# Analysis of Neutrophil Lymphocyte Ratio and Absolute Lymphocyte Count as Predictors of Severity of COVID-19 Patients
> Selanno Y.

URL kanonis: https://discover.unhas.ac.id/publications/analysis-of-neutrophil-lymphocyte-ratio-and-absolute-lymphocyte-count-as-predict
Jurnal / Konferensi: Indonesian Journal of Clinical Pathology and Medical Laboratory
Tahun terbit: 2021
DOI: https://doi.org/10.24293/ijcpml.v27i2.1738
ISSN: 24774685
Kuartil SJR: Q4
Citations: 8

## Authors
- Selanno Y.

## Abstract
It is important to predict the severity of COVID-19 during the pandemic. Both Neutrophil Lymphocyte Ratio (NLR) andAbsolute Lymphocyte Count (ALC) are two easy, low-cost, and fast inflammatory markers, which positively correlate with theseverity of COVID-19. The purpose of this research was to analyze the value of NLR and ALC as predictors of COVID-19severity. This research was a retrospective study using medical record data of 376 COVID-19 patients duringApril-September 2020 at the Hasanuddin University Hospital and Makassar City Regional Hospital. Patients were classifiedinto non-severe and severe COVID-19. Neutrophil lymphocyte ratio and ALC values were determined based on routineblood test (Sysmex XS-800i) results, statistical analysis using Independent T-test, while NLR and ALC diagnostic values wereanalyzed with Receiver Operating Characteristics (ROC) curve to obtain the cut-off value, p < 0.05 was significant. Thesamples consisted of 372 non-severe and 49 severe COVID-19 patients. Neutrophil lymphocyte ratio value in non-severe(4.02±5.22) was significantly different from severe COVID-19 (9.81±7.06) (p < 0.001), similar to ALC in non-severe(2.00±0.83x103/μL) and severe COVID-19 (1.22±0.78x103/μL) (p < 0.001). Receiver operating characteristics curve showedthat NLR had a sensitivity of 91.8% and specificity of 66.4% with a cut-off ≥ 3.17 with Negative Predict Value (NPV) of 98.2%and Positive Predict Value (PPV) of 29.0%; while ALC had a sensitivity of 81.6% and specificity of 64.8% at cut-off≤ 1.74x103/μL with NPV of 95.9% and PPV of 25.8%. Increased NLR and decreased ALC in severe COVID-19 patientsoccurred due to an increased inflammatory response resulting in a decreased cellular immunity. Receiver operatingcharacteristics curve showed a cut-off for NLR of 3.17 and ALC of 1.74x103/μL, indicating an optimum sensitivity andspecificity. It was concluded that NLR and ALC can be used as predictors of COVID-19 severity with a cut-off ≥ 3.17 and≤ 1.74x103/μL, respectively.

## Keywords
- Medicine
- Receiver operating characteristic
- Coronavirus disease 2019 (COVID-19)
- Lymphocyte
- Neutrophil to lymphocyte ratio
- Internal medicine
- Gastroenterology
- Area under the curve
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
- Immunology
- Disease
- Infectious disease (medical specialty)

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Sumber: Discover Unhas — RIMS Universitas Hasanuddin.
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