J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 12, Number 7, July 2020, pages 415-422

Lymphocyte-to-C-Reactive Protein Ratio: A Novel Predictor of Adverse Outcomes in COVID-19

Figure 2. Mean NLR and LCR values at day 1 and day 7 of hospitalization across different interventions and outcomes. NLR: neutrophil-to-lymphocyte ratio; LCR: lymphocyte-to-C-reactive protein ratio.

Figure 3. Forest plots of unadjusted odds ratio of outcomes across NLR and LCR groups. NLR: neutrophil-to-lymphocyte ratio; LCR: lymphocyte-to-C-reactive protein ratio.

**Table 1.** Baseline Characteristics of the Included Population Across Comparison Groups for Which the Pooled Estimate Were Adjusted
	NLR < 10	NLR > 11	Significance	LCR < 10	LCR > 11	Significance
DM: diabetes mellitus; HTN: hypertension; CKD: chronic kidney disease; CAD: coronary artery disease; COPD: chronic obstructive pulmonary disease; HCQ: hydroxychloroquine; TM: tocilizumab; SD: steroid; AC: anticoagulation.
Age	63.6 years	61.6 years	P = 0.71	62.6 years	63.7 years	P = 0.65
Sex
Men	66 (80.50%)	16 (19.50%)	P = 0.167	23 (27.70%)	60 (72.30%)	P = 0.04
Women	75 (88.20%)	10 (11.80%)		13 (14.90%)	74 (85.10%)
DM
No	92 (85.20%)	16 (14.80%)	P = 0.716	23 (21.10%)	86 (78.90%)	P = 0.974
Yes	49 (83.10%)	10 (16.90%)		13 (21.30%)	48 (78.70%)
HTN
No	48 (80.00%)	12 (20.00%)	P = 0.237	14 (23.30%)	46 (76.70%)	P = 0.611
Yes	93 (86.90%)	14 (13.10%)		22 (20.00%)	88 (80.00%)
CAD
No	114 (82.60%)	24 (17.40%)	P = 0.16	30 (21.60%)	109 (78.40%)	P = 0.784
Yes	27 (93.10%)	2 (6.90%)		6 (19.40%)	25 (80.60%)
CKD
No	114 (83.80%)	22 (16.20%)	P = 0.65	28 (20.30%)	110 (79.70%)	P = 0.557
Yes	27 (87.10%)	4 (12.90%)		8 (25.00%)	24 (75.00%)
COPD
No	119 (83.20%)	24 (16.80%)	P = 0.29	32 (21.90%)	114 (78.10%)	P = 0.56
Yes	22 (91.70%)	2 (8.30%)		4 (16.70%)	20 (83.30%)
HCQ
No	27 (87.10%)	4 (12.90%)	P = 0.65	8 (27.60%)	21 (72.40%)	P = 0.354
Yes	114 (83.80%)	22 (16.20%)		28 (19.90%)	113 (80.10%)
TM
No	117 (84.80%)	21 (15.20%)	P = 0.78	28 (20.30%)	110 (79.70%)	P = 0.557
Yes	24 (82.80%)	5 (17.20%)		8 (25.00%)	24 (75.00%)
SD
No	115 (83.30%)	23 (16.70%)	P = 0.39	32 (22.90%)	108 (77.10%)	P = 0.247
Yes	26 (89.70%)	3 (10.30%)		4 (13.30%)	26 (86.70%)
AC
No	115 (85.80%)	19 (14.20%)	P = 0.318	25 (18.40%)	111 (81.60%)	P = 0.075
Yes	26 (78.80%)	7 (21.20%)		11 (32.40%)	23 (67.60%)

Table 1. Baseline Characteristics of the Included Population Across Comparison Groups for Which the Pooled Estimate Were Adjusted

NLR < 10

NLR > 11

Significance

LCR < 10

LCR > 11

Significance

DM: diabetes mellitus; HTN: hypertension; CKD: chronic kidney disease; CAD: coronary artery disease; COPD: chronic obstructive pulmonary disease; HCQ: hydroxychloroquine; TM: tocilizumab; SD: steroid; AC: anticoagulation.

Age

63.6 years

61.6 years

P = 0.71

62.6 years

63.7 years

P = 0.65

Sex

Men

66 (80.50%)

16 (19.50%)

P = 0.167

23 (27.70%)

60 (72.30%)

P = 0.04

Women

75 (88.20%)

10 (11.80%)

13 (14.90%)

74 (85.10%)

92 (85.20%)

16 (14.80%)

P = 0.716

23 (21.10%)

86 (78.90%)

P = 0.974

Yes

49 (83.10%)

10 (16.90%)

13 (21.30%)

48 (78.70%)

HTN

48 (80.00%)

12 (20.00%)

P = 0.237

14 (23.30%)

46 (76.70%)

P = 0.611

Yes

93 (86.90%)

14 (13.10%)

22 (20.00%)

88 (80.00%)

CAD

114 (82.60%)

24 (17.40%)

P = 0.16

30 (21.60%)

