Hematological Parameters as Diagnostic Factors: Correlation with Severity of COVID-19

Hematological Parameters as Diagnostic Factors: Correlation with Severity of COVID-19


  • Masoomeh Dadkhah Ardabil University of Medical Sciences
  • Somaieh Matin
  • Elham Safarzadeh
  • Nima Rezaei
  • Mohammad Negaresh
  • Hossein Salehzadeh
  • Samira Matin
  • Amirhossein Sharifiazar
  • Malek Abazari


COVID-19; Hematological parameters; Prognosis; Severity


Bachground and aim: Coronavirus disease 2019(COVID-19), which is the pandemic of 21st century, is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Prognostic factors play an essential role in predicting the patients who need more care. Therefore, the current study aimed to investigate the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) ratio as discriminated indexes in prognosis of patients with COVID‐19. Methods: Age, NLR, PLR, white blood cell (WBC), neutrophil count, lymphocyte count and platelet from 1007 hospitalized patients with COVID-19, who were admitted to two referring hospitals  in Ardabil, North Western Iran. All confirmed cases divided into non-severe and severe groups. Results:  534 (53.4%) males and 473 (47.3 %) females with mean age of 52 years were enrolled in this study. Patients with severe COVID-19 have lower counts of lymphocyte, but have higher NLR, comparing to non-severe patients (P = 0.001). Conclusion: Elevated NLR can be assumed as an independent biomarker, which could provide a crucial indicator in the monitoring patients with COVID-19 on admission. Increased NLR was correlated with the severity of COVID-19. Assessment of NLR could be proposed to identify high risk individuals with COVID-19.


Guo Y-R, Cao Q-D, Hong Z-S, Tan Y-Y, Chen S-D, Jin H-J, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak–an update on the status. Military Medical Research. 2020;7(1):1-10.

Gorbalenya AE, Baker SC, Baric R, Groot RJd, Drosten C, Gulyaeva AA, et al. Severe acute respiratory syndrome-related coronavirus: The species and its viruses–a statement of the Coronavirus Study Group. 2020.

Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HH, et al. Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. Journal of Infection. 2020.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. Jama. 2020;323(11):1061-9.

Hunter P. The inflammation theory of disease: The growing realization that chronic inflammation is crucial in many diseases opens new avenues for treatment. EMBO reports. 2012;13(11):968-70.

Faria SS, Fernandes Jr PC, Silva MJB, Lima VC, Fontes W, Freitas-Junior R, et al. The neutrophil-to-lymphocyte ratio: a narrative review. ecancermedicalscience. 2016;10.

Azab B, Zaher M, Weiserbs KF, Torbey E, Lacossiere K, Gaddam S, et al. Usefulness of neutrophil to lymphocyte ratio in predicting short-and long-term mortality after non–ST-elevation myocardial infarction. The American journal of cardiology. 2010;106(4):470-6.

Ye Q, Wang B, Mao J. The pathogenesis and treatment of theCytokine Storm'in COVID-19. Journal of infection. 2020;80(6):607-13.

Man MA, Rajnoveanu R-M, Motoc NS, Bondor CI, Chis AF, Lesan A, et al. Neutrophil-to-lymphocyte ratio, platelets-to-lymphocyte ratio, and eosinophils correlation with high-resolution computer tomography severity score in COVID-19 patients. Plos one. 2021;16(6):e0252599.

Qu R, Ling Y, Zhang Yhz, Wei Ly, Chen X, Li Xm, et al. Platelet‐to‐lymphocyte ratio is associated with prognosis in patients with coronavirus disease‐19. Journal of medical virology. 2020.

Altoparlak U, Koca O, Ozkurt Z, Akcay MN. Incidence and risk factors of vancomycin-resistant enterococcus colonization in burn unit patients. Burns. 2011;37(1):49-53.

Yang A-P, Liu J, Tao W, Li H-m. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. International immunopharmacology. 2020:106504.

Sun S, Cai X, Wang H, He G, Lin Y, Lu B, et al. Abnormalities of peripheral blood system in patients with COVID-19 in Wenzhou, China. Clinica chimica acta. 2020;507:174-80.

Xia X, Wen M, Zhan S, He J, Chen W. An increased neutrophil/lymphocyte ratio is an early warning signal of severe COVID-19. Nan fang yi ke da xue xue bao= Journal of Southern Medical University. 2020;40(3):333-6.

Eid MM, Al-Kaisy M, Regeia WAL, Khan HJ. The Prognostic Accuracy of Neutrophil-Lymphocyte Ratio in COVID-19 Patients. Advanced Journal of Emergency Medicine. 2020.

Hanrahan V, Currie MJ, Gunningham SP, Morrin HR, Scott PA, Robinson BA, et al. The angiogenic switch for vascular endothelial growth factor (VEGF)‐A, VEGF‐B, VEGF‐C, and VEGF‐D in the adenoma–carcinoma sequence during colorectal cancer progression. The Journal of Pathology: A Journal of the Pathological Society of Great Britain and Ireland. 2003;200(2):183-94.

Kim S-L, Lee S-T, Trang KTT, Kim SH, Kim IH, Lee SO, et al. Parthenolide exerts inhibitory effects on angiogenesis through the downregulation of VEGF/VEGFRs in colorectal cancer. International journal of molecular medicine. 2014;33(5):1261-7.

Emily S, Weitzman S, Shacter E, Weitzman S. Chronic inflammation and cancer. Oncology. 2002;16(2):217-26.

Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. Jama. 2020;323(14):1406-7.

Pirsalehi A, Salari S, Baghestani A, Vahidi M, Khave LJ, Akbari ME, et al. Neutrophil-to-lymphocyte ratio (NLR) greater than 6.5 may reflect the progression of COVID-19 towards an unfavorable clinical outcome. Iranian Journal of Microbiology. 2020.

Eickmann M, Gravemann U, Handke W, Tolksdorf F, Reichenberg S, Müller TH, et al. Inactivation of three emerging viruses–severe acute respiratory syndrome coronavirus, Crimean–Congo haemorrhagic fever virus and Nipah virus–in platelet concentrates by ultraviolet C light and in plasma by methylene blue plus visible light. Vox sanguinis. 2020;115(3):146-51.

Pilaczyńska-Cemel M, Gołda R, Dąbrowska A, Przybylski G. Analysis of the level of selected parameters of inflammation, circulating immune complexes, and related indicators (neutrophil/lymphocyte, platelet/lymphocyte, CRP/CIC) in patients with obstructive diseases. Central-European journal of immunology. 2019;44(3):292.

Shinya K, Gao Y, Cilloniz C, Suzuki Y, Fujie M, Deng G, et al. Integrated clinical, pathologic, virologic, and transcriptomic analysis of H5N1 influenza virus-induced viral pneumonia in the rhesus macaque. Journal of virology. 2012;86(11):6055-66.

Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry research. 2020:112954.







How to Cite

Dadkhah M, Matin S, Safarzadeh E, Rezaei N, Negaresh M, Salehzadeh H, et al. Hematological Parameters as Diagnostic Factors: Correlation with Severity of COVID-19 . Acta Biomed [Internet]. 2022 May 11 [cited 2024 Jul. 21];93(2):e2022061. Available from: https://www.mattioli1885journals.com/index.php/actabiomedica/article/view/12320