Neutrophil to lymphocyte ratio (NLR) can be a predictor of the outcome and the need for mechanical ventilation in patients with Covid-19 in Pakistan

  • Abida Pervaiz Jinnah Hosspital Lahore
  • Usman Pasha , Institute of Biochemistry and Biotechnology, The University of Punjab, Lahore, Pakistan
  • Sadia Bashir Consultant Physician, Tehsil Head quarter hospital, Lalamusa, Pakistan
  • Rabia Arshad
  • Muhammad Waseem Assistant professor, Pulmonology, Sahiwal Medical College, Sahiwal, Pakistan
  • Omer Qasim Medical Officer, Jinnah Hospital, Lahore, Pakistan


Objective: The aim of our study was to depict whether a neutrophil to lymphocyte ratio can predict the outcome and need for mechanical ventilation in COVID-19 patients. It also defined the trends of the symptoms and hematological/biochemical parameters in COVID-19 patients in Pakistani population.

Material & Methods: The descriptive cross-sectional study was conducted in the corona virus isolation ward at a tertiary referral facility, Jinnah Hospital, Lahore. A total 31 patients were enrolled in study after applying an inclusion and exclusion criterion over a period of one month. COVID-19 confirmed cases via RT-PCR of nasopharyngeal swab included, after taking informed consent to use their data in the study. Peripheral blood in EDTA vial was taken and immediately sent to the hospital laboratory. Detailed history along with clinical examination was done for every patient.

Results: The mean age of patients was 40.03±15.7 years in which 61.30 % (n=19) belong to the 20-45 years age group and 38.70 % (n=12) were having age of 45-70 years. 74.20% (n=23) were males and 25.80 % (n=8) were females. 28 Patients (90.32%) presented with NLR <3.13 and 3 Patients (9.6%) presented with NLR >3.13 along with lymphopenia. 2 out of 3 patients with NLR > 3.13 were predicted to develop critical illness with age more than 50 years. Outcome in the form of either recovery with home discharge or complications in the form of respiratory failure was observed at the 3rd day of hospital admission. Based on risk stratification of NLR according to age, we prioritized the patients and helped in guiding treatment decisions.

Conclusion: It is concluded that Neutrophil to Lymphocyte ratio can be used as a predictor to the use of supportive protective mechanical ventilation. High NLR > 3.13 associated with mortality in COVID-19 patients and with rapid access to intensive care. Among metabolic profiles, there is a propensity of hyponatremia and normal upper limit of serum potassium levels in COVID-19 patients.

Key Words: Neutrophil, lymphocyte, Predictor, Outcome, Mechanical ventilation.