CORRELATION OF SYSTEMIC IMMUNE-INFLAMMATION INDEX (SII) AND FERRITIN TO LYMPHOCYTE PERCENTAGE RATIO (FLPR) WITH NEUTROPHIL TO LYMPHOCYTE RATIO (NLR) AMONG PATIENTS WITH SEVERE COVID-19: A RETROSPECTIVE OBSERVATIONAL STUDY FROM INDIA

Viswanathan  Pandurangan; Arun K; Lakshmi  Marappa; Sudha  Madhavan; Vaasanthi  Rajendran; Sowmya  Gopalan

doi:10.21272/eumj.2025;13(1):198-208

Viswanathan Pandurangan Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai-600116, India https://orcid.org/0000-0002-2721-9657
Arun K Department of General Medicine, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India https://orcid.org/0000-0002-1955-5327
Lakshmi Marappa Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai-600116, India https://orcid.org/0000-0003-1929-948X
Sudha Madhavan Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai-600116, India https://orcid.org/0000-0002-5345-3957
Vaasanthi Rajendran Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai-600116, India https://orcid.org/0000-0003-4925-4127
Sowmya Gopalan Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Porur, Chennai-600116, India https://orcid.org/0000-0003-3117-433X

DOI: https://doi.org/10.21272/eumj.2025;13(1):198-208

Keywords: Coronavirus disease 2019, ferritin to lymphocyte percentage ratio, systemic immune-inflammation index, neutrophil to lymphocyte ratio

Abstract

Objective: Coronavirus disease 2019 (COVID-19) causes multiorgan dysfunction due to hyperinflammation, dysregulated immune response and cytokine storm. Throughout the COVID-19 pandemic, a number of inflammatory biomarkers, including the neutrophil to lymphocyte ratio (NLR), have been investigated. The aim of this study is to assess the correlation of systemic immune-inflammation index (SII) and ferritin to lymphocyte percentage ratio (FLPR) with neutrophil to lymphocyte ratio among patients with severe COVID-19.

Methods: This retrospective observational study was conducted between May 2020 and August 2020 among 55 adult patients (males=35, 65%; females=19, 35%) admitted to intensive care unit (ICU) with severe COVID-19. Neutrophil to lymphocyte ratio (NLR), ferritin to lymphocyte percentage ratio (FLPR), systemic immune-inflammation index (SII) was calculated. Correlation of SII index, FLPR with NLR among severe COVID-19 patients was assessed. Outcome studied was death or recovery and discharge from the hospital.

Results: Majority were aged >65 years (n=22, 40%), and diabetes mellitus (DM) was the predominant comorbidity present (n=36, 65.5%). Mean peripheral oxygen saturation (SpO2) on ambient air at admission was 86.8%, mean days of illness from the symptom onset to hospitalization was 6.05 days and average length of stay was 16.22 days. NLR, mean±SD value was 10.17±12.32 and mean value of serum ferritin was 571.27±920.13 (ng/mL). The median (interquartile range, IQR) value of the SII was 1439.17(575.06-3802.05), and median (IQR) value of FLPR was 28.73 (12.79-62.02). We found statistically significant correlation between SII and NLR (r=0.926, p=0.0005), FLPR and NLR (r=0.580, p=0.0005) among patients with severe COVID-19. Twenty-six patients recovered (47.3%) and 29 patients died (52.7%).

Conclusion: SII and FLPR correlate significantly with most validated inflammatory marker NLR among patients with severe COVID-19.

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