Neutrophil:lymphocyte ratio predicts short-term outcome of COVID-19 in haemodialysis patients

• Published in: Clinical Kidney Journal Vol. 14; no. 1; pp. 124 - 131
• Main Authors: Mutinelli-Szymanski, Prisca, Hude, Iulia, Merle, Emilie, Lombardi, Yannis, Seris, Pascal, Abtahi, Medhi, Azeroual, Latifa, Bourgain, Cecile, Ensergueix, Gael, Katerinis, Ioannis, Kolko, Anne, Kolta, Amir, Maheas, Catherine, Mehrbanian, Saeed, Morel, Pauline, Ossman, Rim, Préneuf, Hélène de, Roux, Arthur, Saltiel, Claudine, Vendé, Florence, Verhoeven, Anne-Sophie, Viron, Béatrice, Laplanche, Sophie, Le Monnier, Alban, Ridel, Christophe, Ureña-Torres, Pablo, Touzot, Maxime
• Format: Journal Article Web Resource
• Language: English
• Published: England Oxford University Press 01.01.2021
• Subjects: Analysis; Bacteriology; C-reactive protein; Coronaviruses; Ecology, environment; Ferritin; Fibrin; Fibrinogen; Health; High-definition television; Human health and pathology; Infectious diseases; Life Sciences; Lymphocytes; Medical research; Medicine, Experimental; Microbiology and Parasitology; Original; Santé publique et épidémiologie; Virology; France; China; dialysis; haemodialysis; survival analysis; prognosis; biomarkers
• ISSN: 2048-8505; 2048-8513
• DOI: 10.1093/ckj/sfaa194

Abstract Background Information regarding coronavirus disease 2019 (COVID-19) in haemodialysis (HD) patients is limited and early studies suggest a poor outcome. We aimed to identify clinical and biological markers associated with severe forms of COVID-19 in HD patients. Methods We conducted a prospective, observational and multicentric study. Sixty-two consecutive adult HD patients with confirmed COVID-19 from four dialysis facilities in Paris, France, from 19 March to 19 May 2020 were included. Blood tests were performed before diagnosis and at Days 7 and 14 after diagnosis. Severe forms of COVID-19 were defined as requiring oxygen therapy, admission in an intensive care unit or death. Cox regression models were used to compute adjusted hazard ratios (aHRs). Kaplan–Meier curves and log-rank tests were used for survival analysis. Results Twenty-eight patients (45%) displayed severe forms of COVID-19. Compared with non-severe forms, these patients had more fever (93% versus 56%, P < 0.01), cough (71% versus 38%, P = 0.02) and dyspnoea (43% versus 6%, P < 0.01) at diagnosis. At Day 7 post-diagnosis, neutrophil counts, neutrophil:lymphocyte (N:L) ratio, C-reactive protein, ferritin, fibrinogen and lactate dehydrogenase levels were significantly higher in severe COVID-19 patients. Multivariate analysis revealed an N:L ratio >3.7 was the major marker associated with severe forms, with an aHR of 4.28 (95% confidence interval 1.52–12.0; P = 0.006). After a median follow-up time of 48 days (range 27–61), six patients with severe forms died (10%). Conclusions HD patients are at increased risk of severe forms of COVID-19. An elevated N:L ratio at Day 7 was highly associated with the severe forms. Assessing the N:L ratio could inform clinicians for early treatment decisions.