The Correlation Between Aminotransferase Enzyme Levels, Neutrophil-to-Lymphocyte Ratio, Absolute Lymphocyte Count and the Severity of COVID-19
Abstract
Background/Aim: Aspartate aminotransferase (AST), alanine aminotransferase (ALT), neutrophil-to-lymphocyte ratio (NLR) and absolute lymphocyte count (ALC) are indicators that are widely used as a determinant of the prognosis of patients with viral pneumonia. Thus, the study aim was to prove the correlation between AST/ALT, NLR and ALC levels with the severity of COVID-19.
Methods: The research method was carried out by collecting medical record data of positive COVID-19 patients who were hospitalised at the Indramayu Hospital in the period September 2020 - January 2021.
Results: The results showed normal AST levels in 63 and elevated AST levels in 57 patients. Normal and elevated ALT levels were in 68 and 52 patients, respectively. The normal NLR was in 102 patients and the high NLR was in 18 patients. The low and normal ALC was in 19 and 101 patients, respectively. AST levels correlated with the severity of COVID-19 (p = 0.045). Other parameters were without statistical significance (p > 0.05).
Conclusion: AST enzyme levels had a weak positive correlation with the severity of COVID-19. On the other hand, ALT, NLR and ALC had not correlated with the severity of COVID-19.
References
1. Carmody PR, McCann G, Colleran C, O'Halloran C.COVID-19 in the global south - impacts and responses. Bristol, UK: Bristol University Press, 2021.
2. Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS-CoV-2 and COVID-19. Nat Rev Microbiol 2021 Mar;19(3):141-54.
3. Abdullah NAA. [Analysis of risk factors affecting severity of Covid-19: review of literature]. Universitas Islam Negeri Alauddin Makassar; 2021. Indonesian.
4. Chowdhury MA, Hossain N, Kashem MA, Shahid MA, Alam A. Immune response in COVID-19: A review. J Infect Public Health 2020 Nov;13(11):1619-29.
5. Fan Z, Chen L, Li J, Cheng X, Yang J, Tian C, et al. Clinical features of COVID-19-related liver functional abnormality. Clin Gastroenterol Hepatol 2020;18(7):1561–6.
6. Fix OK, Hameed B, Fontana RJ, Kwok RM, McGuire BM, Mulligan DC, et al. Clinical best practice advice for hepatology and liver transplant providers during the COVID‐19 pandemic: AASLD expert panel consensus statement. Hepatology 2020;72(1):287–304.
7. Wang Q, Zhao H, Liu L-G, Wang Y-B, Zhang T, Li M-H, et al. Pattern of liver injury in adult patients with COVID-19: a retrospective analysis of 105 patients. Mil Med Res 2020;7(1):1–8.
8. Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382(18):1708–20.
9. Darnindro N, Mokoagow MI, Manurung A, Nasarudin J, Wardoyo EY, Sari AP, et al. Association of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) with mortality in patients with Coronavirus Disease 2019 (COVID-19) in Fatmawati General Hospital: a preliminary data. Indones J Gastroenterol Hepatol Dig Endosc 2020;21(2):89–94.
10. BG S, Gosavi S, Ananda Rao A, Shastry S, Raj SC, Sharma A, et al. Neutrophil-to-lymphocyte, lymphocyte-to-monocyte, and platelet-to-lymphocyte ratios: prognostic significance in COVID-19. Cureus 2021;13(1):1–9.
11. Singh Y, Singh A, Rudravaram S, Soni KD, Aggarwal R, Patel N, et al. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio as markers for predicting the severity in covid-19 patients: A prospective observational study. Indian J Crit Care Med 2021;25(8):847–53.
12. Pranata S, Vranada A, Armiyati Y, Samiasih A, Aisah S. Inflammatory markers for predicting severity, mortality, and need for intensive care treatments of a patient infected with covid-19 : a scoping review. Bali MedJ 2023;12(1):324–30.
