Characterisation of Ferritin–Lymphocyte Ratio in COVID-19
<b>Introduction:</b> The ferritin–lymphocyte ratio (FLR) is a novel inflammatory biomarker for the assessment of acute COVID-19 patients. However, the prognostic value of FLR for predicting adverse clinical outcomes in COVID-19 remains unclear, which hinders its clinical translation. <...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-10-01
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| Series: | Biomedicines |
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| Online Access: | https://www.mdpi.com/2227-9059/11/10/2819 |
| _version_ | 1797574593282572288 |
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| author | Alexander Liu Robert Hammond Kenneth Chan Chukwugozie Chukwuenweniwe Rebecca Johnson Duaa Khair Eleanor Duck Oluwaseun Olubodun Kristian Barwick Winston Banya James Stirrup Peter D. Donnelly Juan Carlos Kaski Anthony R. M. Coates |
| author_facet | Alexander Liu Robert Hammond Kenneth Chan Chukwugozie Chukwuenweniwe Rebecca Johnson Duaa Khair Eleanor Duck Oluwaseun Olubodun Kristian Barwick Winston Banya James Stirrup Peter D. Donnelly Juan Carlos Kaski Anthony R. M. Coates |
| author_sort | Alexander Liu |
| collection | DOAJ |
| description | <b>Introduction:</b> The ferritin–lymphocyte ratio (FLR) is a novel inflammatory biomarker for the assessment of acute COVID-19 patients. However, the prognostic value of FLR for predicting adverse clinical outcomes in COVID-19 remains unclear, which hinders its clinical translation. <b>Methods:</b> We characterised the prognostic value of FLR in COVID-19 patients, as compared to established inflammatory markers. <b>Results:</b> In 217 study patients (69 years [IQR: 55–82]; 60% males), FLR was weakly correlated with CRP (R = 0.108, <i>p</i> = 0.115) and white cell count (R = −0.144; <i>p</i> = 0.034). On ROC analysis, an FLR cut-off of 286 achieved a sensitivity of 86% and a specificity of 30% for predicting inpatient mortality (AUC 0.60, 95% CI: 0.53–0.67). The negative predictive values of FLR for ruling out mortality, non-invasive ventilation requirement and critical illness (intubation and/or ICU admission) were 86%, 85% and 93%, respectively. FLR performed similarly to CRP (AUC 0.60 vs. 0.64; <i>p</i> = 0.375) for predicting mortality, but worse than CRP for predicting non-fatal outcomes (all <i>p</i> < 0.05). On Kaplan–Meier analysis, COVID-19 patients with FLR values > 286 had worse inpatient survival than patients with FLR ≤ 286, <i>p</i> = 0.041. <b>Conclusions:</b> FLR has prognostic value in COVID-19 patients, and appears unrelated to other inflammatory markers such as CRP and WCC. FLR exhibits high sensitivity and negative predictive values for adverse clinical outcomes in COVID-19, and may be a good “rule-out” test. Further work is needed to improve the sensitivity of FLR and validate its role in prospective studies for guiding clinical management. |
| first_indexed | 2024-03-10T21:24:40Z |
| format | Article |
| id | doaj.art-9aeef0c6d76a4c4bb7c75d2c6cc3e20a |
| institution | Directory Open Access Journal |
| issn | 2227-9059 |
| language | English |
| last_indexed | 2024-03-10T21:24:40Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Biomedicines |
