Prognostic significance of neutrophil-tolymphocyte ratio in the determination of severe prognosis of hematological patients with covid-19 infection. Data of moldovan hematological center

Background: COVID-19 infection represents a continuous challenge for the medical society. . Patients with hematologic disease and a COVID-19 infection were found to have a significantly worse prognosis compared to the ones infected with COVID-19 but without hematological cancer. Aims: Evaluation of neutrophil-to-lymphocyte ratio(NLR) as a potential marker of the severity and morbidity of COVID-19 infection among hematological patients. Methods: A retrospective study was conducted on 56 COVID positive patients who have been hospitalized between July 2020 and January 2021. Medical records of the cases are analyzed and compared retrospectively for demographic, clinical, laboratory data, and radiological findings. The standard deviation, receiver operating curve (ROC) and area under the curve (AUC) were calculated to compare the diagnostic performance NLR into the determination of the disease severity. Results: Out of 56 examined patients 29 (51,2%) were females, the median age of infection was 57 years (21-84 years). The most frequent hematological malignancies among the studies group were: Non- Hodgkin lymphomas (46,2%), followed by multiple myeloma(16%), acute leukemias(10,7%), chronic lymphocytic leukemia (7,1%), and others. 35 out of 56 patients developed a severe form of COVID-19 infection(62,5%), out of them, 27(77,1%) necessitating access into an ICU unit. Medium severity was detected in 16 patients(28,6%), mild form being diagnosed in just 5 of them(8,9%). The mortality rate in the study group constitutes 35,7%(20 of 56 patients). NLR had a mean of 8,03±7,41, having a lower index in patients with mild to moderate COVID-19: 6.11±6,09 and higher in the group of patients with severe forms: 9.18±7,96. On receiver operating characteristic curve (ROC) analysis, the predictive ability of NLR to detect critical patients was significant (p= 0.003;AUC:0.729), with an optimal cut-off value of 8.375 having 82% sensitivity and 66.7% specificity to determine the severe COVID-19 cases among hematological patients. Summary/Conclusion: This study confirmed the high risk of mortality among hematological patients showed previously in the literature. Severe forms of COVID-19 were diagnosed in 62,5% of cases. The mortality rate in the study group constitutes 35,7%. NLR can be a useful tool in the prediction of severe cases of COVID-19 infection with quite high sensitivity (82%) but with a moderate specificity(66,7%).