Combination of the CD8+:B-cell and Neutrophil-to-Lymphocyte Ratio as a Novel Prediction Model for Intubation Need and Disease Severity in COVID-19 Patients

Abstract

Background: The study provides a novel prediction model for COVID-19 progression and outcome by the combination of the CD8⁺: B-cells ratio with neutrophil-to-lymphocyte ratio (NLR).

Patients and methods: Immune phenotyping was performed in 120 COVID-19 patients.

Results: A decrease in CD8⁺:B-cell (p<0.0001) and in lymphocyte-to-CRP (LCR) ratio (p<0.0001) was observed in intubated patients versus non-intubated with an increase for CD4⁺:CD8⁺ (p<0.01), NLR (p<0.0001) and CRP: Albumin (p<0.001). Receiving operating curve (ROC) analysis predicting requirement for mechanical ventilation revealed the highest AUC for CD8⁺:B-cells, (AUC=0.795, p<0.001) versus NLR (AUC=0.783, p<0.001), LCR (AUC=0.779, p<0.001), Albumin:CRP (AUC=0.750, p<0.001) and CD4⁺:CD8⁺ (AUC=0.779, p<0.001). Combination of the CD8⁺: B-cell ratio with the NLR increased the AUC (AUC=0.845, p<0.001). The combined ratios correlated with outcome defined as duration of hospital (r=0.435, p<0.001) or ICU stay (r=0.596, p<0.001).

Conclusion: Combination of the CD8⁺: B-cell ratio and NLR serves as a useful prognostic tool for COVID-19 patient progression.

Keywords: COVID-19; SARS-COV-2; disease progression; immune phenotyping; intensive care unit; mechanical ventilation; prognostic markers.