Neutrophil-to-lymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19

J Infect. 2020 Jul;81(1):e6-e12. doi: 10.1016/j.jinf.2020.04.002. Epub 2020 Apr 10.


Background: Several studies have described the clinical characteristics of patients with novel coronavirus (SARS-CoV-2) infected pneumonia (COVID-19), indicating severe patients tended to have higher neutrophil to lymphocyte ratio (NLR). Whether baseline NLR could be an independent predictor of in-hospital death in Chinese COVID-19 patients remains to be investigated.

Methods: A cohort of patients with COVID-19 admitted to the Zhongnan Hospital of Wuhan University from January 1 to February 29 was retrospectively analyzed. The baseline data of laboratory examinations, including NLR, were collected. Univariate and multivariate logistic regression models were developed to assess the independent relationship between the baseline NLR and in-hospital all-cause death. A sensitivity analysis was performed by converting NLR from a continuous variable to a categorical variable according to tertile. Interaction and stratified analyses were conducted as well.

Results: 245 COVID-19 patients were included in the final analyses, and the in-hospital mortality was 13.47%. Multivariate analysis demonstrated that there was 8% higher risk of in-hospital mortality for each unit increase in NLR (Odds ratio [OR] = 1.08; 95% confidence interval [95% CI], 1.01 to 1.14; P = 0.0147). Compared with patients in the lowest tertile, the NLR of patients in the highest tertile had a 15.04-fold higher risk of death (OR = 16.04; 95% CI, 1.14 to 224.95; P = 0.0395) after adjustment for potential confounders. Notably, the fully adjusted OR for mortality was 1.10 in males for each unit increase of NLR (OR = 1.10; 95% CI, 1.02 to 1.19; P = 0.016).

Conclusions: NLR is an independent risk factor of the in-hospital mortality for COVID-19 patients especially for male. Assessment of NLR may help identify high risk individuals with COVID-19.

Keywords: COVID-19; Mortality; Neutrophil-to-Lymphocyte Ratio; Risk factors.

MeSH terms

  • Adult
  • Aged
  • Betacoronavirus*
  • COVID-19
  • Cohort Studies
  • Coronavirus Infections / blood
  • Coronavirus Infections / mortality*
  • Coronavirus Infections / pathology*
  • Female
  • Humans
  • Inpatients
  • Lymphocyte Count*
  • Male
  • Middle Aged
  • Neutrophils / cytology
  • Odds Ratio
  • Pandemics
  • Pneumonia, Viral / blood
  • Pneumonia, Viral / mortality*
  • Pneumonia, Viral / pathology*
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2
  • Young Adult