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Heny Syahrini Trinugroho Heri Fadjari Nadjwa Zamalek Dalimoenthe

Abstract

Covid-19 diagnosis generally uses RT-PCR as the gold standard to detect coronavirus-2 (SARS-CoV-2); however, this method requires advanced laboratory equipment. Alternatively, Neutrophil-Lymphocyte Ratio (NLR) and Lymphocyte-Monocyte Ratio (LMR) can be used to identify viral infection. The study aimed: (1) to compare each NLR and LMR ratio in patients with and without COVID-19 and (2) to test the effectiveness of these ratios in identifying COVID-19. The study was conducted at the Haji Adam Malik Central General Hospital by acquiring 87 medical records data. The complete hematologic profile was analyzed from patients with and without COVID-19. The NLR and LMR ratio accuracy were analyzed as a screening tool for COVID-19. The AUC of NLR was 0.638, with cut-off ≤ 2.49, 47.6% sensitivity, and 80% specificity; therefore, the NLR accuracy as a screening for COVID-19 was defined as not good (just sufficient) because of AUC <0,7. The AUC of LMR was 0.661, with cut-off ≥ 3.23, 45.2% sensitivity, and 82.2% specificity; therefore, the LMR accuracy as a screening parameter for COVID-19 is defined as not good (just sufficient) because of AUC <0,7. There were significant differences in hematologic profile in neutrophil, lymphocyte, NLR, LMR between the patients in the COVID-19 group and non-COVID-19 group. NLR and LMR cannot be used as a screening tool because the Area Under Curve (AUC) is not good enough (just sufficient) in detecting COVID-19.

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How to Cite
Syahrini, H., Fadjari, T. H. . and Dalimoenthe, N. Z. (2022) “Neutrophil-Lymphocyte Ratio (NLR) and Lymphocyte-Monocyte Ratio (LMR) as Covid-19 Screening Parameters”, Indonesian Journal of Medical Laboratory Science and Technology, 4(1), pp. 10–23. doi: 10.33086/ijmlst.v4i1.2281.
Section
Articles
COVID-19, Neutrophil-Lymphocyte Ratio, Lymphocyte-Monocyte Ratio

References

Xu P, Zhou Q, Xu J. Mechanism of thrombocytopenia in Covid-19 patients. Annals of Hematology. 2020;99:1205–1208

World Health Organization. WHO Director General’s remarks at the media briefing on 2019 nCov on 11 February 2020.

Huang C, Wang Y, Li X, Ren L, Zhao J, Zang Li, Fan G, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020;395: 497-506.

Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al. Neutrophil-to lymphocyte Ratio Predicts Severe Illness Patients with 2019 Novel Coronavirus in the Early Stage. MedRxiv. Available from https://doi.org/10.1101/2020.02.10.20021584

He F, Deng Y, Li W. Coronavirus Disease 2019 (COVID-19): What we know?. J Med Virol [Internet]. 2020 Mar 14; jmv.25766. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/jmv.25766

Adhikari SP, Meng S, Wu Y, Mao Y, Ye R, Wang Q, et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis poverty [Internet]. 2020 Mar 17;9(1):29. Available from: http://www.preprints.org

WHO. Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCov) infection is suspected. Interim guidance.

Y. Liu, X. Du, J. Chen, Y. Jin, L. Peng, H. Wang, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID19, J Infect, 2020;81:e6-e12.

Naess A, Nilssen SS, Mo R, Eide GE, Sjursen H. Role of neutrophil to lymphocyte and monocyte to lymphocyte ratios in the diagnosis of bacterial infection in patients with fever. Infection [Internet]. 2017;45(3):299–307.

George Merekoulias, Evangelos C Alexopoulus, T. Belezos, E. Panagiotopoulou, E. Jelastopulu. Lymphocyte to monocyte ratio as a screening tool for influenza. PLoS Currents. March 2010.

Mardani R, Ahmadi Vasmehjani A, Zali F, Gholami A, Mousavi Nasab SD, Kaghazian H, et al. Laboratory Parameters in Detection of COVID-19 Patients with Positive RT-PCR; a Diagnostic Accuracy Study. Arch Acad Emerg Med [Internet]. 2020;8(1):e43. p 1-5.

Yang AP, Liu J, Tao W, Li H. The diagnostic and predictive role of NLR, d-NLR, and PLR in COVID-19 patients. International Immunopharmacology (2020). Available from:https://doi.org/10.1016/j.intimp.2020.106504

Song CY, Xu J, He JQ, Lu YQ. COVID-19 early warning score: a multi-parameter screening tool to identify highly suspected patients. medRxiv 8 March 2020. Available from: https://doi.org/10.1101/2020.03.05.20031906

Ish P, Malhotra N, Agrawal S, Gupta N. Relative lymphocytosis in COVID-19 — a ray of hope. Advances in Respiratory Medicine 2020;88(3):1–2.

Lin L, Lu L, Cao W, Li T. Hypothesis for potential pathogenesis of SARS-CoV-2 infection–a review of immune changes in patients with viral pneumonia. Emerging Microbes & Infections 2020;9:727-732.

Brzeszczyńska J. Quantitative Real-Time PCR Application Workshop. The University of the West of Scotland (UWS). Feb 2020. [ diunduh tanggal 14 Agustus 2020]. Available from: https://www.breath-copd.org/app/uploads/2017/11/QPCR-training-Joanna-Brzeszczynska.pdf

Zheng S, Fan J, Yu F, Feng B, Lou B, Zou Q, et al. Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province, China, January-March 2020: retrospective cohort study. BMJ 2020;369:m1443

Warny M, Helby J, Nordestgaard BG, Birgens H, Bojesen SE. Lymphopenia and risk of infection and infection-related death in 98,344 individuals from a prospective Danish population-based study. PLOS Medicine, 1 November 2018. p1-22. Available from: https://doi.org/10.1371/journal.pmed.1002685

Xiang F, Zhu J, Cao X, Shen B, Zou J, Liu Z, et al. Lymphocyte depletion and subset alteration correlate to renal function in chronic kidney disease patients. Ren Fail, Early Online: 1–8. Available from: http://dx.doi.org/10.3109/0886022X.2015.1106871

Gu J, Korteweg C. Pathology and Pathogenesis of Severe Acute Respiratory Syndrome. The American Journal of Pathology, 2007. Vol. 170, p 1136-1147

Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of Immune Response in Patients With Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020;12:1–7.