Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR) as Prognostic Markers of COVID-19 Disease Irrespective of Immunosuppression Status: A Case-Control Retrospective Single-Center Study
2025
Amalia Papanikolopoulou | Vasiliki Rapti | Polyxeni Alexiou | Charalampos M. Charalampous | Maria Effrosyni Livanou | Vissaria Sakka | Konstantinos N. Syrigos | Garyfallia Poulakou
Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been studied as predictors for severe COVID-19 outcomes. The aim of the present study is to identify prognostic cut-off values of NLR and PLR for intubation and death in hospitalized COVID-19 patients, with or without immunosuppression. From June 2021 to December 2022, we retrospectively analyzed 393 consecutively admitted COVID-19 patients, who were divided in two cohorts according to immunosuppression status (hematological malignancy and/or autoimmune condition vs. non-immunocompromised), using a propensity score-matching in 1:2 ratio. Higher NLR and PLR values were observed on days 1 and 4 for severe COVID-19, irrespective of immunosuppression status. NLR on day 1 >:5.06 and day 4 >:6.40 (p <: 0.001), as well as PLR on day 1 >:262.2 and day 4 >:217.3 (p = 0.003), were associated with a greater probability for intubation. Similarly, a higher probability for death was found in the subset of patients with NLR on day 1 >:4.82 (p <: 0.001) and day 4 >:6.41 (p <: 0.001) and PLR on day 1 >:229 (p = 0.009) and day 4 >:205.4 (p = 0.003). Both PLR and NLR exhibited consistently higher negative predictive values (NPVs) (>:93%) compared to positive predictive values (PPVs) for intubation and death. NLR and PLR displayed strong prognostic potential in hospitalized COVID-19 patients regarding intubation and death, irrespective of immunosuppression status, thus the surveillance of these biomarkers may help clinicians identify high-risk COVID-19 patients at an early stage.
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