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Elevated neutrophil-lymphocyte ratio is associated with high rates of ICU mortality, length of stay, and invasive mechanical ventilation in critically ill patients with COVID-19

NRL and severe COVID-19

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Abstract

Neutrophil and lymphocyte ratio (NLR) has emerged as a complementary marker in intensive care. This study aimed to associate high NLR values with mortality as the primary outcome, and length of stay and need for invasive mechanical ventilation as secondary outcomes, in critically ill patients with COVID-19. A cross-sectional study encompassing 189 critically ill patients with COVID-19 was performed. The receiver operating characteristic curve was used to identify the best NLR cutoff value for ICU mortality (≥ 10.6). An NLR ≥ 10.6, compared with an NLR < 10.6, was associated with higher odds of ICU mortality (odds ratio [OR], 2.77; 95% confidence interval [CI], 1.24–6.18), ICU length of stay ≥ 14 days (OR, 3.56; 95% CI, 1.01–12.5), and need for invasive mechanical ventilation (OR, 5.39; 95% CI, 1.96–14.81) in the fully adjusted model (age, sex, kidney dysfunction, diabetes, obesity, hypertension, deep vein thrombosis, antibiotics, anticoagulants, antivirals, corticoids, neuromuscular blockers, and vasoactive drugs). In conclusion, elevated NLR is associated with high rates of mortality, length of stay, and need for invasive mechanical ventilation in critically ill patients with COVID-19.

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The data that support the findings of this study are available in the article. If additional data were required, it may be requested to the corresponding author.

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Acknowledgements

We are thankful for the São Lucas Hospital. This work did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. HOS has been supported by Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brazil (CAPES).

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Authors and Affiliations

  1. School of Medicine, Federal University of Uberlandia (UFU), Para Street, 1720, Umuarama. Block 2H, Uberlandia, 38400-902, MG, Brazil

    Heitor O. Santos

  2. Postgraduate in Nursing, Federal University of Pelotas (UFPel), Pelotas, Rio Grande do Sul, Brazil

    Felipe M. Delpino

  3. Department of Medicine, Federal University of Sergipe (UFS), Sergipe. Augusto Franco Avenue, 3500. Unit 134. Aracaju – Sergipe, Aracaju, Sergipe, Brazil

    Octavio M. Veloso & Cristina G. M. Pereira

  4. São Lucas Hospital – Rede D’OR (HSL), Aracaju, Sergipe, Brazil

    Juliana M. R. Freire, Erlaine S. N. Gomes & Cristina G. M. Pereira

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Contributions

HOS – Conceptualization, writing of original draft, review of manuscript. FMD – Statistical analyses. OMV – data collection. JMRF – data collection. ESNG – data collection. CGMP – project administration, data collection, and supervision. All authors critically revised the article and finally approved the version to be published.

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Correspondence to Heitor O. Santos.

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This research was ratified by the Federal University of Sergipe and was approved by the local Research Ethics Committee (nº 35128820.0.0000.5546.). Data were collected from the medical record system. There was no intervention.

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Santos, H.O., Delpino, F.M., Veloso, O.M. et al. Elevated neutrophil-lymphocyte ratio is associated with high rates of ICU mortality, length of stay, and invasive mechanical ventilation in critically ill patients with COVID-19. Immunol Res 72, 147–154 (2024). https://doi.org/10.1007/s12026-023-09424-x

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