JHSM
Journal of Health Sciences and Medicine

Journal of Health Sciences and Medicine (JHSM) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

ISSN: Active
eISSN: 2636-8579
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Submit Manuscript

Index
Original Article
Platelet-to-lymphocyte ratio and mean platelet volume- to-platelet count ratio for predicting mortality in critical COVID-19 patients
Abstract
Introduction: Defining the markers that can be used in clinical practice for predicting the mortality of critical patients will be cautionary for taking necessary measures in high-risk cases. Although there are a large number of studies conducted during the pandemic, no mortality marker to predict the prognosis of intensive care unit (ICU) patients with COVID-19 has yet been defined. Platelet indices can be easily evaluated with a complete blood count (CBC) analysis, one of the most accessible tests worldwide. This study aimed to evaluate the role of platelet indices such as mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), platelet-to-lymphocyte ratio (PLR), and MPV-to-platelet count ratio (MPV/PLT) in predicting the mortality of ICU patients with COVID-19. Material and Method: This single-center, retrospective, cross-sectional study included 201 critical COVID-19 patients over 18 years of age who were hospitalized in ICU between August 2020 and February 2021. Patients were divided into two groups as survivors and non-survivors. The relationship of MPV , PDW , PCT , PLR, and MPV/PLT parameters evaluated at ICU admission with mortality was investigated. Results: There was no significant difference between the survivor and non-survivor groups in terms of platelet count, MPV , PCT, and PDW . The comparison of the platelet ratios revealed higher PLR and MPV/PLT ratio in the non-survivor group than in the survivor group (p<0.05). The cut-off value of PLR for predicting mortality was found to be 292.20 (AUC: 0.601 [95% CI 0.522-0.681]) (p<0.05), while the cut-off of MPV/PLT was found to be 0.0289 (AUC: 0.590 [95% CI 0.510-0.671]) (p<0.05). Conclusion: The results of this study demonstrated PLR and MPV/PLT ratio were associated with mortality. The use of ratios such as MPV/PLT and PLR as an early prognostic indicator instead of platelet indices alone, like MPV in ICU patients with COVID-19, may help identify high-risk patients early.

