• Juan R Ulloque-Badaracco, Ivan Salas-TelloWW0000-0001-5105-4082Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru., Ali Al-Kassab-Córdova, Esteban A Alarcón-Braga, Vicente A Benites-Zapata, Jorge L Maguiña, and Adrian V Hernandez.
• Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.
• Int. J. Clin. Pract. 2021 Nov 1; 75 (11): e14596e14596.

BackgroundNeutrophil-to-lymphocyte ratio (NLR) is an accessible and widely used biomarker. NLR may be used as an early marker of poor prognosis in patients with COVID-19.ObjectiveTo evaluate the prognostic value of the NLR in patients diagnosed with COVID-19.MethodsWe conducted a systematic review and meta-analysis. Observational studies that reported the association between baseline NLR values (ie, at hospital admission) and severity or all-cause mortality in COVID-19 patients were included. The quality of the studies was assessed using the Newcastle-Ottawa Scale (NOS). Random effects models and inverse variance method were used for meta-analyses. The effects were expressed as odds ratios (ORs) and their 95% confidence intervals (CIs). Small study effects were assessed with the Egger's test.ResultsWe analysed 61 studies (n = 15 522 patients), 58 cohorts, and 3 case-control studies. An increase of one unit of NLR was associated with higher odds of severity (OR 6.22; 95%CI 4.93 to 7.84; P < .001) and higher odds of all-cause mortality (OR 12.6; 95%CI 6.88 to 23.06; P < .001). In our sensitivity analysis, we found that 41 studies with low risk of bias and moderate heterogeneity (I2  = 53% and 58%) maintained strong association between NLR values and both outcomes (severity: OR 5.36; 95% CI 4.45 to 6.45; P < .001; mortality: OR 10.42 95% CI 7.73 to 14.06; P = .005).ConclusionsHigher values of NLR were associated with severity and all-cause mortality in hospitalised COVID-19 patients.© 2021 John Wiley & Sons Ltd.

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