Comparison of Lymphocyte-CRP ratio to conventional inflammatory markers for predicting clinical outcomes in COVID-19

Alexander Qichen Liu; Robert Hammond; Kenneth Chan; Chukwugozie Chukwuenweniwe; Rebecca Johnson; Duaa Khair; Eleanor Duck; Oluwaseun Olubodun; Kristian Barwick; Winston Banya; James Stirrup; Peter Duncan Donnelly; Juan Carlos Kaski; Anthony R Coates

doi:10.3390/jpm13060909

Comparison of Lymphocyte-CRP ratio to conventional inflammatory markers for predicting clinical outcomes in COVID-19

Alexander Qichen Liu, Robert Hammond, Kenneth Chan, Chukwugozie Chukwuenweniwe, Rebecca Johnson, Duaa Khair, Eleanor Duck, Oluwaseun Olubodun, Kristian Barwick, Winston Banya, James Stirrup, Peter Duncan Donnelly, Juan Carlos Kaski, Anthony R Coates^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background: In COVID-19 patients, lymphocyte–CRP ratio (LCR) is a promising biomarker for predicting adverse clinical outcomes. How well LCR performs compared to conventional inflammatory markers for prognosticating COVID-19 patients remains unclear, which hinders the clinical translation of this novel biomarker.

Methods: In a cohort of COVID-19 inpatients, we characterised the clinical applicability of LCR by comparing its prognostic value against conventional inflammatory markers for predicting inpatient mortality and a composite of mortality, invasive/non-invasive ventilation and intensive care unit admissions.

Results: Of the 413 COVID-19 patients, 100 (24%) patients suffered inpatient mortality. On Receiver Operating Characteristics analysis, LCR performed similarly to CRP for predicting mortality (AUC 0.74 vs. 0.71, p = 0.049) and the composite endpoint (AUC 0.76 vs. 0.76, p = 0.812). LCR outperformed lymphocyte counts (AUC 0.74 vs. 0.66, p = 0.002), platelet counts (AUC 0.74 vs. 0.61, p = 0.003) and white cell counts (AUC 0.74 vs. 0.54, p < 0.001) for predicting mortality. On Kaplan–Meier analysis, patients with a low LCR (below a 58 cut-off) had worse inpatient survival than patients with other LCR values (p < 0.001).

Conclusion: LCR appears comparable to CRP, but outperformed other inflammatory markers, for prognosticating COVID-19 patients. Further studies are required to improve the diagnostic value of LCR to facilitate clinical translation.

Original language	English
Article number	909
Number of pages	11
Journal	Journal of Personalized Medicine
Volume	13
Issue number	6
DOIs	https://doi.org/10.3390/jpm13060909
Publication status	Published - 29 May 2023

Keywords

Lymphocyte–CRP ratio
Coronavirus disease 19
C-reactive protein
Risk stratification
Prognostic risk
COVID-19

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Copyright: © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/4.0/).
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Liu, A. Q., Hammond, R., Chan, K., Chukwuenweniwe, C., Johnson, R., Khair, D., Duck, E., Olubodun, O., Barwick, K., Banya, W., Stirrup, J., Donnelly, P. D., Kaski, J. C., & Coates, A. R. (2023). Comparison of Lymphocyte-CRP ratio to conventional inflammatory markers for predicting clinical outcomes in COVID-19. Journal of Personalized Medicine, 13(6), Article 909. https://doi.org/10.3390/jpm13060909

@article{f66b935885ab42fcbdc0d2616913ba91,

title = "Comparison of Lymphocyte-CRP ratio to conventional inflammatory markers for predicting clinical outcomes in COVID-19",

abstract = "Background: In COVID-19 patients, lymphocyte–CRP ratio (LCR) is a promising biomarker for predicting adverse clinical outcomes. How well LCR performs compared to conventional inflammatory markers for prognosticating COVID-19 patients remains unclear, which hinders the clinical translation of this novel biomarker. Methods: In a cohort of COVID-19 inpatients, we characterised the clinical applicability of LCR by comparing its prognostic value against conventional inflammatory markers for predicting inpatient mortality and a composite of mortality, invasive/non-invasive ventilation and intensive care unit admissions. Results: Of the 413 COVID-19 patients, 100 (24%) patients suffered inpatient mortality. On Receiver Operating Characteristics analysis, LCR performed similarly to CRP for predicting mortality (AUC 0.74 vs. 0.71, p = 0.049) and the composite endpoint (AUC 0.76 vs. 0.76, p = 0.812). LCR outperformed lymphocyte counts (AUC 0.74 vs. 0.66, p = 0.002), platelet counts (AUC 0.74 vs. 0.61, p = 0.003) and white cell counts (AUC 0.74 vs. 0.54, p < 0.001) for predicting mortality. On Kaplan–Meier analysis, patients with a low LCR (below a 58 cut-off) had worse inpatient survival than patients with other LCR values (p < 0.001). Conclusion: LCR appears comparable to CRP, but outperformed other inflammatory markers, for prognosticating COVID-19 patients. Further studies are required to improve the diagnostic value of LCR to facilitate clinical translation.",

keywords = "Lymphocyte–CRP ratio, Coronavirus disease 19, C-reactive protein, Risk stratification, Prognostic risk, COVID-19",

