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Meta-Analysis
. 2020 Nov 16;24(1):647.
doi: 10.1186/s13054-020-03374-8.

Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis

Xiaoming Li  1   2 , Chao Liu  2 , Zhi Mao  1 , Minglu Xiao  3 , Li Wang  1 , Shuang Qi  1   2 , Feihu Zhou  4
Affiliations
Meta-Analysis

Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis

Xiaoming Li et al. Crit Care. .

Abstract

Background: Coronavirus disease 2019 (COVID-19), a highly infectious disease, has been rapidly spreading all over the world and remains a great threat to global public health. Patients diagnosed with severe or critical cases have a poor prognosis. Hence, it is crucial for us to identify potentially severe or critical cases early and give timely treatments for targeted patients. In the clinical practice of treating patients with COVID-19, we have observed that the neutrophil-to-lymphocyte ratio (NLR) of severe patients is higher than that in mild patients. We performed this systematic review and meta-analysis to evaluate the predictive values of NLR on disease severity and mortality in patients with COVID-19.

Methods: We searched PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and Wanfang databases to identify eligible studies (up to August 11, 2020). Two authors independently screened studies and extracted data. The methodological quality of the included studies was assessed by Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2).

Results: Thirteen studies involving 1579 patients reported the predictive value of NLR on disease severity. The pooled sensitivity (SEN), specificity (SPE) and area under curve (AUC) were 0.78 (95% CI 0.70-0.84), 0.78 (95% CI 0.73-0.83) and 0.85 (95% CI 0.81-0.88), respectively. Ten studies involving 2967 patients reported the predictive value of NLR on mortality. The pooled SEN, SPE and AUC were 0.83 (95% CI 0.75-0.89), 0.83 (95% CI 0.74-0.89) and 0.90 (95% CI 0.87-0.92), respectively.

Conclusions: NLR has good predictive values on disease severity and mortality in patients with COVID-19 infection. Evaluating NLR can help clinicians identify potentially severe cases early, conduct early triage and initiate effective management in time, which may reduce the overall mortality of COVID-19.

Trial registry: This meta-analysis was prospectively registered on PROSPERO database (Registration number: CRD42020203612).

Keywords: Disease severity; Meta-analysis; Mortality; Neutrophil-to-lymphocyte ratio; Predictive; Systematic review.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram for the identification of eligible studies
Fig. 2
Fig. 2
a. Forest plot of the sensitivity and specificity of NLR for predicting disease severity in patients with COVID-19. The pooled sensitivity and specificity were 0.78 (95% CI 0.70–0.84) and 0.78 (95% CI 0.73–0.83), respectively. b. Forest plot of the sensitivity and specificity of NLR for predicting mortality in patients with COVID-19. The pooled sensitivity and specificity were 0.83 (95% CI 0.75–0.89) and 0.83 (95% CI 0.74–0.89), respectively
Fig. 3
Fig. 3
Summary receiver operating characteristic graph for the included studies. a. The AUC of NLR for predicting disease severity was 0.85 (95% CI 0.81–0.88). b. The AUC of NLR for predicting mortality was 0.90 (95% CI 0.87–0.92)
Fig. 4
Fig. 4
Fagan nomogram of NLR for predicting disease severity and mortality in patients with COVID-19. The pre-test probability was set to 50%. a. The post-test probability of NLR for the detection of severe cases was 78% when the NLR was above the cut-off value. The post-test probability was 22% when the NLR was below the cut-off value. b. The post-test probability of NLR for the detection of mortality was 83% when the NLR was above the cut-off value. The post-test probability was 17% when the NLR was below the cut-off value
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