| spelling | doaj.art-9aeef0c6d76a4c4bb7c75d2c6cc3e20a2023-11-19T15:47:34ZengMDPI AGBiomedicines2227-90592023-10-011110281910.3390/biomedicines11102819Characterisation of Ferritin–Lymphocyte Ratio in COVID-19Alexander Liu0Robert Hammond1Kenneth Chan2Chukwugozie Chukwuenweniwe3Rebecca Johnson4Duaa Khair5Eleanor Duck6Oluwaseun Olubodun7Kristian Barwick8Winston Banya9James Stirrup10Peter D. Donnelly11Juan Carlos Kaski12Anthony R. M. Coates13School of Medicine, University of St Andrews, St Andrews KY16 9TF, UKSchool of Medicine, University of St Andrews, St Andrews KY16 9TF, UKRoyal Berkshire NHS Foundation Trust, Reading RG1 5AN, UKRoyal Berkshire NHS Foundation Trust, Reading RG1 5AN, UKRoyal Berkshire NHS Foundation Trust, Reading RG1 5AN, UKRoyal Berkshire NHS Foundation Trust, Reading RG1 5AN, UKRoyal Berkshire NHS Foundation Trust, Reading RG1 5AN, UKRoyal Berkshire NHS Foundation Trust, Reading RG1 5AN, UKRoyal Berkshire NHS Foundation Trust, Reading RG1 5AN, UKRoyal Brompton Hospital, London SW3 6NP, UKRoyal Berkshire NHS Foundation Trust, Reading RG1 5AN, UKSchool of Medicine, University of St Andrews, St Andrews KY16 9TF, UKMolecular and Clinical Sciences Research Institute, St George’s University of London, London SW17 0QT, UKInstitute of Infection and Immunity, St George’s University of London, London SW17 0QT, UK<b>Introduction:</b> The ferritin–lymphocyte ratio (FLR) is a novel inflammatory biomarker for the assessment of acute COVID-19 patients. However, the prognostic value of FLR for predicting adverse clinical outcomes in COVID-19 remains unclear, which hinders its clinical translation. <b>Methods:</b> We characterised the prognostic value of FLR in COVID-19 patients, as compared to established inflammatory markers. <b>Results:</b> In 217 study patients (69 years [IQR: 55–82]; 60% males), FLR was weakly correlated with CRP (R = 0.108, <i>p</i> = 0.115) and white cell count (R = −0.144; <i>p</i> = 0.034). On ROC analysis, an FLR cut-off of 286 achieved a sensitivity of 86% and a specificity of 30% for predicting inpatient mortality (AUC 0.60, 95% CI: 0.53–0.67). The negative predictive values of FLR for ruling out mortality, non-invasive ventilation requirement and critical illness (intubation and/or ICU admission) were 86%, 85% and 93%, respectively. FLR performed similarly to CRP (AUC 0.60 vs. 0.64; <i>p</i> = 0.375) for predicting mortality, but worse than CRP for predicting non-fatal outcomes (all <i>p</i> < 0.05). On Kaplan–Meier analysis, COVID-19 patients with FLR values > 286 had worse inpatient survival than patients with FLR ≤ 286, <i>p</i> = 0.041. <b>Conclusions:</b> FLR has prognostic value in COVID-19 patients, and appears unrelated to other inflammatory markers such as CRP and WCC. FLR exhibits high sensitivity and negative predictive values for adverse clinical outcomes in COVID-19, and may be a good “rule-out” test. Further work is needed to improve the sensitivity of FLR and validate its role in prospective studies for guiding clinical management.https://www.mdpi.com/2227-9059/11/10/2819coronavirus disease 19ferritin–lymphocyte ratioinflammatory biomarkersrisk stratificationC-reactive proteinwhite cell count |
| spellingShingle | Alexander Liu Robert Hammond Kenneth Chan Chukwugozie Chukwuenweniwe Rebecca Johnson Duaa Khair Eleanor Duck Oluwaseun Olubodun Kristian Barwick Winston Banya James Stirrup Peter D. Donnelly Juan Carlos Kaski Anthony R. M. Coates Characterisation of Ferritin–Lymphocyte Ratio in COVID-19 Biomedicines coronavirus disease 19 ferritin–lymphocyte ratio inflammatory biomarkers risk stratification C-reactive protein white cell count |
| title | Characterisation of Ferritin–Lymphocyte Ratio in COVID-19 |
| title_full | Characterisation of Ferritin–Lymphocyte Ratio in COVID-19 |
| title_fullStr | Characterisation of Ferritin–Lymphocyte Ratio in COVID-19 |
| title_full_unstemmed | Characterisation of Ferritin–Lymphocyte Ratio in COVID-19 |
| title_short | Characterisation of Ferritin–Lymphocyte Ratio in COVID-19 |
| title_sort | characterisation of ferritin lymphocyte ratio in covid 19 |
| topic | coronavirus disease 19 ferritin–lymphocyte ratio inflammatory biomarkers risk stratification C-reactive protein white cell count |
| url | https://www.mdpi.com/2227-9059/11/10/2819 |
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