European Journal of Therapeutics
Original Article

The Neutrophil to Lymphocyte Ratio and In-Hospital All-Cause Mortality in Patients with COVID-19


Department of Cardiology, İstanbul Aydın University VM Medical Park Florya Hospital, İstanbul, Turkey


Clinic of Cardiology, Medline Hospital Adana, Adana, Turkey


Clinic of Cardiology, Düzce Atatürk State Hospital, Düzce, Turkey


Department of Cardiology, Okmeydanı Training and Research Hospital, İstanbul, Turkey


Clinic of Cardiology, Ağrı State Hospital, Ağrı, Turkey


Department of Cardiology, Adana City Training and Research Hospital, Adana, Turkey

Eur J Ther 2020; 26: 251-256
DOI: 10.5152/eurjther.2020.20067
Read: 2201 Downloads: 692 Published: 22 September 2020

Objective: In December 2019, pneumonia associated with severe acute respiratory syndrome coronavirus 2 emerged in China, and has been spread worldwide eventuating the coronavirus disease 2019 (COVID-19) pandemic. As of June 27, 2020, 195,883 people have been diagnosed with COVID-19 in Turkey, among them 5082 are dead. Moreover, 9,999,606 people were infected worldwide. The neutrophil-to-lymphocyte ratio (NLR) has been reported as an inflammatory biomarker. This study aimed to evaluate the relationship between NLR on admission and in-hospital all-cause mortality in adult patients with COVID-19.

Methods: This retrospective cohort study included a total of 455 COVID-19 patients from Turkey. The diagnosis of COVID-19 was made according to the World Health Organization’s interim guidance and confirmed by RNA detection of SARS-CoV-2. The NLR was calculated for each patient.

Results: The NLR on admission was found to be significantly higher in nonsurvivor COVID-19 patients than survivors (12.3 [0.8–137.3] vs. 3.2 [0.6–79.0], p<0.001). Forward stepwise logistic regression analysis was carried out to determine the independent predictors of in-hospital all-cause mortality of patients with COVID-19. The analysis demonstrated that age [odds ratio (OR)=1.203, 95% confidence interval (CI): 1.027–1.408, p=0.022], NLR (OR=1.261, 95% CI: 1.054–1.509, p=0.011), lactate dehydrogenase level (OR=1.013, 95% CI: 1.004–1.022, p=0.005), glomerular filtration rate (OR=0.920, 95% CI: 0.853–0.992, p=0.030), alanine transaminase level (OR=1.107, 95% CI: 1.011–1.212, p=0.028), and aspartate transaminase level on admission (OR=0.939, 95% CI: 0.888–0.993, p=0.027) were independent predictors of in-hospital all-cause mortality of patients with COVID-19. In the receiver operating characteristic curve analysis, the sensitivity and specificity of the NLR for predicting in-hospital all-cause mortality were found to be 92% and 53%, respectively, at the cut-off value of 3.

Conclusion: The NLR on admission predicts in-hospital all-cause mortality of patients with COVID-19.

How to cite: Allahverdiyev S, Quisi A, Harbalıoğlu H, Alıcı G, Genç Ö, Yıldırım A, et al. The Neutrophil to Lymphocyte Ratio and in Hospital All-Cause Mortality in Patients with COVID-19. Eur J Ther 2020; 26(3): 251-6.

EISSN 2564-7040