الفهرس 
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Abstract
The corona virus disease 2019 (COVID-19) caused catastrophic effects on the world’s demographics as the disease has a high rate of infection and mortality. It was first discovered in Wuhan, China, in December 2019 as an infectious disease in which patients suffered from acute respiratory distress syndrome (ARDS) of unknown cause .The disease which was found to be caused by one of beta-corona viruses was considered as a pandemic in March 2020 ,as the virus was of a highly infectious deadly strain. COVID -19 affects many systems and organs in the body leading to their failure, it can also cause endothelial damage and cytokine storm. The early detection of COVID-19 infection has a great effect on clinical outcome of the patients so there was a need for rapid available laboratory tests for early detection of infection. Multiple hematological abnormalities and acute phase reactants have been well correlated with disease severity and progression .
Several previous studies have been performed on neutrophils, lymphocytes, CRP, serum ferritin and other reactive proteins in COVID-19 patients. But little is known about their association with early disease prediction in Egypt.
In this retrospective study we analyzed the clinical data of 100 patients. Fifty of them were COVID-19 patients (diagnosed with a positive reverse transcription polymerase chain reaction (RT-PCR) oronasopharyngeal swab for SARS-CoV-2) (group I; COVID group). Another 50 patients with non-COVID-19-related fevers and/ or respiratory illness (negative swab and CT chest) (group II; Non COVID group). The laboratory data of another 50 healthy volunteers of matched age and sex were included as a control group (group III). Patients’ data were collected from the patients’ clinical records of Zaweit Alnaora central hospital,
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Menofia governorate.
The data records of the included patients were tabulated with special interest on:
The clinical presenting symptoms and signs of the included patients at the time of admission especially respiratory symptoms.
The existence of chronic diseases especially cardiovascular, respiratory, kidney, liver, hematological diseases or malignancies, immune suppressant drugs.
Clinical examination: Vital signs records, Oxygen saturation at the time of admission, cardiac, chest and abdominal examination findings.
Laboratory Investigations:
Complete blood count including: haemoglobin concentration (Hb), red blood cell (RBCs) count, white blood cell (WBCs) count, absolute neutrophil count, absolute lymphocyte count, neutrophil / lymphocyte ratio and platelet count.
Liver function tests including: Serum total and direct bilirubin, Serum albumin, ALT, AST, Prothrombin time and concentration. Renal function tests including Blood urea, Serum creatinine. C-reactive protein and Imaging studies including: CT chest
Our results declared that:
There was a statistically-significant difference between the studied groups regarding hypertension, while there was a statistically-insignificant difference between the studied groups regarding COPD, diabetes, heart failure, chronic kidney disease, malignancy and immunosuppressive therapy (p>0.05).
About patients laboratory data the absolute lymphocyte count, absolute neutrophil count, NLR, CRP, serum ferritin, D-dimer, LDH, procalcitonin and serum creatinine showed highly significant differences among the studied groups (p<0.001) while there were no significant
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differences between the studied groups regarding Hb, Prothrombin time, ALT and AST (p>0.05).
Also, There was a significant correlation between NLR and CRP, lymphopenia and absolute neutrophil count. On the other hand, there were no significant correlations between NLR and other parameters like BMI, heart rate, SBP, DBP, respiratory rate, oxygen saturation, Hb , platelet count, serum ferritin, Prothrombin time and concentration, serum creatinine, blood urea, ALT, AST, total bilirubin and serum albumin (p>0.05).
The study also, declares that NLR can discriminate COVID-19 patients from healthy individuals at a cutoff point of >3.06 with sensitivity 61% and specificity 86% while, at a cutoff point of > 2.69, NLR can discriminate COVID-19 patients from other non-COVID respiratory illness was with sensitivity and specificity of 88%, 62% respectively.
NLR could be a useful, cheap, simple marker for early prediction of patients infected with COVID-19 with cutoff point more than 3.06 and . neutrophil/ lymphocyte ratio could be used as a dependable risk predictor in the diagnosis of COVID-19 infections apart from it’s cut-off point.
In conclusion:
The current study suggest that,
NLR could be a useful marker for early prediction of patients infected with COVID-19 as the NLR is simple, rapid and low cost test and due to the significantly higher levels of NLR in advanced stages compared to earlier stages of COVID-19 with good accuracy to diagnose and predict the disease, especially to predict mortality from COVID-19 also, NLR had a higher diagnostic accuracy than other assessment tools such as the CRP , procalcitonin ,D_dimer and serum ferritin .
There was a significant correlation between NLR and CRP, lymphopenia and absolute neutrophil count. On the other hand, there
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were no significant correlations between NLR and other parameters like BMI, heart rate, SBP, DBP, respiratory rate, oxygen saturation, Hb , platelet count, serum ferritin, Prothrombin time and concentration, serum creatinine, blood urea, ALT, AST, total bilirubin and serum albumin (p>0.05).
That NLR can discriminate COVID-19 patients from healthy individuals at a cutoff point of >3.06 with sensitivity 61% and specificity 86% while, at a cutoff point of > 2.69, NLR can discriminate COVID-19 patients from other non-COVID respiratory illness was with sensitivity and specificity of 88%, 62% respectively.