The correlation of neutrophil-to-lymphocyte ratio (NLR) and monocytes-to-lymphocytes ratio (MLR) with disease severity in hospitalized patients with Coronavirus disease 2019 (COVID-19)

Background: Early intervention of cases with potential progression to severe disease is essential to improve survival probability in Coronavirus disease 2019 (COVID-19). Systemic inflammation plays an essential role in the process of disease aggravation. This study aimed to assess the correlation of systemic inflammatory response related biomarkers neutrophillymphocyte ratio (NLR) and monocyte-lymphocyte ratio (MLR) on time to admission with the disease severity of inpatients with COVID-19. Methods: We performed a retrospective study using secondary data from medical records of inpatients with COVID-19 at Murni Teguh Memorial Hospital, Medan, Indonesia, from June 1 to September 30, 2020. The demographic data were collected from the medical record and the hematologic parameter from the laboratory. NLR and MLR were calculated by dividing the absolute neutrophils and monocytes counts by the absolute lymphocyte counts. The data were tabulated and analyzed by univariate and bivariate analysis with a significance level of p<0.05. Results: Study subjects consisted of 55 non-severe cases and 40 severe cases. The median NLR and MLR of severe and non severe groups were 7.65 vs 2.92 (p<0.001) and 0.46 vs 0.25 (p=0.013). The correlation coefficients of NLR and MLR with disease severity were 0.564 (p 0.001) and 0.257 (p=0.012). The AUC of ROC analysis was 0.830 (cut-off : 0.001) in NLR and 0.650 (cut-off : 0.31; p=0.013) in MLR to predict the severe disease. Conclusion: NLR and MLR had a significant positive correlation with the disease severity. NLR is better than MLR in predicting severe disease in hospitalized patients with COVID-19.