109 (78.40%)

P = 0.784

Yes

27 (93.10%)

2 (6.90%)

6 (19.40%)

25 (80.60%)

CKD

114 (83.80%)

22 (16.20%)

P = 0.65

28 (20.30%)

110 (79.70%)

P = 0.557

Yes

27 (87.10%)

4 (12.90%)

8 (25.00%)

24 (75.00%)

COPD

119 (83.20%)

24 (16.80%)

P = 0.29

32 (21.90%)

114 (78.10%)

P = 0.56

Yes

22 (91.70%)

2 (8.30%)

4 (16.70%)

20 (83.30%)

HCQ

27 (87.10%)

4 (12.90%)

P = 0.65

8 (27.60%)

21 (72.40%)

P = 0.354

Yes

114 (83.80%)

22 (16.20%)

28 (19.90%)

113 (80.10%)

117 (84.80%)

21 (15.20%)

P = 0.78

28 (20.30%)

110 (79.70%)

P = 0.557

Yes

24 (82.80%)

5 (17.20%)

8 (25.00%)

24 (75.00%)

115 (83.30%)

23 (16.70%)

P = 0.39

32 (22.90%)

108 (77.10%)

P = 0.247

Yes

26 (89.70%)

3 (10.30%)

4 (13.30%)

26 (86.70%)

115 (85.80%)

19 (14.20%)

P = 0.318

25 (18.40%)

111 (81.60%)

P = 0.075

Yes

26 (78.80%)

7 (21.20%)

11 (32.40%)

23 (67.60%)

**Table 2.** ORs of Outcomes in NLR Groups on Day 1 and Day 7 of Treatment
Outcomes	Day 1	Day 7
aOR: adjusted odds ratio; OR: odds ratio; NLR: neutrophil-to-lymphocyte ratio.
Vent	57	46 (81%)	11 (19%)	OR 1.5 (0.6 - 3.5, P = 0.46)	aOR 1.5 (0.6 - 3.7, P = 0.33)	55	36 (66%)	19 (34%)	OR 3.3 (1.4 - 7.7, P = 0.008)	aOR 3.1 (1.2 - 8.4, P = 0.024)
No vent	110	95 (86%)	15 (14%)			80	69 (86%)	11 (14%)
Upgrade	53	42 (79%)	11 (21%)	OR 1.7 (0.7 - 4.1, P = 0.30)	aOR 1.7 (0.7 - 4.1, P = 0.24)	50	34 (68%)	16 (32%)	OR 2.4 (1.0 - 5.4, P = 0.06)	aOR 2.3 (0.9 - 6.1, P = 0.08)
No upgrade	114	99 (87%)	15 (13%)			85	71 (84%)	14 (16%)
Dialysis	10	7 (70%)	3 (30%)	OR 2.5 (0.6 - 10.3, P = 0.39)	aOR 2.5 (0.5 - 11.2, P = 0.25)	8	6 (75%)	2 (25%)	OR 1.2 (0.2 - 6.1, P = 0.81)	aOR 0.7 (0.1 - 5.7, P = 0.73)
No dialysis	157	134 (85%)	23 (15%)			127	99 (78%)	28 (22%)
Died	18	14 (78%)	4 (22%)	OR 1.6 (0.5 - 5.5, P = 0.63)	aOR 1.9 (0.5 - 6.7, P = 0.30)	18	12 (67%)	6 (33%)	OR 11.0 (3.6 - 33.0, P < 0.0001)	aOR 11.1 (3.11 - 39.1, P < 0.0001)
Alive	149	127 (85%)	22 (15%)			117	99 (85%)	18 (15%)

Table 2. ORs of Outcomes in NLR Groups on Day 1 and Day 7 of Treatment

Outcomes

Day 1

Day 7

NLR < 10

NLR > 11

Unadjusted odds (P value)

aOR (P value)

NLR < 10

NLR > 11

Unadjusted odds (P value)

aOR (P value)

aOR: adjusted odds ratio; OR: odds ratio; NLR: neutrophil-to-lymphocyte ratio.

Vent

46 (81%)

11 (19%)

OR 1.5 (0.6 - 3.5, P = 0.46)

aOR 1.5 (0.6 - 3.7, P = 0.33)

36 (66%)

19 (34%)

OR 3.3 (1.4 - 7.7, P = 0.008)

aOR 3.1 (1.2 - 8.4, P = 0.024)

No vent

110

95 (86%)

15 (14%)

69 (86%)

11 (14%)

Upgrade

42 (79%)

11 (21%)

OR 1.7 (0.7 - 4.1, P = 0.30)

aOR 1.7 (0.7 - 4.1, P = 0.24)

34 (68%)

16 (32%)

OR 2.4 (1.0 - 5.4, P = 0.06)

aOR 2.3 (0.9 - 6.1, P = 0.08)

No upgrade

114

99 (87%)

15 (13%)

71 (84%)

14 (16%)

Dialysis

7 (70%)

3 (30%)

