Acta Scientific Medical Sciences (ASMS)(ISSN: 2582-0931)

Research Article Volume 5 Issue 9

WBCs, Neutrophils to Lymphocytes, Monocytes to Lymphocytes and Platelets to Lymphocytes Ratios to Predict the Severity of Covid-19 Cases among Intensive Care Unit Patients

Haytham Dahlwi*, Rana Zaini and Mazen Almehmadi

Clinical Laboratory Sciences, Taif University, Saudi Arabia

*Corresponding Author: Haytham Dahlawi, Associate Professor, Hematology, Clinical Laboratory Department, College of Applied Medical Science, Taif University, Taif, Saudi Arabia.

Received: July 28, 2021; Published: August 13, 2021


Introduction: On March 2020, the World Health Organization (WHO) introduced the disease of Coronavirus 2019 (COVID-19) as a pandemic disorder. Although Covid-19 has spread rapidly causing serious health problems and might lead to death no effective treatment has discovered yet, the detection of reliable and useful prognostic markers is helpful to predict the severity and prognosis among Covid-19 patients. Thus, the current study aimed to assess and compare the level of WBCs, lymphocytes, neutrophils, monocytes and platelets in Covid-19 patients and control group. This study also evaluated neutrophils to lymphocytes, monocytes to lymphocytes and platelets to lymphocytes ratio.

Methods: This is a retrospective study included 385 participants 350 of which were confirmed COVID- 19 cases. Whereas the control group include 35 healthy individuals.

Results: The result of this study showed a significant increase in total WBCs count, significant low lymphocytes count and significant high neutrophil count in Covid-19 patients admitted in intensive care unit (ICU) compared to the control group. The result of this study also reported significantly (P < 0.0001) higher values for neutrophil-to-lymphocyte ratio (NLR), monocytes-to-lymphocyte ratios (MLR) and platelet-to-lymphocyte ratio (PLR), in Covid-19 patients admitted in ICU.

Conclusion: Based on the findings of this study, which revealed significant changes in a number of blood cells among Covid-19 patients admitted to ICU, it is suggested that level of WBCs, NLR, MLR and PLR can be use as a useful prediction marker to predict the severity of Covid-19 cases in ICU.

Keywords: White Blood Cells; Neutrophils to Lymphocytes Ratio; Monocytes to Lymphocytes Ratio and Platelets to Lymphocytes Ratio; Covid-19


  1. Sayed A A A., et al. "The use of neutrophil-to-lymphocyte ratio (NLR) as a marker for COVID-19 infection in Saudi Arabia: A case-control retrospective multicenter study”. (2021).‏
  2. Guo Yan-Rong., et al. "The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak–an update on the status”. Military Medical Research1 (2020): 1-10.‏
  3. Rothan Hussin A and Siddappa N Byrareddy. "The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak”. Journal of Autoimmunity 109 (2020): 102433.‏
  4. R Ruan, Qiurong., et al. "Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China”. Intensive Care Medicine5 (2020): 846-848.
  5. Cheng Olivia Z and Nades Palaniyar. "NET balancing: a problem in inflammatory lung diseases”. Frontiers in Immunology 4 (2013): 1.
  6. Lamichhane Prem P and Amali E Samarasinghe. "The role of innate leukocytes during influenza virus infection”. Journal of Immunology Research 2019 (2019).‏
  7. Dahlawi Haytham. "Changes in Haematological Parameters among COVID-19 Patients”. International Journal of Current Research and Review 18 (2020): 2-4.‏
  8. LLagunas‐Rangel Francisco Alejandro. "Neutrophil‐to‐lymphocyte ratio and lymphocyte‐to‐C‐reactive protein ratio in patients with severe coronavirus disease 2019 (COVID‐19): a meta‐analysis”. Journal of Medical Virology (2020).‏
  9. Shang Weifeng., et al. "The value of clinical parameters in predicting the severity of COVID‐19”. Journal of Medical Virology10 (2020): 2188-2192.‏
  10. Ding Xiurong., et al. "Dynamic profile and clinical implications of hematological parameters in hospitalized patients with coronavirus disease 2019”. Clinical Chemistry and Laboratory Medicine (CCLM) 8 (2020): 1365-1371.‏
  11. Udugama Buddhisha., et al. "Diagnosing COVID-19: the disease and tools for detection”. ACS Nano4 (2020): 3822-3835.‏
  12. Terpos Evangelos., et al. "Hematological findings and complications of COVID‐19”. American Journal of Hematology7 (2020): 834-847.‏
  13. Shivakumar BG., et al. "Neutrophil-to-Lymphocyte, Lymphocyte-to-Monocyte, and Platelet-to-Lymphocyte Ratios: Prognostic Significance in COVID-19”. Cureus1 (2021).
  14. Xu Xiaoping., et al. "Analysis of blood index characteristics in COVID-19 patients and their associations with different outcomes”. Journal of Laboratory Medicine3 (2021): 149-157.‏
  15. Pozdnyakova Olga., et al. "Clinical significance of CBC and WBC morphology in the diagnosis and clinical course of COVID-19 infection”. American Journal of Clinical Pathology3 (2021): 364-375.
  16. ‏Chen Nanshan., et al. "Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study”. The Lancet10223 (2020): 507-513.‏
  17. Eslamijouybari Mohammad., et al. "Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios in COVID-19 Patients and Control Group and Relationship with Disease Prognosis”. Caspian Journal of Internal Medicine1 (2020): 531.‏
  18. Kamel Fatemah O., et al. "Clinical and hematologic presentations of adults with COVID-19 patients in Jeddah: A case control study”. Journal of Infection and Public Health6 (2021): 709-716.‏
  19. Silvin Aymeric., et al. "Elevated calprotectin and abnormal myeloid cell subsets discriminate severe from mild COVID-19”. Cell6 (2020): 1401-1418.‏
  20. Biamonte Flavia., et al. "Combined lymphocyte/monocyte count, D-dimer and iron status predict COVID-19 course and outcome in a long-term care facility”. Journal of Translational Medicine1 (2021): 1-10.‏
  21. Qu Rong., et al. "Platelet‐to‐lymphocyte ratio is associated with prognosis in patients with coronavirus disease‐19”. Journal of Medical Virology9 (2020): 1533-1541.‏
  22. Jayanthi Hari Kishan and Sai Krishna Tulasi. "Correlation study between platelet count, leukocyte count, nonhemorrhagic complications, and duration of hospital stay in dengue fever with thrombocytopenia”. Journal of Family Medicine and Primary Care1 (2016): 120.
  23. LLippi, Giuseppe, Mario Plebani, and Brandon Michael Henry. "Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis”. Clinica Chimica Acta 506 (2020): 145-148.‏
  24. Seyit Murat., et al. "Neutrophil to lymphocyte ratio, lymphocyte to monocyte ratio and platelet to lymphocyte ratio to predict the severity of COVID-19”. The American Journal of Emergency Medicine 40 (2021): 110-114.‏
  25. Kong Man., et al. "Higher level of neutrophil-to-lymphocyte is associated with severe COVID-19”. Epidemiology and Infection 148 (2020).


Citation: Haytham Dahlwi., et al. “WBCs, Neutrophils to Lymphocytes, Monocytes to Lymphocytes and Platelets to Lymphocytes Ratios to Predict the Severity of Covid-19 Cases among Intensive Care Unit Patients”.Acta Scientific Medical Sciences 5.9 (2021): 57-62.


Copyright: © 2021 Haytham Dahlwi., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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