|| ISSN(online): 2589-8698 || ISSN(print): 2589-868X || International Journal of Medical and Biomedical Studies Available Online at www.ijmbs.info NLM (National Library of Medicine ID: 101738825) Index Copernicus Value 2019: 79.34 Original Research Article Volume 5, Issue 8; August: 2021; Page No. 188-198 188 | Page NEUTROPHIL-LYMPHOCYTIC RATIO (NLR) OR ALBUMIN-GLOBULIN RATIO (AGR) WHICH ONE IS A BETTER PREDICTOR MARKER IN ASSESSMENT OF SEVERITY OF COVID-19 INFECTION Dr. Parul Barya 1 (JR-3 rd Year), Dr. Sanjeev Narang 2 (Professor & Head), Dr. V. K. Jain 3 (Professor) & Dr. Romi Shrivastava 4 (Associate Professor) Dept. of Pathology, Index Medical College Hospital Research Centre, Indore 1,2,3&4 Article Info: Received 16 June 2021; Accepted 06 August 2021 DOI: https://doi.org/10.32553/ijmbs.v5i8.2109 Corresponding author: Dr. Sanjeev Narang Conflict of interest: No conflict of interest. Abstract The current study retrospectively enrolled, 75 confirmed COVID-19 patients who were hospitalized in a tertiary care hospital from December 2020 to February 2021. The diagnosis was confirmed by RT-PCR from nasopharyngeal swab. Demographic data and laboratory values were collected from medical records and patient file. The following variables were recorded for each COVID-19 patient: age, sex, chest CT severity scores of lung involvement at admission, history of Comorbidities like diabetes mellitus, hypertension were noted and laboratory findings like Absolute neutrophils count, Absolute lymphocytes count recorded from Complete blood count of patient and Serum albumin, globulin level recorded from Liver function test of patient. This study proves that N-L ratio is more accurate predictor of severity of SARS-COVID-19 infection than A-G ratio with more sensitivity, specificity, positive and negative predictive value and can be used as a severity marker in places where medical resources is limited. However, a larger study with more subjects requires for exact correlation. Keywords: NLR, AGR, Severity & COVID-19. Introduction Since December 2019, cases of disease related severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), now known as COVID-19 (coronavirus disease 2019), have rapidly spread world-wide in short period of time. The World Health Organization (WHO) has officially recognised COVID-19 as a pandemic and countries worldwide are now facing huge challenges trying to prevent its further spread as well as treating the growing number of COVID-19 patients. In fact, although the majority of cases are usually self-limiting with mild symptoms such as low- grade fever and cough, the disease can be fatal [6] . There is an increased urgent need to detect new biomarkers in order to identify cases of COVID-19 that will evolve unfavourably in adults and children. These biomarkers must be easy to measure and accessible to most hospitals that manage COVID-19 cases. The proposed ratios (albumin to globulin and Neutrophil-Lymphocytic Ratio) seem to be more accurate than each value separately and could be included in the initial assessment of patients that have tested PCR positive for SARS-CoV-2, in order to identify those who are at risk of developing ARDS. In addition, they can be measured during hospital or ICU admissions to evaluate the course of the illness In a recent meta-analysis, increased CRP, lymphopenia, and increased LDH were significantly associated with the severity of the disease (1). The levels of certain laboratory values that proved to be elevated in cytokine storm (ferritin, procalcitonin, and troponin) may not be available at most hospital laboratories or are mainly used for research purposes (IL-6) (2, 3). On the other hand, complete blood count, albumin, and globulin are readily available, shortly after admittance, and are often part of an admission workup, in general hospitals and particularly in intensive care units (ICU). Albumin and globulin are two important components of serum proteins and have been proven to be involved in systemic inflammation. A low serum albumin reflects a poor nutritional status, liver and kidney dysfunction, and has been shown to be an independent predictor of poor survival in critically ill patients. Decreased albumin at admission has been an independent risk factor associated with unimprovement during follow-up in COVID-19 patients (4). On the other hand, an increased globulin level may reflect a chronic inflammatory response. Thus, the additive effect of both albumin and globulin would not only be a prognostic factor for potential COVID-19 complications during the course of the illness, but also an initial risk index of SARS-CoV-2 positive individuals. Wu et al. showed recently that the level of albumin is significantly lower [30.40 g/L (27.15–33.35) vs. 33.70 g/L (30.95–36.30), p < 0.001] and the globulin level higher [31.60 g/L (29.35–35.05) vs. 30.00 g/L (28.25–32.55), p = 0.004] in COVID-19 patients with ARDS comparative with those without ARDS (5). The NLR in the peripheral blood is related to the systemic inflammatory state and disease activity and shows prognostic value in cardiovascular diseases, autoimmune diseases, malignant tumours and infectious diseases [7-10].