OR 2.5 (0.6 - 10.3, P = 0.39)

aOR 2.5 (0.5 - 11.2, P = 0.25)

6 (75%)

2 (25%)

OR 1.2 (0.2 - 6.1, P = 0.81)

aOR 0.7 (0.1 - 5.7, P = 0.73)

No dialysis

157

134 (85%)

23 (15%)

127

99 (78%)

28 (22%)

Died

14 (78%)

4 (22%)

OR 1.6 (0.5 - 5.5, P = 0.63)

aOR 1.9 (0.5 - 6.7, P = 0.30)

12 (67%)

6 (33%)

OR 11.0 (3.6 - 33.0, P < 0.0001)

aOR 11.1 (3.11 - 39.1, P < 0.0001)

Alive

149

127 (85%)

22 (15%)

117

99 (85%)

18 (15%)

**Table 3.** ORs of Outcomes in LCR Groups on Day 1 and Day 7 of Treatment
Outcomes	Day 1	Day 7
aOR: adjusted odds ratio; OR: odds ratio; LCR: lymphocyte-to-C-reactive protein ratio.
Vent	60	17 (28%)	43 (72%)	OR 2.5 (1.3 - 5.0, P = 0.01)	aOR 2.5 (1.3 - 5.0, P = 0.009)	56	12 (21%)	44 (78%)	OR 1.8 (0.8 - 4.0, P = 0.21)	aOR 1.06 (0.43 - 2.64, P = 0.89)
No vent	110	55 (50%)	55 (50%)			76	25 (33%)	51 (68%)
Upgrade	55	14 (26%)	41 (75%)	OR 2.9 (1.47 - 6.1, P = 0.004)	aOR 3.1 (1.5 - 6.3, P = 0.003)	50	10 (20%)	40 (80%)	OR 2.0 (0.9 - 5.0, P = 0.16)	aOR 1.16 (0.46 - 2.96, P = 0.74)
No upgrade	115	58 (50%)	57 (50%)			82	27 (33%)	55 (67%)
Dialysis	10	3 (30%)	7 (70%)	OR 1.8 (0.4 - 7.1, P = 0.63)	aOR 1.8 (0.4 - 8.0, P = 0.44)	7	1 (14%)	6 (86%)	OR 2.4 (0.3 - 21.0, P = 0.70)	aOR 3.7 (0.2 - 55.6, P = 0.34)
No dialysis	160	69 (43%)	91 (57%)			125	36 (29%)	89 (71%)
Died	20	10 (50%)	10 (50%)	OR 0.71 (0.3 - 1.8, P = 0.62)	aOR 0.8 (0.3 - 2.0, P = 0.60)	19	12 (63%)	7 (37%)	OR 0.2 (0.06 - 0.47, P = 0.001)	aOR 0.1 (0.01 - 0.30, P < 0.0001)
Alive	150	62 (41%)	88 (58%)			113	25 (22%)	88 (78%)

Table 3. ORs of Outcomes in LCR Groups on Day 1 and Day 7 of Treatment

Outcomes

Day 1

Day 7

LCR < 100

LCR > 101

Unadjusted odds (P value)

aOR (P value)

LCR < 100

LCR > 101

Unadjusted odds (P value)

aOR (P value)

aOR: adjusted odds ratio; OR: odds ratio; LCR: lymphocyte-to-C-reactive protein ratio.

Vent

17 (28%)

43 (72%)

OR 2.5 (1.3 - 5.0, P = 0.01)

aOR 2.5 (1.3 - 5.0, P = 0.009)

12 (21%)

44 (78%)

OR 1.8 (0.8 - 4.0, P = 0.21)

aOR 1.06 (0.43 - 2.64, P = 0.89)

No vent

110

55 (50%)

25 (33%)

51 (68%)

Upgrade

14 (26%)

41 (75%)

OR 2.9 (1.47 - 6.1, P = 0.004)

aOR 3.1 (1.5 - 6.3, P = 0.003)

10 (20%)

40 (80%)

OR 2.0 (0.9 - 5.0, P = 0.16)

aOR 1.16 (0.46 - 2.96, P = 0.74)

No upgrade

115

58 (50%)

57 (50%)

27 (33%)

55 (67%)

Dialysis

3 (30%)

7 (70%)

OR 1.8 (0.4 - 7.1, P = 0.63)

aOR 1.8 (0.4 - 8.0, P = 0.44)

1 (14%)

6 (86%)

OR 2.4 (0.3 - 21.0, P = 0.70)

aOR 3.7 (0.2 - 55.6, P = 0.34)

No dialysis

160

69 (43%)

91 (57%)

125

36 (29%)

89 (71%)

Died

10 (50%)

OR 0.71 (0.3 - 1.8, P = 0.62)

aOR 0.8 (0.3 - 2.0, P = 0.60)

12 (63%)

7 (37%)

OR 0.2 (0.06 - 0.47, P = 0.001)

aOR 0.1 (0.01 - 0.30, P < 0.0001)

Alive

150

62 (41%)

88 (58%)

113

25 (22%)

88 (78%)