasushi Nakano; Yoshikazu Mutoh; Yusuke Suzuki; Ryuya Edahiro; Koji Murakami; Yukinori Okada; Ryuji Koike; Yuko Kitagawa; Katsushi Tokunaga; Akinori Kimura; Seiya Imoto; Satoru Miyano; Seishi Ogawa; Takanori Kanai; Koichi Fukunaga; Japan COVID-19 Task Force

doi:10.1016/j.resinv.2023.03.007

Use of the neutrophil-to-lymphocyte ratio and an oxygen requirement to predict disease severity in patients with COVID-19

Respir Investig. 2023 Jul;61(4):454-459. doi: 10.1016/j.resinv.2023.03.007. Epub 2023 Apr 19.

Authors

Takuya Ozawa¹, Takanori Asakura², Shotaro Chubachi¹, Ho Namkoong³, Hiromu Tanaka¹, Ko Lee¹, Takahiro Fukushima¹, Shiro Otake¹, Kensuke Nakagawara¹, Mayuko Watase⁴, Katsunori Masaki¹, Hirofumi Kamata¹, Makoto Ishii¹, Naoki Hasegawa³, Norihiro Harada⁵, Tetsuya Ueda⁶, Soichiro Ueda⁷, Takashi Ishiguro⁸, Ken Arimura⁹, Fukuki Saito¹⁰, Takashi Yoshiyama¹¹, Yasushi Nakano¹², Yoshikazu Mutoh¹³, Yusuke Suzuki¹⁴, Ryuya Edahiro¹⁵, Koji Murakami¹⁶, Yukinori Okada¹⁷, Ryuji Koike¹⁸, Yuko Kitagawa¹⁹, Katsushi Tokunaga²⁰, Akinori Kimura²¹, Seiya Imoto²², Satoru Miyano²³, Seishi Ogawa²⁴, Takanori Kanai²⁵, Koichi Fukunaga¹; Japan COVID-19 Task Force

Affiliations

¹ Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
² Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan; Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan; Department of Clinical Medicine (Laboratory of Bioregulatory Medicine), Kitasato University School of Pharmacy, Tokyo, Japan. Electronic address: takanori.asakura@keio.jp.
³ Department of Infectious Diseases, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan.
⁴ Department of Respiratory Medicine, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
⁵ Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan.
⁶ Department of Respiratory Medicine, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan.
⁷ JCHO (Japan Community Health Care Organization) Saitama Medical Center, Internal Medicine, Saitama, Japan.
⁸ Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Kumagaya, Japan.
⁹ Department of Respiratory Medicine, Tokyo Women's Medical University, Tokyo, Japan.
¹⁰ Department of Emergency and Critical Care Medicine, Kansai Medical University General Medical Center, Moriguchi, Japan.
¹¹ Fukujuji Hospital, Kiyose, Japan.
¹² Kawasaki Municipal Ida Hospital, Department of Internal Medicine, Kawasaki, Japan.
¹³ Department of Infectious Diseases, Tosei General Hospital, Seto, Japan.
¹⁴ Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan; Department of Clinical Medicine (Laboratory of Bioregulatory Medicine), Kitasato University School of Pharmacy, Tokyo, Japan.
¹⁵ Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan.
¹⁶ Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
¹⁷ Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan; Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan; The Center for Infectious Disease Education and Research (CiDER), Osaka University, Suita, Japan; Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan.
¹⁸ Medical Innovation Promotion Center, Tokyo Medical and Dental University, Tokyo, Japan.
¹⁹ Department of Surgery, Keio University School of Medicine, Tokyo, Japan.
²⁰ Genome Medical Science Project (Toyama), National Center for Global Health and Medicine, Tokyo, Japan.
²¹ Institute of Research, Tokyo Medical and Dental University, Tokyo, Japan.
²² Division of Health Medical Intelligence, Human Genome Center, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
²³ M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan.
²⁴ Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan; Institute for the Advanced Study of Human Biology (WPI-ASHBi), Kyoto University, Kyoto, Japan; Department of Medicine, Center for Hematology and Regenerative Medicine, Karolinska Institute, Stockholm, Sweden.
²⁵ Division of Gastroenterology and Hepatology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.

Abstract

We investigated the association between complete blood count, including neutrophil-to-lymphocyte ratio (NLR) in combination with patient characteristics, and coronavirus disease (COVID-19) outcomes to identify the best prognostic indicator. We analyzed data of patients with confirmed COVID-19 from the nationwide database of the Japan COVID-19 Task Force between February 2020 and November 2021. A composite outcome was defined as the most severe condition, including noninvasive positive-pressure ventilation, high-flow nasal cannula, invasive mechanical ventilation, extracorporeal membrane oxygenation, or death. Of 2425 patients in the analysis, 472 (19.5%) experienced a composite outcome. NLR was the best predictor of composite outcomes, with an area under the curve (AUC) of 0.81, and a sensitivity and specificity of 72.3% and 75.7%, respectively, using a cut-off value of 5.04. The combination of NLR and an oxygen requirement on admission had the highest AUC (0.88). This simple combination may help identify patients at risk of progression to severe disease.

Keywords: Area under the curve; COVID-19; Neutrophil-to-lymphocyte ratio; Prognostic indicator; SARS-CoV-2.

MeSH terms

COVID-19*
Humans
Lymphocytes
Neutrophils
Oxygen
Patient Acuity
Retrospective Studies
SARS-CoV-2

Substances

Oxygen