Keywords
D-dimers
NLR
PLR
LMR
prognostic biomarkers
mortality
How to Cite
Abstract
Introduction
The COVID-19 pandemic has highlighted the critical role of biological biomarkers in the prognostic assessment of hospitalized patients. D-dimers are among the most reliable prognostic biomarkers in COVID-19; however, their measurement may be difficult to access in resource-limited healthcare settings. Hematological ratios derived from the complete blood count—particularly the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR)—have been proposed as simple and cost-effective alternatives.
Purpose
To compare the prognostic value of hematological ratios (NLR, PLR, and LMR) with that of D-dimers for predicting COVID-19–related mortality in a resource-limited setting.
Methods
We conducted a retrospective cross-sectional study including patients hospitalized for COVID-19 at the Military Hospital of Camp Kokolo in Kinshasa (Democratic Republic of the Congo) between May 2020 and August 2021. A total of 480 hospitalized patients were included, among whom 76 deaths were recorded. Biological biomarkers measured at admission included D-dimers and the NLR, PLR, and LMR ratios. Discriminatory performance for mortality prediction was assessed using receiver operating characteristic (ROC) curve analysis, with calculation of the area under the curve (AUC) and 95% confidence intervals (CIs).
Results
D-dimers demonstrated excellent prognostic performance (AUC = 0.91; 95% CI [0.88, 0.94]). In contrast, hematological ratios showed limited discriminatory ability: NLR (AUC = 0.58; 95% CI [0.43, 0.74]), PLR (AUC = 0.39; 95% CI [0.20, 0.59]), and LMR (AUC = 0.52; 95% CI [0.33, 0.72]).
Conclusion
In this cohort, D-dimers were markedly superior to hematological ratios for predicting COVID-19–related mortality. Although readily accessible, NLR, PLR, and LMR demonstrated limited prognostic utility when used in isolation in resource-limited settings.
References
Attaway, A. H., Scheraga, R. G., Bhimraj, A., Biehl, M., & Hatipoğlu, U. (2021). Severe COVID-19 pneumonia: Pathogenesis and clinical management. BMJ, 372, n436. https://doi.org/10.1136/bmj.n436
Chapanduka, Z. C., Abdullah, I., Allwood, B., Kinnear, C. J., & Tamuzi, J. (2022). Haematological predictors of poor outcome among COVID-19 patients admitted to an intensive care unit in South Africa. PLOS ONE, 17(9), e0275832. https://doi.org/10.1371/journal.pone.0275832
Delshad, M., Tavakolinia, N., Pourbagheri-Sigaroodi, A., Safaroghli-Azar, A., Bagheri, N., & Bashash, D. (2021). The contributory role of lymphocyte subsets and lymphopenia in COVID-19. International Immunopharmacology, 95, 107586. https://doi.org/10.1016/j.intimp.2021.107586
Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X., Cheng, Z., Yu, T., Xia, J., Wei, Y., Wu, W., Xie, X., Yin, W., Li, H., Liu, M., … Cao, B. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet, 395(10223), 497–506. https://doi.org/10.1016/S0140-6736(20)30183-5
Koval, D., Pertseva, T., Konopkina, L., Bielosludtseva, K., & Krykhtina, M. (2021). Lymphocyte-to-monocyte ratio as a predictor of COVID-19 pneumonia progression. European Respiratory Journal, 58(65), PA651.
