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All Journal Indonesian Journal of Clinical Pathology and Medical Laboratory (IJCPML)
Mansyur Arif
Department of Clinical Pathology, Faculty of Medicine, Hasanuddin University/Wahidin Sudirohusodo Hospital, Makassar
Biochemistry, Genetics & Molecular Biology Health Professions Medicine & Pharmacology Neuroscience

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Analysis of Neutrophil Lymphocyte Ratio and Absolute Lymphocyte Count as Predictors of Severity of COVID-19 Patients Yunianingsih Selanno; Yuyun Widaningsih; Tenri Esa; Mansyur Arif
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 27, No 2 (2021)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v27i2.1738

Abstract

It is important to predict the severity of COVID-19 during the pandemic. Both Neutrophil Lymphocyte Ratio (NLR) andAbsolute Lymphocyte Count (ALC) are two easy, low-cost, and fast inflammatory markers, which positively correlate with theseverity of COVID-19. The purpose of this research was to analyze the value of NLR and ALC as predictors of COVID-19severity. This research was a retrospective study using medical record data of 376 COVID-19 patients duringApril-September 2020 at the Hasanuddin University Hospital and Makassar City Regional Hospital. Patients were classifiedinto non-severe and severe COVID-19. Neutrophil lymphocyte ratio and ALC values were determined based on routineblood test (Sysmex XS-800i) results, statistical analysis using Independent T-test, while NLR and ALC diagnostic values wereanalyzed with Receiver Operating Characteristics (ROC) curve to obtain the cut-off value, p < 0.05 was significant. Thesamples consisted of 372 non-severe and 49 severe COVID-19 patients. Neutrophil lymphocyte ratio value in non-severe(4.02±5.22) was significantly different from severe COVID-19 (9.81±7.06) (p < 0.001), similar to ALC in non-severe(2.00±0.83x103/μL) and severe COVID-19 (1.22±0.78x103/μL) (p < 0.001). Receiver operating characteristics curve showedthat NLR had a sensitivity of 91.8% and specificity of 66.4% with a cut-off ≥ 3.17 with Negative Predict Value (NPV) of 98.2%and Positive Predict Value (PPV) of 29.0%; while ALC had a sensitivity of 81.6% and specificity of 64.8% at cut-off≤ 1.74x103/μL with NPV of 95.9% and PPV of 25.8%. Increased NLR and decreased ALC in severe COVID-19 patientsoccurred due to an increased inflammatory response resulting in a decreased cellular immunity. Receiver operatingcharacteristics curve showed a cut-off for NLR of 3.17 and ALC of 1.74x103/μL, indicating an optimum sensitivity andspecificity. It was concluded that NLR and ALC can be used as predictors of COVID-19 severity with a cut-off ≥ 3.17 and≤ 1.74x103/μL, respectively.
PRIMARY MYELOFIBROSIS Muhammad Irhamsyah; Darwati Muhadi; Mansyur Arif
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 25, No 1 (2018)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i1.1518

Abstract

 A 55-year-old male was admitted to hospital with chief complaint of abdominal distention since one year before admission, and it became more prominent than before. The physical examination showed splenomegaly with schuffner line S5, and it was confirmed with ultrasonography. The routine blood test showed a hemoglobin level of 9.2 g/L, leukocyte count of 14.690/µL and thrombocyte count of 115 x 103/µL. From the peripheral blood smear results, the suspected diagnosis of chronic myeloid leukemia with differential diagnosis of a leukemoid reaction was made. However, bone marrow aspiration revealed hypoplastic marrow of primary myelofibrosis. The patients with primary myelofibrosis need early diagnosis and treatment to manage the symptoms of splenomegaly, stop fibrosis process and extramedullary hematopoiesis. Early treatment, in this case, can decrease poor prognosis and mortality rate.
LEUKEMIC PHASE OF MALIGNANT LYMPHOMA IN CHILDREN Sahriany S; Agus Alim Abdulah; Mansyur Arif
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol 25, No 1 (2018)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i1.1519

