Correlation of Neutrophil Lymphocyte Ratio, Alanine Transaminase, and Aspartate Transaminase with Disease Severity in Mild-Moderate and Severe-Critical Coronavirus Disease-19 Patients

Abstract

The SARS-CoV-2 pandemic has a very high daily mortality rate. Rapid spread and worsening of clinical manifestations need early intervention. Systemic inflammation in COVID-19 can cause multi-organ damage, thus one of inflammation markers, Neutrophil Lymphocyte Ratio (NLR) can be used as an early predictive factor for COVID-19. Liver is one of the organs affected by COVID-19, which can be seen from increased Alanine Transaminase (ALT) and Aspartate Transaminase (AST). This study aims to analyze the correlation between NLR, ALT, and AST with disease severity of COVID-19 patients. Total of 50 patients with mild-moderate COVID-19 and 50 severe-critical patients, were taken by consecutive sampling from medical records of Primasatya Husada Citra Hospital Surabaya with cross sectional design. The spearman test analysis test on NLR, ALT, and AST with severity of COVID-19 patients, had a significant result, p = 0.000 (p <0.05). The correlation coefficient of clinical severity of COVID-19 with NLR had strong correlation (r=0.746), and moderate correlation to ALT, and AST (r=0.653, r=0.704). Immune dysregulation due to COVID-19 triggers a cytokine storm and causes multi-organ damage. Liver damage will increase the release of liver enzymes. It can be concluded that NLR, ALT, and AST have a correlation with severity of COVID-19 patients.