The Relationship Between Neutrophil-Lymphocyte Ratio (NLR), C-Reactive Protein (CRP), Interleukin 6 (IL-6), and D-Dimer Levels on the Severity of Covid-19 Patients at RSU Muhammadiyah University of Malang

Diah Hermayanti; Thahri Iskandar; Djoni Djunaedi; Silvana Gadis Ardhistix’s; Maulana Faishol Charisma M; Fajrul Falah; Muhammad Samir

doi:10.22219/sm.Vol19.SMUMM2.33202

Authors

Diah Hermayanti
Thahri Iskandar
Djoni Djunaedi
Silvana Gadis Ardhistix’s
Maulana Faishol Charisma M
Fajrul Falah
Muhammad Samir

DOI:

https://doi.org/10.22219/sm.Vol19.SMUMM2.33202

Abstract

Background: COVID-19 virus infection has the potential to become severe in individuals who are susceptible or who have comorbid diseases. Natural immunity status in infected sufferers can cause an increase in the number of neutrophil cells and a decrease in the number of lymphocyte cells (increased neutrophil-lymphocyte ratio), serum inter-leukin-6 (IL-6), C-reactive protein (CRP) levels which are associated with severity. covid-19. Hypercoagulability that occurs in COVID-19 infection causes an increase in D-dimer levels, reflecting a response to prothrombotic phenomena and is associated with an increased risk of mortality in COVID-19 patients.

Objective: To determine the relationship between Neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), Interleukin-6 (IL-6), and D-dimer levels on the severity of Covid-19 patients at Muhammadiyah Malang University (UMM) Hospital

Method: Using a retrospective design by taking a total sampling of medical record data for COVID-19 patients treated at UMM Hospital in 2021-2022.

Results and Discussion: Spearman correlation on NLR 0.426 (p=0.000), OR=3.67, 95% CI=1.622-8.226, CRP 0.343 (p=0.000) with OR 5.143, 95%CI=1.128-23.448, D- Dimer 0.326 (p=0.000), OR 2.497, 95% CI=1.142-5.458. Meanwhile, the correlation and IL-6 estimation values could not be calculated because the sample size was insufficient. CRP levels in COVID-19 patients are the best predictor of worsening compared to other parameters.

Conclusion: NLR values, CRP levels, and D-Dimer levels are related to the degree of severity in COVID-19 patients.

Downloads

Download data is not yet available.

References

de Bont, C.M., Boelens, W.C. and Pruijn, G.J.M. (2019) ‘NETosis, complement, and coagulation: a triangular relationship’, Cellular and Molecular Immunology, 16(1), pp. 19–27. Available at: https://doi.org/10.1038/s41423-018-0024-0.

Cascella M et al. (2022) ‘Features, Evaluation, and Treatment of Coronavirus (COVID-19) - StatPearls - NCBI Bookshelf’. Available at: https://www.ncbi.nlm.nih.gov/books/NBK554776/.

Daneshkhah, A. et al. (2020) ‘The Possible Role of Vitamin D in Suppressing Cytokine Storm and Associated Mortality in COVID-19 Patients’, medRxiv, p. 2020.04.08.20058578. Available at: https://www.medrxiv.org/content/10.1101/2020.04.08.20058578v4%0Ahttps://www.medrxiv.org/content/10.1101/2020.04.08.20058578v4.abstract.

Ganguli, S. et al. (2022) ‘Association of food habit with the COVID-19 severity and hospitalization: A cross-sectional study among the recovered individuals in Bangladesh’, Nutrition and Health, 28(4), pp. 771–782. Available at: https://doi.org/10.1177/02601060221124068.

Guan, W. et al. (2020) ‘Clinical Characteristics of Coronavirus Disease 2019 in China’, New England Journal of Medicine, 382(18), pp. 1708–1720. Available at: https://doi.org/10.1056/NEJMoa2002032.

Haddad, C. et al. (2021) ‘Smoking and COVID-19: A Scoping Review’, Tobacco Use Insights, 14, p. 1179173X2199461. Available at: https://doi.org/10.1177/1179173X21994612.

Hannah M, et al. 2022 (2022) ‘Correlation of D-dimer and Outcomes in COVID-19 Patients - PubMed’. Available at: https://doi.org/10.1177/00031348221091940.

Hu, B., Huang, S. and Yin, L. (2021) ‘The cytokine storm and COVID‐19’, Journal of Medical Virology, 93(1), pp. 250–256. Available at: https://doi.org/10.1002/jmv.26232.

Jun Mi et al. (2020) ‘Gender, Age and Comorbidities as the main factors in patient with COVID-19 pneumonia’, Am J Transl Res, 12(10), pp. 6537–6548.

Kalantari, H., Tabrizi, A.H.H. and Foroohi, F. (2020) ‘Determination of COVID-19 prevalence with regards to age range of patients referring to the hospitals located in western Tehran, Iran’, Gene Reports, 21, p. 100910. Available at: https://doi.org/10.1016/j.genrep.2020.100910.

Kang, S.-J. and Jung, S.I. (2020) ‘Age-Related Morbidity and Mortality among Patients with COVID-19’, Infection & Chemotherapy, 52(2), p. 154. Available at: https://doi.org/10.3947/ic.2020.52.2.154.

Liu, J. et al. (2020) ‘Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage’, Journal of Translational Medicine. Available at: https://doi.org/10.1186/s12967-020-02374-0.

Luo, X. et al. (2020) ‘Prognostic value of C-reactive protein in patients with COVID-19 | Clinical Infectious Diseases | Oxford Academic’, pp. 2174–2179. Available at: https://doi.org/https://doi.org/10.1093/cid/ciaa641.

Maryati, W. et al. (2022) ‘Analisis Karakteristik Pada Pasien Rawat Inap Kasus Covid-19’, Infokes: Jurnal Ilmiah Rekam Medis dan Informatika Kesehatan, 12(1), pp. 20–25. Available at: https://doi.org/10.47701/infokes.v12i1.1354.

Nemec, A., Ferenczy, A. and Montgomery, A. (2022) ‘Correlation of D-dimer and Outcomes in COVID-19 Patients’. The American Surgeon. Available at: https://journals.sagepub.com/doi/10.1177/00031348221091940.

Nguyen, N. et al. (2022) ‘Relation of interleukin-6 levels in COVID-19 patients with major adverse cardiac events’, Baylor University Medical Center Proceedings, 35(1), pp. 6–9. Available at: https://doi.org/10.1080/08998280.2021.1961571.

Rauf, A. et al. (2020) ‘COVID-19 Pandemic : Epidemiology, Etiology, Conventional and Non-Conventional Therapies’. Int J Environ Res Public Health 17(21), pp. 1–32. Available at: https://doi.org/doi: 10.3390/ijerph17218155.

Sapir, T. et al. (2022) ‘COVID-19 and the Immune Response: A Multi-Phasic Approach to the Treatment of COVID-19’, International Journal of Molecular Sciences. Available at: https://doi.org/10.3390/ijms23158606.

WH0 (2023) ‘Statement on the fourteenth meeting of the International Health Regulations ( 2005 ) Emergency Committee regarding the coronavirus disease ( COVID-19 ) pandemic’, pp. 1–6.