The Role of Different Inflammatory Indices in the Diagnosis of COVID-19

Figures & data

Table 1 Clinical and Laboratory Findings of the COVID-19 Patients and Control Group

	COVID-19 Patients (n=88)	Control Group (n=41)	P value
Age	41 (10–85)	40 (13–62)	0.103
Gender
Male	47 (53.4%)	18 (43.9%)	0.671
Female	41 (46.6%)	23 (56.1%)
Comorbidities
Negative	75 (85.2%)	29 (70.7%)	0.06
Positive	13 (14.8%)	12 (29.3%)
Hb (g/dl)	12.6 (7–15.9)	11.6 (5.9–14.1)	0.039
RBCs (10^6/ul)	4.6 (2.2–5.9)	4.6 (3.1–5.6)	0.601
HCT (%)	38.5 (21–49.3)	34.8 (19.5–41.3)	0.081
MCV (fL)	82.4 (51.5–108)	77.4 (56.2–88.3)	0.107
MCH (Pg)	27 (16.2–34.2)	25.5 (18.8–28)	0.051
RDW (fL)	13.6 (12–23)	13.7 (12–22)	0.289
Platelets (×10^9/L)	227 (90–448)	296.5 (205–532)	0.004
MPV (fL)	9.2 (8–11)	9.7 (9–10)	0.355
TLC (×10^9/L)	6.5 (3.1–14.1)	5.8 (5.6–6)	0.873
Neutrophil %	57.5 (0.64–87)	64.7(32.6–90.2)	0.208
Neutrophil (10^3/ul)	2.9 (0.04–21.8)	4.4 (1.8–9.7)	0.992
Segmented %	60 (0.56–86.4)	52 (45–59)	0.651
Eosinophil (10^3/ul)	0.05 (0–0.26)	0.13 (0.11–0.14)	0.002
Monocyte (10^3/ul)	0.38 (0–1.6)	0.46 (0.36–1.3)	0.318
Basophil (10^3/ul)	0 (0–0.23)	0 (0–0.07)	0.520
Lymphocyte %	25 (0.25–55.3)	35 (6.5–56.7)	0.007
Lymphocytes (10^3/ul)	1.5 (0.02–4)	2.3 (1.3–3.4)	P<0.001
CRP (mg/L)	13.1 (0–337)	6 (0–34)	0.003
Ferritin (ng/L)	200 (8–1764)	43 (13–1967)	0.008
D-dimer (ng/mL)	0.33 (0.07–4164)	0.1 (0–0.5)	P<0.001
LDH (U/L)	282 (141–1300)	304 (165–443)	0.952

Note: The P value is significant if <0.05.

Abbreviations: CRP, C-reactive protein; Hb, haemoglobin concentration; HCT, haematocrit value; LDH, lactate dehydrogenase; MCH, mean corpuscular hemoglobin; MCV, mean corpuscular volume; MPV, mean platelet volume; RBCs, red blood cells; RDW, red cell distribution width; TLC, total leukocyte count.

Figure 1 The results of (A) NLR: the neutrophil to lymphocyte ratio, (B) LMR: lymphocyte to monocyte ratio, (C) PLR: platelet to lymphocyte ratio, (D) dNLR: derived neutrophil to lymphocyte ratio, (E) SII: systemic inflammation index, (F) NLPR: neutrophil to lymphocyte, platelet ratio, (G) SIRI: systemic inflammation response index, (H) AISI: aggregate index of systemic inflammation, and (I) CRP/L: C-reactive protein to lymphocyte ratio, in the COVID-19 patients and the control group.

Table 2 ROC Curve Analysis for the Diagnostic Value of Different Inflammation Indices in COVID-19 Patients

	AUC	Cut-off	Sensitivity	Specificity	P value	95% Confidence Interval
						Lower	Upper
NLR	0.649	2.5	52.7%	82.9%	0.008	0.550	0.747
LMR	0.738	6	71%	65.9%	P<0.001	0.645	0.831
PLR	0.643	118	67.6%	58.5%	0.011	0.543	0.743
dNLR	0.590	1.7	50%	82.9%	0.111	0.489	0.690
SII	0.571	807	37.8%	92.7%	0.207	0.468	0.674
NLPR	0.721	0.0105	52.7%	95.1%	P<0.001	0.631	0.811
SIRI	0.623	0.8	47.8%	82.9%	0.032	0.520	0.725
AISI	0.567	252	42%	82.9%	0.244	0.461	0.673
CRP/L	0.692	7.6	50%	95%	0.002	0.584	0.800

Note: The P value is significant if <0.05.