Abstract

Leukemic phase of malignant lymphoma is a group of lymphoid malignancies typically localized in lymph node and present typical clinical features such as lymphadenopathy with irregular distribution. It can manifest as an extranodal disorder infiltrates the bloodstream (leukemic phase). Lymphomas are differentiated into Hodgkin and non-Hodgkin. The presentation of Reed-Sternberg (RS) cells in histological evaluation establishes Hodgkin lymphoma. A number of classification systems have been used before the publication of Revised European American Lymphoma (REAL) classification in 1994 which includes all lymphoid and lymphoma malignancies according to typical histology, morphology, immunophenotype, genetic, and clinical manifestation. A highly proliferative and fatal malignant lymphoma with leukemic phase case in 13 years and a one-month-old male was reported. The diagnosis was established based on marble-sized lymph nodes enlargement that increased in size, two weeks after initial identification on the neck, head, and inguinal regions and followed by lymphadenopathies in submental, right submandibular, preauricular and right inguinal region. No fever history of this patient or malignant history among his family was found. Laboratory findings included WBC of 26,050/µL, Hb 9.6 g/dL, and PLT 16,000/µL. Peripheral blood smear results indicated suspected leukemic phase of malignant lymphoma DD/ALL. Bone marrow aspiration showed leukemic-phase of malignant lymphoma with bone marrow infiltration. Cytological evaluation of Fine Needle Aspiration (FNA) identified atypical round nucleated cells with nucleus size mostly larger than the mature lymphocytes, minimum cytoplasm, diffuse erythrocyte as background, a conclusion was malignant lymphoma.
PRIMARY MYELOFIBROSIS Muhammad Irhamsyah; Darwati Muhadi; Mansyur Arif
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 25 No. 1 (2018)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v25i1.1518

Abstract

 A 55-year-old male was admitted to hospital with chief complaint of abdominal distention since one year before admission, and it became more prominent than before. The physical examination showed splenomegaly with schuffner line S5, and it was confirmed with ultrasonography. The routine blood test showed a hemoglobin level of 9.2 g/L, leukocyte count of 14.690/µL and thrombocyte count of 115 x 103/µL. From the peripheral blood smear results, the suspected diagnosis of chronic myeloid leukemia with differential diagnosis of a leukemoid reaction was made. However, bone marrow aspiration revealed hypoplastic marrow of primary myelofibrosis. The patients with primary myelofibrosis need early diagnosis and treatment to manage the symptoms of splenomegaly, stop fibrosis process and extramedullary hematopoiesis. Early treatment, in this case, can decrease poor prognosis and mortality rate.
Analysis of Neutrophil Lymphocyte Ratio and Absolute Lymphocyte Count as Predictors of Severity of COVID-19 Patients Yunianingsih Selanno; Yuyun Widaningsih; Tenri Esa; Mansyur Arif
INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY Vol. 27 No. 2 (2021)
Publisher : Indonesian Association of Clinical Pathologist and Medical laboratory

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24293/ijcpml.v27i2.1738

Abstract

It is important to predict the severity of COVID-19 during the pandemic. Both Neutrophil Lymphocyte Ratio (NLR) and Absolute Lymphocyte Count (ALC) are two easy, low-cost, and fast inflammatory markers, which positively correlate with the severity of COVID-19. The purpose of this research was to analyze the value of NLR and ALC as predictors of COVID-19 severity. This research was a retrospective study using medical record data of 376 COVID-19 patients during April-September 2020 at the Hasanuddin University Hospital and Makassar City Regional Hospital. Patients were classified into non-severe and severe COVID-19. Neutrophil lymphocyte ratio and ALC values were determined based on routine blood test (Sysmex XS-800i) results, statistical analysis using Independent T-test, while NLR and ALC diagnostic values were analyzed with Receiver Operating Characteristics (ROC) curve to obtain the cut-off value, p < 0.05 was significant. The samples consisted of 372 non-severe and 49 severe COVID-19 patients. Neutrophil lymphocyte ratio value in non-severe (4.02±5.22) was significantly different from severe COVID-19 (9.81±7.06) (p < 0.001), similar to ALC in non-severe (2.00±0.83x103/μL) and severe COVID-19 (1.22±0.78x103/μL) (p < 0.001). Receiver operating characteristics curve showed that NLR had a sensitivity of 91.8% and specificity of 66.4% with a cut-off ≥ 3.17 with Negative Predict Value (NPV) of 98.2% and Positive Predict Value (PPV) of 29.0%; while ALC had a sensitivity of 81.6% and specificity of 64.8% at cut-off ≤ 1.74x103/μL with NPV of 95.9% and PPV of 25.8%. Increased NLR and decreased ALC in severe COVID-19 patients occurred due to an increased inflammatory response resulting in a decreased cellular immunity. Receiver operating characteristics curve showed a cut-off for NLR of 3.17 and ALC of 1.74x103/μL, indicating an optimum sensitivity and specificity. It was concluded that NLR and ALC can be used as predictors of COVID-19 severity with a cut-off ≥ 3.17 and ≤ 1.74x103/μL, respectively.
Co-Authors Agus Alim Abdulah Darwati Muhadi Esa, Tenri Muhammad Irhamsyah Sahriany S Yunianingsih Selanno Yuyun Widaningsih