A systematic review and meta-analysis of the association between the neutrophil, lymphocyte, and platelet count, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio and COVID-19 progression and mortality

Angelo Zinellu, Arduino A. Mangoni

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)

Abstract

Background and aims: Severe manifestations of coronavirus disease 2019 (COVID-19) are associated with alterations in blood cells that regulate immunity, inflammation, and hemostasis. We conducted an updated systematic review and meta-analysis of the association between the neutrophil, lymphocyte, and platelet count, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), and COVID-19 progression and mortality.

Methods: A systematic literature search was conducted in PubMed, Web of Science, and Scopus for studies published between January 2020 and June 2022. 

Results: In 71 studies reporting the investigated parameters within 48 hours of admission, higher NLR (HR 1.21, 95% CI 1.16 to 1.27, p < 0.0001), relative neutrophilia (HR 1.62, 95% CI 1.46 to 1.80, p < 0.0001), relative lymphopenia (HR 1.62, 95% CI 1.27 to 2.08, p < 0.001), and relative thrombocytopenia (HR 1.74, 95% CI 1.36 to 2.22, p < 0.001), but not PLR (p = 0.11), were significantly associated with disease progression and mortality. Between-study heterogeneity was large-to-extreme. The magnitude and direction of the effect size were not modified in sensitivity analysis. 

Conclusions: NLR and neutrophil, lymphocyte, and platelet count significantly discriminate COVID-19 patients with different progression and survival outcomes. (PROSPERO registration number: CRD42021267875).

Original languageEnglish
Pages (from-to)1187-1202
Number of pages16
JournalExpert Review of Clinical Immunology
Volume18
Issue number11
Early online date5 Sep 2022
DOIs
Publication statusPublished - 2022

Keywords

  • COVID-19 outcomes
  • lymphocyte count
  • Neutrophil count
  • neutrophil-to-lymphocyte ratio
  • platelet count
  • platelet-to-lymphocyte ratio

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