Abbreviations: AISI, aggregate index of systemic inflammation; CRP/L, C-reactive protein to lymphocyte ratio; dNLR, derived neutrophil to lymphocyte ratio; LMR, lymphocyte to monocyte ratio; NLPR, neutrophil to lymphocyte; platelet ratio; NLR, the neutrophil to lymphocyte ratio; PLR, platelet to lymphocyte ratio; SII, systemic inflammation index; SIRI, systemic inflammation response index.

Figure 2 The ROC curve analysis for (A) NLR: the neutrophil to lymphocyte ratio, (B) LMR: lymphocyte to monocyte ratio, (C) PLR: platelet to lymphocyte ratio, (D) dNLR: derived neutrophil to lymphocyte ratio, (E) SII: systemic inflammation index, (F) NLPR: neutrophil to lymphocyte, platelet ratio, (G) SIRI: systemic inflammation response index, (H) AISI: aggregate index of systemic inflammation, and (I) CRP/L: C-reactive protein to lymphocyte ratio, in the diagnosis of COVID-19 patients.

Table 3 Univariate and Multivariate Analysis for the Diagnosis of COVID-19 Patients

	Univariate Analysis				Multivariate Analysis
	Odds Ratio (OR)	95% C.I.		P value	Odds Ratio (OR)	95% C.I.		P value
		Lower	Upper			Lower	Upper
Age (>40)	3.397	1.454	7.937	0.005	5.697	0.487	66.653	0.166
Hb (>12.6) g/dl	0.532	0.243	1.167	0.115
RBCs (>4.6) 10^6/ul	2.049	0.713	5.890	0.183
HCT (>38.5) %	3.410	1.030	11.296	0.045	30.73	0.760	1243.09	0.070
MCV (<82.4) fL	1.732	0.683	4.394	0.247
MCH (>27) Pg	2.847	0.999	8.114	0.050	3.228	0.216	48.202	0.395
RDW (>13.6) %	0.500	0.115	2.175	0.355
Platelets (>227) ×10^9/L	0.290	0.127	0.661	0.003	0.045	0.001	1.505	0.083
TLC (>6.5)×10^9/L	1.065	0.497	2.283	0.872
Neutrophil (>2.9) 10^3/ul	0.453	0.198	1.034	0.060
Segmented% (>60)	2.000	0.649	6.166	0.228
Eosinophil (>0.05) 10^3/ul	0.178	0.056	0.560	0.003	0.030	0.001	1.629	0.085
Basophil (>0) 10^3/ul	1.646	0.683	3.968	0.267
Lymphocytes (>1.5) 10^3/ul	0.075	0.021	0.264	P<0.001	0.312	0.007	13.647	0.546
CRP (>13.1) mg/L	11.908	3.291	43.090	P<0.001	8.543	0.207	352.901	0.259
Ferritin (>200) ng/L	7.619	0.872	66.541	0.066
D-dimer (>0.33)ng/mL	12.000	3.140	45.855	P<0.001	3.721	0.049	283.207	0.552
NLR (>2.5)	5.412	2.130	13.755	P<0.001	0.158	0.009	2.932	0.216
LMR (<6)	3.828	1.694	8.648	0.001	0.360	0.097	1.335	0.127
PLR (>118)	2.412	1.102	5.280	0.028	0.659	0.191	2.272	0.509
dNLR (>1.7)	1.509	0.703	3.237	0.291
SII (>807)	7.710	2.174	27.340	0.002	3.897	0.269	56.428	0.318
NLPR (>0.011)	21.729	4.885	96.651	P<0.001	38.751	2.080	722.060	0.014
SIRI (>0.8)	4.452	1.738	11.406	0.002	6.68	0.000		0.999
AISI (>252)	3.521	1.371	9.047	0.009	0.884	0.000		0.999
CRP/L (>7.6)	19.000	4.146	87.070	P<0.001	7.604	1.338	43.224	0.022

Note: The P value is significant if <0.05.

Abbreviations: AISI, aggregate index of systemic inflammation; CRP, C-reactive protein; CRP/L, CRP to lymphocyte ratio; dNLR, derived neutrophil to lymphocyte ratio; Hb, haemoglobin concentration; HCT, haematocrit value; LDH, lactate dehydrogenase; MCH, mean corpuscular hemoglobin; MCV, mean corpuscular volume; LMR, lymphocyte to monocyte ratio; NLPR, neutrophil to lymphocyte; platelet ratio; NLR, the neutrophil to lymphocyte ratio; PLR, platelet to lymphocyte ratio; RBCs, red blood cells; RDW, red cell distribution width; SII, systemic inflammation index; SIRI, systemic inflammation response index; TLC, total leukocyte count.