13. Bal T, Dogan S, Cabalak M, Dirican E. Lymphocyte-to-C-reactive protein ratio may serve as an effective biomarker to determine COVID-19 disease severity. Turkish J Biochem 2020;46(1):21–6.
14. Lagunas-Rangel FA. Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. J Med Virol 2020 Oct;92(10):1733-4.
15. Wagner J, DuPont A, Larson S, Cash B, Farooq A. Absolute lymphocyte count is a prognostic marker in Covid‐19: a retrospective cohort review. Int J Lab Hematol 2020;42(6):761–5.
16. Pedersen SF, Ho Y-C. SARS-CoV-2: a storm is raging. J Clin Invest 2020 May;130(5):2202–5.
17. Korkusuz R, Şenoğlu S, Polat Ö, Kart Yaşar K. The importance of healthcare workers to comply with infection prevention and control instructions during COVID-19 outbreak-a survey study. Bezmialem Sci 2021;9(1):32–9.
18. Waris A, Din M, Khalid A, Abbas Lail R, Shaheen A, Khan N, et al. Evaluation of hematological parameters as an indicator of disease severity in Covid-19 patients: Pakistan’s experience. J Clin Lab Anal 2021;35(6):1–10.
19. Terpos E, Ntanasis‐Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, et al. Hematological findings and complications of COVID‐19. Am J Hematol 2020;95(7):834–47.
20. Ng R, Sutradhar R, Yao Z, Wodchis WP, Rosella LC. Smoking, drinking, diet and physical activity-modifiable lifestyle risk factors and their associations with age to first chronic disease. Int J Epidemiol 2020 Feb;49(1):113–30.
21. Yang T, Li F, Yang X, Wu Z, Feng X, Wang Y, et al. Smoking patterns and sociodemographic factors associated with tobacco use among Chinese rural male residents: A descriptive analysis. BMC Public Health 2008;8:1–7.
22. Jacobson J, Paul P. Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral Circulation. In: Brunner Sudarth’s Can Textb Medical-Surgical Nursing. Philadelphia, Pennsylvania, United States: Lippincott Williams & Wilkins 2016; pp. 896–937.
23. Gupta SK, Lakshmi PVM, Kaur M, Rastogi A. Role of self-care in COVID-19 pandemic for people living with comorbidities of diabetes and hypertension. J Family Med Prim Care 2020 Nov 30;9(11):5495-501.
24. Woods JA, Hutchinson NT, Powers SK, Roberts WO, Gomez-Cabrera MC, Radak Z, et al. The COVID-19 pandemic and physical activity. Sport Med Heal Sci 2020;2(January):55–64.
25. Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol 2020 Jul;84:106504. doi: 10.1016/j.intimp.2020.106504.
26. Syed Khalid M, Aljohani MMH, Alomrani NA, A. Oyoun AA, Alzahrani O, Ahmad MA, et al. COVID-19 and Immune Function – “A Significant” Zinc. Orient J Chem 2020;36(6):1026–36.
27. deKay JT, Emery IF, Rud J, Eldridge A, Lord C, Gagnon DJ, et al. DEspRhigh neutrophils are associated with critical illness in COVID-19. Sci Rep 2021 Nov 17;11(1):22463. doi: 10.1038/s41598-021-01943-7.
28. Bastug A, Bodur H, Erdogan S, Gokcinar D, Kazancioglu S, Kosovali BD, et al. Clinical and laboratory features of COVID-19: Predictors of severe prognosis. Int Immunopharmacol 2020 Nov;88:106950. doi: 10.1016/j.intimp.2020.106950.
29. Wu C, Chen X, Cai Y, Zhou X, Xu S, Huang H, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020;180(7):934–43.
30. Turan D. The relationship between SII, PLR, LCR, MPV / PLT indexes and prognosis in COVID-19. South Clin Istanbul Eurasia 2021;32(2):109–15.
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).