Predictive Value of Neutrophil/Lymphocyte Ratio (NLR) on Cardiovascular Events in Patients with COVID-19
Lili Zhan, Yang Liu, Yanxiang Cheng, Weichun Guo, Jing Yang
Abstract
Background: The research on the association between coronavirus disease 2019 (COVID-19) and cardiovascular disease (CVD) is still insufficient. Aim: This study aimed to investigate the association between neutrophil/lymphocyte ratio (NLR) and risk of cardiovascular events in patients with COVID-19. Methods: Our study included 159 patients with COVID-19 who were measured for NLR value within the first 24 hours of admission. They were followed up for 6 months after discharge and then the relationship between levels of NLR and risk of cardiovascular events was assessed. Results: In all included patients with COVID-19, NLR values in patients with cardiovascular events [16.28 (4.95– 45.18)] were significantly higher than patients without cardiovascular events [4.75 (2.60– 7.47)]. A multivariate logistic regression model revealed that elevated NLR value [increased per SD, 2.41 (1.43– 4.29), P < 0.001; increased 1 of NLR, 2.05 (1.33– 4.01), P =0.010] was significantly and independently associated with increased risk of CVD history on admission after adjustment of related confounding factors. Then, Cox regression analysis revealed that elevated NLR value had a significant association with increased risk of cardiovascular events [increased per SD, 2.36 (1.42– 4.36), P < 0.001; Increased 1 of NLR, 2.00 (1.30– 3.97), P =0.014] after adjustments of these same confounding factors. Furthermore, the ROC curve suggested that NLR value (AUC=0.803, 95% CI=0.731– 0.875, P < 0.001, sensitivity 81.2%, and specificity 82.6%) has a good predictive value for cardiovascular events during follow-up. Conclusion: High NLR value was clinically associated with elevated risk of cardiovascular events in patients with COVID-19, which might be a potential biomarker for predicting cardiovascular events in the current COVID-19 pandemic. Keywords: cardiovascular events, COVID-19, neutrophil/lymphocyte ratio, predictive value, biomarker