The Neutrophil Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR) and routine hematological parameters of COVID-19 Patient : A perspective of the Indian scenario from a frontline pilot study of 32 COVID-19 cases in a Tertiary Care Institute of North India

  1. Neema Tiwari
  2. Devajit Nath
  3. Jyotsna Madan
  4. Savitri Singh
  5. Prashant Bajpai
  6. Ujjwal Madan

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Abstract

Introduction The coronavirus disease 2019(COVID-19) is caused by the virus SARS-CoV-2 and is declared as a global pandemic by the World Health Organization (WHO). Various hematological parameters alteration has been documented in the Chinese literature in SARS-Cov-2 infection. However, there is a need for research to evaluate the pattern of the hematological parameters of COVID-19 patients in the Indian population. Aims & Objectives: The objective of the study is to see the Neutrophil-Lymphocyte Ratio (NLR), Platelet Lymphocyte Ratio (PLR), and other hematological parameters alteration of COVID-19 patients along with their clinical course in the Indian scenario. Methods: A single-center prospective study of 32 patients with laboratory-confirmed COVID-19 admitted to Super Speciality Pediatric Hospital & Post Graduate Teaching Institute NOIDA, from March to April, were enrolled for the study. The demographic data, the clinical status of the patients during admission and follow up, baseline, and follow up hematological findings were recorded. Statistical analysis of the data was carried out, and relevant findings were presented. Results: Demographic characterization shows a mean age of 37.7 years, male (41.9%), female (58.1%)with the majority of patients are mildly symptomatic to asymptomatic(93%). The CBC values and NLR, PLR at baseline between the male and the female patients, are not showing any statistically significant difference as the 95% C.I. A statistically significant increment in the lab parameters is observed in follow-up visits. Conclusion: The majority of the patients are younger and have mild clinical presentation with female predominance. Pediatric cases have mild symptomology. Baseline CBC findings show mild neutrophilia, lymphopenia, eosinopenia, and normal to mild thrombocytopenia. An increase in CBC parameters, NLR was noted in follow up cases. Anemia was not noted in baseline CBC and in the follow-up group. A onetime PLR is not indicative of disease progression. Key words: Corona virus,COVID-19,CBC,NLR,PLR

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  1. ScreenIT

    SciScore for 10.1101/2020.05.29.20102913: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All statistical analyses were carried out by SPSS 15.0 (SPSS Inc., Chicago, USA).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A small follow up group is a statistical limitation of our study. A follow-up analysis of CBC Parameters of a large Indian cohort is suggested to statistically prove the association of parameters with prognosis. In a recently discussed paper, it is suggested that in addition to various mechanisms, SARS-CoV-2 viral protein infects hemoglobin by the immune hemolysis of red blood cells28. However, in our study, the baseline RBC count and hemoglobin levels were not changed in all the 32 cases and in the 3 follow up cases on 1st, 2nd, 3rd reading. These statistically insignificant findings of baseline CBC in Indian population with a stable clinical course as compared to other foreign data are promising and could explain worse COVID-19 outcome in western countries, unlike India which is leading globally in disease containment with only 12759 cased,1515 recoveries and only 420 deaths compared to world data of 1,40,773 deaths (0.29% of the world deaths). However, a relevant trend in follows up CBC in a large Indian cohort might predict the disease progression and prognosis. Limitation of the Study: There may be missing laboratory data as CBC investigation was not performed daily on all patients, especially those who are minimally symptomatic and improving in the general Isolation Ward. Also, a very low sample size of follow up as well as no follow up cases analyzed is a big limitation for definitive statistical findings.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.05.29.20102913v1 on medRxiv