Keywords : COVID-19, mortality, PLR, MPV/PLT, intensive care

Download Article


1. World Health Organization. WHO Coronavirus (COVID-19) Dashboard. https //covid19.who.int/ (accessed date: 19 April 2022).
2. Marin BG, Aghagoli G, Lavine K, et al. Predictors of COVID-19 severity: A literature review. Rev Med Virol 2021; 31:1-10.
3. Qi J, He D, Yang D, et al. Severity-associated markers and assessment model for predicting the severity of COVID-19: a retrospective study in Hangzhou, China. BMC Infect Dis 2021; 21: 774.
4. Hou H, Zhang B, Huang H, et al. Using IL-2R/lymphocytes for predicting the clinical progression of patients with COVID-19. Clin Exp Immunol 2020; 201: 76-84.
5. Smilowitz NR, Kunichoff D, Garshick M, et al. C-reactive protein and clinical outcomes in patients with COVID-19. Eur Heart J 2021; 42: 2270-9.
6. Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med 2020; 58: 1021-8.
7. Wang S, Sheng Y, Tu J, Zhang L. Association between peripheral lymphocyte count and the mortality risk of COVID-19 inpatients. BMC Pulm Med 2021; 21: 55.
8. Vardon-Bounes F, Gratacap MP , Groyer S, et al. Kinetics of mean platelet volume predicts mortality in patients with septic shock. PLoS One 2019; 14: e0223553.
9. Güçlü E, Kocayiğit H, Okan HD, et al. Effect of COVID-19 on platelet count and its indices. Rev Assoc Med Bras (1992) 2020; 66: 1122-7.
10. Vélez-Páez JL, Legua P , Vélez-Páez P , et al. Mean platelet volume and mean platelet volume to platelet count ratio as predictors of severity and mortality in sepsis. PLoS One 2022; 17: e0262356.
11. Zhang Z, Xu X, Ni H, Deng H. Platelet indices are novel predictors of hospital mortality in intensive care unit patients. J Crit Care 2014; 29: 885.
12. Liu Y , Sun W , Guo Y , et al. Association between platelet parameters and mortality in coronavirus disease 2019: Retrospective cohort study. Platelets 2020; 31: 490-6.
13. Larsen JB, Pasalic L, Hvas AM. Platelets in coronavirus disease 2019. Semin Thromb Hemost 2020; 46: 823-5.
14. Pujani M, Raychaudhuri S, Verma N, et al. Association of Hematologic biomarkers and their combinations with disease severity and mortality in COVID-19- an Indian perspective. Am J Blood Res 2021; 11: 180-90.
15. Ostadi Z, Shadvar K, Sanaie S, Mahmoodpoor A, Saghaleini SH: Thrombocytopenia in the intensive care unit. Pak J Med Sci 2019; 35: 282-7.
16. Shankaralingappa A, Tummidi S, Arun Babu T. Diagnostic value of platelet indices in COVID 19 infection: a case-control study from a single tertiary care center. Egypt J Intern Med 2022; 34: 35.
17. Golwala ZM, Shah H, Gupta N, Sreenivas V, Puliyel JM. Mean platelet volume (MPV), platelet distribution width (PDW), platelet count and plateletcrit (PCT) as predictors of in-hospital paediatric mortality: a case-control Study. Afr Health Sci 2016; 16: 356-62.
18. Mobarki AA, Dobie G, Saboor M, et al. MPR and NLR as prognostic markers in ICU-admitted patients with COVID-19 in Jazan, Saudi Arabia. Infect Drug Resist 2021; 14: 4859-64.
19. Yardımcı AC, Yıldız S, Ergen E, et al. Association between platelet indices and the severity of the disease and mortality in patients with COVID-19. Eur Rev Med Pharmacol Sci 2021; 25: 6731-40.
20. Shen Y, Huang X, Zhang W. Platelet-to-lymphocyte ratio as a prognostic predictor of mortality for sepsis: interaction effect with disease severity-a retrospective study. BMJ Open 2019; 9: e022896.
21. Damar Çakırca T, Torun A, Çakırca G, Portakal RD. Role of NLR, PLR, ELR and CLR in differentiating COVID-19 patients with and without pneumonia. Int J Clin Pract 2021; 75: e14781.
22. Sarkar S, Kannan S, Khanna P, Singh AK. Role of platelet-to-lymphocyte count ratio (PLR), as a prognostic indicator in COVID-19: a systematic review and meta-analysis. J Med Virol 2022; 94: 211-21.
23. Gao YD, Ding M, Dong X, et al. Risk factors for severe and critically ill COVID-19 patients: a review. Allergy 2021; 76: 428-55.
24. Wang J, Jiang M, Chen X, Montaner LJ. Cytokine storm and leukocyte changes in mild versus severe SARS-CoV-2 infection: review of 3939 COVID-19 patients in China and emerging pathogenesis and therapy concepts. J Leukoc Biol 2020; 108: 17-41.
25. Han Q, Wen X, Wang L, et al. Role of hematological parameters in the diagnosis of influenza virus infection in patients with respiratory tract infection symptoms. J Clin Lab Anal 2020; 34: e23191.
26. Wang X, Li X, Shang Y, et al. Ratios of neutrophil-to-lymphocyte and platelet-to-lymphocyte predict all-cause mortality in inpatients with coronavirus disease 2019 (COVID-19): a retrospective cohort study in a single medical centre. Epidemiol Infect 2020; 148: e211.
27. Simadibrata DM, Calvin J, Wijaya AD, Ibrahim NAA. Neutrophil-to-lymphocyte ratio on admission to predict the severity and mortality of COVID-19 patients: A meta-analysis. Am J Emerg Med 2021; 42: 60-9.
Article available in :
Volume 5, Issue 6, 2022
Page : 1512-1517
https://doi.org/10.32322/jhsm.1160392
Article Information
Received : 10 Ağu 2022
Accepted : 22 Ağu 2022
Published : 25 Eki 2022
Corresponding Author :

Hayriye Cankar Dal: University of Health Sciences, Ankara City Hospital, Department of Intensive Care Unit, Ankara, Turkey

[email protected]
Citation : Cankar Dal H, Y alnız KY , Tosun D, et al. Platelet-to-lymphocyte ratio and mean platelet volume-to-platelet count ratio for predicting mortality in critical COVID-19 patients. J Health Sci Med 2022; 5(6): 1512-1517.

Read: 1107
Cited: 0
Download : 481
_Footer