author = "Liu, {Alexander Qichen} and Robert Hammond and Kenneth Chan and Chukwugozie Chukwuenweniwe and Rebecca Johnson and Duaa Khair and Eleanor Duck and Oluwaseun Olubodun and Kristian Barwick and Winston Banya and James Stirrup and Donnelly, {Peter Duncan} and Kaski, {Juan Carlos} and Coates, {Anthony R}",

year = "2023",

month = may,

day = "29",

doi = "10.3390/jpm13060909",

language = "English",

volume = "13",

journal = "Journal of Personalized Medicine",

issn = "2075-4426",

publisher = "MDPI",

number = "6",

}

Liu, AQ, Hammond, R, Chan, K, Chukwuenweniwe, C, Johnson, R, Khair, D, Duck, E, Olubodun, O, Barwick, K, Banya, W, Stirrup, J, Donnelly, PD, Kaski, JC & Coates, AR 2023, 'Comparison of Lymphocyte-CRP ratio to conventional inflammatory markers for predicting clinical outcomes in COVID-19', Journal of Personalized Medicine, vol. 13, no. 6, 909. https://doi.org/10.3390/jpm13060909

TY - JOUR

T1 - Comparison of Lymphocyte-CRP ratio to conventional inflammatory markers for predicting clinical outcomes in COVID-19

AU - Liu, Alexander Qichen

AU - Hammond, Robert

AU - Chan, Kenneth

AU - Chukwuenweniwe, Chukwugozie

AU - Johnson, Rebecca

AU - Khair, Duaa

AU - Duck, Eleanor

AU - Olubodun, Oluwaseun

AU - Barwick, Kristian

AU - Banya, Winston

AU - Stirrup, James

AU - Donnelly, Peter Duncan

AU - Kaski, Juan Carlos

AU - Coates, Anthony R

PY - 2023/5/29

Y1 - 2023/5/29

N2 - Background: In COVID-19 patients, lymphocyte–CRP ratio (LCR) is a promising biomarker for predicting adverse clinical outcomes. How well LCR performs compared to conventional inflammatory markers for prognosticating COVID-19 patients remains unclear, which hinders the clinical translation of this novel biomarker. Methods: In a cohort of COVID-19 inpatients, we characterised the clinical applicability of LCR by comparing its prognostic value against conventional inflammatory markers for predicting inpatient mortality and a composite of mortality, invasive/non-invasive ventilation and intensive care unit admissions. Results: Of the 413 COVID-19 patients, 100 (24%) patients suffered inpatient mortality. On Receiver Operating Characteristics analysis, LCR performed similarly to CRP for predicting mortality (AUC 0.74 vs. 0.71, p = 0.049) and the composite endpoint (AUC 0.76 vs. 0.76, p = 0.812). LCR outperformed lymphocyte counts (AUC 0.74 vs. 0.66, p = 0.002), platelet counts (AUC 0.74 vs. 0.61, p = 0.003) and white cell counts (AUC 0.74 vs. 0.54, p < 0.001) for predicting mortality. On Kaplan–Meier analysis, patients with a low LCR (below a 58 cut-off) had worse inpatient survival than patients with other LCR values (p < 0.001). Conclusion: LCR appears comparable to CRP, but outperformed other inflammatory markers, for prognosticating COVID-19 patients. Further studies are required to improve the diagnostic value of LCR to facilitate clinical translation.

AB - Background: In COVID-19 patients, lymphocyte–CRP ratio (LCR) is a promising biomarker for predicting adverse clinical outcomes. How well LCR performs compared to conventional inflammatory markers for prognosticating COVID-19 patients remains unclear, which hinders the clinical translation of this novel biomarker. Methods: In a cohort of COVID-19 inpatients, we characterised the clinical applicability of LCR by comparing its prognostic value against conventional inflammatory markers for predicting inpatient mortality and a composite of mortality, invasive/non-invasive ventilation and intensive care unit admissions. Results: Of the 413 COVID-19 patients, 100 (24%) patients suffered inpatient mortality. On Receiver Operating Characteristics analysis, LCR performed similarly to CRP for predicting mortality (AUC 0.74 vs. 0.71, p = 0.049) and the composite endpoint (AUC 0.76 vs. 0.76, p = 0.812). LCR outperformed lymphocyte counts (AUC 0.74 vs. 0.66, p = 0.002), platelet counts (AUC 0.74 vs. 0.61, p = 0.003) and white cell counts (AUC 0.74 vs. 0.54, p < 0.001) for predicting mortality. On Kaplan–Meier analysis, patients with a low LCR (below a 58 cut-off) had worse inpatient survival than patients with other LCR values (p < 0.001). Conclusion: LCR appears comparable to CRP, but outperformed other inflammatory markers, for prognosticating COVID-19 patients. Further studies are required to improve the diagnostic value of LCR to facilitate clinical translation.

KW - Lymphocyte–CRP ratio

KW - Coronavirus disease 19

KW - C-reactive protein

KW - Risk stratification

KW - Prognostic risk

KW - COVID-19

UR - https://www.mdpi.com/2075-4426/13/6/909

U2 - 10.3390/jpm13060909

DO - 10.3390/jpm13060909

M3 - Article

SN - 2075-4426

VL - 13

JO - Journal of Personalized Medicine

JF - Journal of Personalized Medicine

IS - 6

M1 - 909

ER -

Comparison of Lymphocyte-CRP ratio to conventional inflammatory markers for predicting clinical outcomes in COVID-19

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