Dynamic Changes in Platelet-Lymphocyte Ratio in Diabetic Patients with COVID-19 within First Week of Hospitalization

Nenci Siagian, Hermina Novida, Agung Pranoto, Usman Hadi, Cupuwatie Cahyani


The platelet-to-lymphocyte ratio (PLR) is an inexpensive, readily available marker of inflammation response that is widely investigated as a prognosis predictor in acute and chronic disease, such as viral pneumonia and diabetes mellitus (DM). Recently, dynamic changes in the PLR during hospitalization have become a concern in novel coronavirus pneumonia cases. The study objective is to determine the PLR trend of diabetic patients with COVID-19 on the basis of some clinical characteristics and outcomes. The records of 35 confirmed COVID-19 patients with DM who were hospitalized in a single center (Dr. Soetomo General Teaching Hospital, Surabaya, Indonesia) for seven days from May 2020 to August 2020 were retrospectively analyzed. We collected data about their clinical characteristics, clinical outcomes, and dynamic changes in the platelet and lymphocyte counts and the PLR. Of the 35 patients, 20 were female, 15 were male, and the median (interquartile range) age was 57. Cough was the most common symptom on admission (71.4%), and most patients were admitted with severe COVID-19 (48.6%). Fifteen patients had new-onset diabetes on admission, and 16 patients had had diabetes for less than five years. Hypertension was the other leading comorbidity (42.8%). There were 22 nonsurvival cases (62.9%). During admission, thrombocytopenia episodes were significantly observed among the elderly (p = 0.001), while lymphopenia episodes were significantly found in the nonsurvival cases (p = 0.037). The peak PLR commonly occurred on admission (40.0%), while the lowest was typically identified during the last evaluation (42.9%). A declining trend in the average PLR was evident in the severe and nonsurvival cases, and the average ∆PLR showed a statistically significant association with cardiac injury (p = 0.023), liver injury (p = 0.028), and respiratory failure (p = 0.045). The PLR may reflect the inflammatory response caused by COVID-19 infection and might be helpful in the monitoring of COVID-19 patients with DM.



Keywords: COVID-19, diabetes mellitus, platelet-lymphocyte ratio.



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YANG J., ZHENG Y., GOU X., PU K., CHEN Z., GUO Q., JI R., WANG H., WANG Y., and ZHOU Y. Prevalence of comorbidities and its effects in coronavirus disease 2019 patients: A systematic review and meta-analysis. International Journal of Infectious Diseases, 2020, 94: 91-95.

YANG A.P., LIU J.P., TAO W.Q., and LI H.M. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. International Immunopharmacology, 2020, 84: 106504. https://doi.org/10.1016/j.intimp.2020.106504

MERTOGLU C., & GUNAY M. Neutrophil-Lymphocyte ratio and Platelet-Lymphocyte ratio as useful predictive markers of prediabetes and diabetes mellitus. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2017, 11(Supplement 1): S127-S131. https://doi.org/10.1016/j.dsx.2016.12.021

YE G.L., CHEN Q., CHEN X., LIU Y.Y., YIN T.T., MENG Q.H., LIU Y.C., WEI H.Q., and ZHOU Q.H. The prognostic role of platelet-to-lymphocyte ratio in patients with acute heart failure: A cohort study. Scientific Reports, 2019, 9(1): 10639. https://doi.org/10.1038/s41598-019-47143-2

WORLD HEALTH ORGANIZATION. Clinical management of COVID-19: interim guidance, 2020. https://apps.who.int/iris/bitstream/handle/10665/332196/WHO-2019-nCoV-clinical-2020.5-eng.pdf

SINGH A.K., GUPTA R., GHOSH A., and MISRA A. Diabetes in COVID-19: Prevalence, pathophysiology, prognosis and practical considerations. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 2020, 14(4): 303-310. https://doi.org/10.1016/j.dsx.2020.04.004

APICELLA M., CAMPOPIANO M.C., MANTUANO M., MAZONI L., COPPELLI A., and DEL PRATO S. COVID-19 in people with diabetes: understanding the reasons for worse outcomes. The Lancet Diabetes & Endocrinology, 2020, 8(9): 782-792. https://doi.org/10.1016/S2213-8587(20)30238-2

RAJPAL A., RAHIMI L., ISMAIL-BEIGI F. Factors leading to high morbidity and mortality of COVID-19 in patients with type 2 diabetes. Journal of Diabetes, 2020, 12(12): 895-908. https://doi.org/10.1111/1753-0407.13085

ZHOU F., YU T., DU R., FAN G., LIU Y., LIU Z., XIANG J., WANG Y., SONG B., GU X., GUAN L., WEI Y., LI H., WU X., XU J., TU S., ZHANG Y., CHEN H., and CAO B. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet, 2020, 395(10229): 1054-1062. https://doi.org/10.1016/S0140-6736(20)30566-3

CHEN R., SANG L., JIANG M., YANG Z., JIA N., FU W., XIE J., GUAN W., LIANG W., NI Z., HU Y., LIU L., SHAN H., LEI C., PENG Y., WEI L., LIU Y., HU Y., PENG P., WANG J., LIU J., CHEN Z., LI G., ZHENG Z., QIU S., LUO J., YE C., ZHU S., ZHENG J., ZHANG N., LI Y., HE J., LI J., LI S., ZHONG N., and MEDICAL TREATMENT EXPERT GROUP FOR COVID-19. Longitudinal hematologic and immunologic variations associated with the progression of COVID-19 patients in China. Journal of Allergy and Clinical Immunology, 2020, 146(1): 89-100. https://doi.org/10.1016/j.jaci.2020.05.003

LIPPI G., PLEBANI M., and HENRY B.M. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis. Clinica Chimica Acta, 2020, 506: 145-182. https://doi.org/10.1016/j.cca.2020.03.022

QU R., LING Y., ZHANG Y.H., WEI L.Y., CHEN X., LI X.M., LIU X.Y., LIU H.M., GUO Z., REN H., and WANG Q. Platelet-to-lymphocyte ratio is associated with prognosis in patients with coronavirus disease-19. Journal of Medical Virology, 2020, 92(9): 1533-1541. https://doi.org/10.1002/jmv.25767

MINA A., VAN BESIEN K., and PLATANIAS L.C. Hematological manifestations of COVID-19. Leukemia & Lymphoma, 2020, 61(12): 2790-2798. https://doi.org/10.1080/10428194.2020.1788017

YANG L., LIU S., LIU J., ZHANG Z., WAN X., HUANG B., CHEN Y., and ZHANG Y. COVID-19: immunopathogenesis and Immunotherapeutics. Signal Transduction and Targeted Therapy, 2020, 5(1): 128. https://doi.org/10.1038/s41392-020-00243-2

CHENG Y., YUE L., WANG Z., ZHANG J., and XIANG G. Hyperglycemia associated with lymphopenia and disease severity of COVID-19 in type 2 diabetes mellitus. Journal of Diabetes and Its Complications, 2021, 35(2): 107809. https://doi.org/10.1016/j.jdiacomp.2020.107809


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