The Diagnostic Value of Kinetics of NLR to Identify Secondary Pulmonary Bacterial Infection Among COVID-19 Patients at Single Tertiary Hospital in Indonesia

Figures & data

Figure 1 Study flow chart.

Abbreviations: COVID-19, coronavirus disease 2019; ICD-10, International Classification of Disease version 10; n, number of patients.

Table 1 Baseline Characteristics of Study Population

Characteristics	SPBI		p
	Proven n = 87	Non-Proven n = 149
Age (years)
Mean ± SD	56 ± 13	52 ± 14	0.060
Gender, n (%)
Male	56 (64.4)	81 (54.4)	0.133
Female	31 (35.6)	68 (45.6)
Comorbidities*, n (%)
COPD	3 (3.4)	6 (4.0)	1.000
CKD	16 (18.4)	4 (2.7)	<0.001
Hypertension	38 (43.7)	55 (36.9)	0.305
Type 2 DM	19 (21.8)	34 (22.8)	0.862
Disease severity, n (%)
Mild	0 (0)	13 (8.7)	<0.001
Moderate	19 (21.8)	53 (35.6)
Severe	48 (55.2)	76 (51.0)
Critical	20 (23.0)	7 (4.7)
The onset of illness (days)
Mean ± SD	7 ± 4	6 ± 3	0.264
Outcome, n (%)
Non-survivor	32 (36.8)	19 (12.8)	<0.001
Survivor	55 (63.2)	130 (87.2)

Note: (*) multiple comorbidities can be observed among study population.

Abbreviations: COPD, chronic obstructive pulmonary disease; CKD, chronic kidney disease; DM, diabetes mellitus; SD, standard deviation; p, p-value; SPBI, secondary pulmonary bacterial infection.

Table 2 Distribution of Identified Pathogens Among COVID-19 Patients with (Proven) Secondary Pulmonary Bacterial Infection Group

Pathogens	Total Isolate*		MDR
	n = 114		n = 42
	n	%	n	%
GNB
Acinetobacter baumannii	34	29.8	22	52.4
Klebsiella pneumoniae	25	21.9	6	14.3
Pseudomonas aeruginosa	8	7.0	1	2.4
Stenotrophomonas maltophilia	8	7.0	0	–
Enterobacter cloacae	5	4.4	0	–
Escherichia coli	5	4.4	4	9.5
Klebsiella oxytoca	1	0.9	0	–
Proteus mirabilis	1	0.9	0	–
Serratia marcescens	1	0.9	0	–
Burkholderia cepacia	1	0.9	0	–
GPB
Staphylococcus haemolyticus	11	9.6	9	21.4
Enterococcus faecalis	3	2.6	0	–
Staphylococcus aureus	1	0.9	0	–
Staphylococcus epidermidis	1	0.9	0	–
Streptococcus mitis	1	0.9	0	–
Fungal
Candida albicans	4	3.5	0	–
Candida tropicalis	4	3.5	0	–

Note: (*) multiple isolate can be obtained from single culture result.

Abbreviations: MDR, multi-drug resistance pathogens; GNB, Gram-negative bacteria; GPB, Gram-positive bacteria.

Figure 2 Box-plots distribution of NLR values on D1 and D3 among COVID-19 patients with (proven) and without (non-proven) secondary pulmonary bacterial infection. Thick black line, median value; blue or red box, 25th–75th quartile range; thin bars, range of values excluding outliers.

Abbreviations: D1, day 1, first day on admission; D3, day 3, third day (72 hours thereafter); p, p-value; NLR, neutrophil-to-lymphocyte ratio.

Figure 3 Receiver operating characteristics (ROC) curves of NLR for differentiating COVID- 19 patient with (proven) and without (non-proven) secondary pulmonary bacterial infection. (A) ROC curves of NLR based on first day on admission (D1); (B) ROC curves of NLR based on third day or 72 hours thereafter (D3).

Abbreviations: COV, cut-off value; AUC, area under curve value; NLR, neutrophil-to-lymphocyte ratio.