d-nlr, and neutrophil count as early predictive biomarkers of disease severity and poor disease outcome in sars-cov-2 infected patients from kashmir

Background: the complete blood count (cbc) profile has been found extremely useful in monitoring the growth of sars-cov-2 infection; however, predictive cbc parameters that could be used in the management of the disease may vary in different populations.methods: this study comparatively analyzed the cbc profile of sars-cov-2 patients (n = 75; confirmed positive by real-time polymerase chain reaction [pcr]) and healthy individuals (confirmed negative by real-time pcr) from kashmir (north india).results: compared with healthy individuals, most of the cbc parameters (hemoglobin levels [13.43 vs 10.9 g/dl; p = 0.0001], lymphocytes [16.04% vs 30.8%; p = 0.00001], monocytes [5.53% vs 7.53%; p = 0.009], and platelet count [150 vs 186 ×103 µl; p = 0.037]) were significantly low in sars-cov-2 infected patients, while neutrophilia was more common in infected patients (76.77% vs 59.26%). among derived parameters, the neutrophil-to-lymphocyte ratio (nlr; 7.31 vs 2.04; p = 0.001) and derived nlr (d-nlr; 4.43 vs 1.5; p = 0.0002) were significantly high in sars-cov-2 patients. further correlation analysis revealed a significant association of neutrophilia with the severity of the disease in sars-cov-2 infected patients. moreover, receiver operating characteristic (roc) analysis of derived cbc parameters (nlr, d-nlr, and platelet‐to-lymphocyte ratio [plr] with disease severity and disease outcome) revealed d-nlr as better predictive marker of disease severity (area under the curve [auc] = 0.658) and disease outcome (auc = 0.766) compared to plr with disease severity (auc = 0.645) and disease outcome (auc = 0.693).conclusion: we therefore conclude, of the cbc parameters neutrophilia as the marker of disease severity and among derived parameters, d-nlr as an early predictive biomarker of both disease severity and poor disease outcome in sars-cov-2 patients.