The clinical implication of dynamic neutrophil to lymphocyte ratio and D-dimer in COVID-19: A retrospective study in Suzhou China

Thromb Res. 2020 Aug;192:3-8. doi: 10.1016/j.thromres.2020.05.006. Epub 2020 May 6.


Objective: To investigate the clinical features of COVID-19 cases in Suzhou China. Biomarkers were screened out of hematological parameters for risk stratification.

Method: Confirmed COVID-19 adult patients in Suzhou were included. The patient data was collected, and the results of laboratory examinations were compared between the mild/moderate and severe COVID-19 groups. A ROC was calculated to compare the diagnostic performance of candidate indexes, and dynamic levels of hematological indexes were compared between the two groups.

Result: 75 patients were enrolled, with a mean age of 46.6 ± 14 years, and 45 patients were male. All patients were classified into two groups: the mild/moderate group and the severe group. WBC, neutrophil to lymphocyte ratio (NLR), D-dimer, and fibrinogen levels of the severe group were significantly higher (P < 0.05) than the mild/moderate, and the lymphocyte was lower. The ROC test showed that the hematological parameters had a larger AUC than that of inflammatory factors. There was a significant difference in lymphocyte and fibrinogen levels between the two groups on day 1 (P < 0.05). However, NLR of the severe group was higher than the mild/moderate on days 1, 4 and 14 (P < 0.01), and so was D-dimer on days 1, 7 and 14 (P < 0.05).

Conclusion: The common COVID-19 abnormal hematological indexes on admission included hyperfibrinogenemia, lymphopenia, the elevation of D-dimer, and leukopenia, which were significantly different between the mild/moderate and severe COVID-19 groups. Furthermore, the dynamic change of NLR and D-dimer level can distinguish severe COVID-19 cases from the mild/moderate.

Keywords: Coronavirus disease 2019; D-dimer; Neutrophil to lymphocyte ratio.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Betacoronavirus / pathogenicity*
  • Biomarkers / blood
  • China
  • Clinical Laboratory Techniques*
  • Coronavirus Infections / blood
  • Coronavirus Infections / diagnosis*
  • Coronavirus Infections / therapy
  • Coronavirus Infections / virology
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis*
  • Host-Pathogen Interactions
  • Humans
  • Lymphocyte Count
  • Lymphocytes*
  • Male
  • Middle Aged
  • Neutrophils*
  • Pandemics
  • Pneumonia, Viral / blood
  • Pneumonia, Viral / diagnosis*
  • Pneumonia, Viral / therapy
  • Pneumonia, Viral / virology
  • Predictive Value of Tests
  • Prognosis
  • Reproducibility of Results
  • Retrospective Studies
  • Severity of Illness Index
  • Young Adult


  • Biomarkers
  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D

Supplementary concepts

  • COVID-19
  • COVID-19 diagnostic testing
  • severe acute respiratory syndrome coronavirus 2