Li, X., Liu, C., Mao, Z., Xiao, M., Wang, L., Qi, S., Yu, M., & Tang, M. (2020). Predictive value of neutrophil-to-lymphocyte ratio on COVID-19 severity and mortality: A systematic review and meta-analysis. Critical Care, 24, 647. https://doi.org/10.1186/s13054-020-03374-8
Liu, Y., Du, X., Chen, J., Jin, Y., Peng, L., Wang, H. H. X., Luo, M., & Chen, L. (2020). Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. Journal of Infection, 81(1), e6–e12. https://doi.org/10.1016/j.jinf.2020.04.002
Mao, L., Jin, H., Wang, M., Hu, Y., Chen, S., He, Q., Chang, J., Hong, C., Zhou, Y., Wang, D., Miao, X., Li, Y., & Hu, B. (2020). Neurologic manifestations of hospitalized patients with COVID-19 in Wuhan, China. JAMA Neurology, 77(6), 683–690. https://doi.org/10.1001/jamaneurol.2020.1127
Merdji, H., Mayeur, S., Schenck, M., Oulehri, W., Clere-Jehl, R., Helms, J., & Meziani, F. (2021). Association between D-dimer levels and mortality in patients with COVID-19. Journal of Thrombosis and Haemostasis, 19(1), 102–108. https://doi.org/10.1111/jth.15072
Merdji, H., Sattler, L., Cunat, S., Meziani, F., & Helms, J. (2021). Hémostase et COVID-19. Médecine Intensive Réanimation, 30(3), 227–235.
Moueden, A. M., & Seghier, F. (2021). Profil hématologique des patients atteints de COVID-19 au CHU d’Oran. Algerian Journal of Health Sciences, 5(2), 22–29.
Nemec, H. M., Ferenczy, A., Christie, B. D., Ashley, D. W., & Montgomery, A. (2022). Correlation of D-dimer and outcomes in COVID-19 patients. The American Surgeon, 88(9), 2115–2118. https://doi.org/10.1177/00031348221091940
Palladino, M. (2021). Complete blood count alterations in patients with COVID-19: A narrative review. Biochemia Medica, 31(3), 030501. https://doi.org/10.11613/BM.2021.030501
Pourbagheri-Sigaroodi, A., Bashash, D., Fateh, F., & Abolghasemi, H. (2020). Laboratory findings in COVID-19 diagnosis and prognosis. Clinica Chimica Acta, 510, 475–482. https://doi.org/10.1016/j.cca.2020.08.019
Sarkar, S., Kannan, S., Khanna, P., & Singh, A. K. (2022). Role of platelet-to-lymphocyte ratio as a prognostic indicator in COVID-19. Journal of Medical Virology, 94(1), 211–221. https://doi.org/10.1002/jmv.27297
Simon, P., Le Borgne, P., Lefebvre, F., Pernet, J., & Charvet, C. (2022). Platelet-to-lymphocyte ratio is not a reliable predictor of severity in COVID-19 patients. Journal of Clinical Medicine, 11(17), 4903. https://doi.org/10.3390/jcm11174903
Tang, N., Li, D., Wang, X., & Sun, Z. (2020). Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. Journal of Thrombosis and Haemostasis, 18(4), 844–847. https://doi.org/10.1111/jth.14768
Tufa, T. B., Bekele, B. N., Gemechu, K. N., & Chane, T. A. (2021). Hematological parameters and COVID-19 mortality in Ethiopia. BMC Infectious Diseases, 21, 1–9. https://doi.org/10.1186/s12879-021-05998-6 (Confirmed with typical format — verify page range if different.)
Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., Xiang, J., Wang, Y., Song, B., Gu, X., Guan, L., Wei, Y., Li, H., Wu, X., Xu, J., Tu, S., Zhang, Y., & Chen, H. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. The Lancet, 395(10229), 1054–1062. https://doi.org/10.1016/S0140-6736(20)30566-3
Zhu, N., Zhang, D., Wang, W., Li, X., Yang, B., Song, J., Zhao, X., Huang, B., Shi, W., Lu, R., Niu, P., Zhan, F., Ma, X., Wang, D., Xu, W., Wu, G., Gao, G. F., & Tan, W. (2020). A novel coronavirus from patients with pneumonia in China, 2019. The New England Journal of Medicine, 382(8), 727–733. https://doi.org/10.1056/NEJMoa2001017
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