Dataset Information

Comparative effectiveness of anti-inflammatory and antiviral therapies on NLR and survival outcomes in severe COVID-19: multicenter retrospective study.

ABSTRACT:

Background

The COVID-19 pandemic has highlighted the critical role of immune dysregulation and systemic inflammation in disease severity, particularly in patients with severe respiratory illness. Elevated levels of pro-inflammatory cytokines, such as IL-6, and biomarkers like the neutrophil-to-lymphocyte ratio (NLR) have been associated with worse outcomes. This study enrolled laboratory-confirmed SARS-CoV-2 patients with acute respiratory illness requiring intestive care unit (ICU) admission, including mechanical ventilation, to evaluate the effect of different treatments on NLR, neutrophil count (NC), and lymphocyte count (LC).

Methods

A retrospective, multicenter, observational cohort study was conducted across 15 tertiary hospitals in Saudi Arabia, involving 1,490 ICU-admitted COVID-19 patients between March 1, 2020, and October 30, 2020. Data on patient demographics, comorbidities, laboratory results, and treatment outcomes were collected using the Research Electronic Data Capture (REDCap) system. The study evaluated the effect of different treatments on NLR, neutrophil count (NC), and lymphocyte count (LC).

Results

This study utilized 1,490 patients in the study of whom 73.6% were male and 26.1% were female. The average age of patients was 56.2 years, with a mean NLR of 8.77 ± 8.64, showing significant systemic inflammation. Tocilizumab (p = 0.031), oseltamivir (p = 0.004), and linezolid (0.029) showed statistically significant effects on NLR. Tocilizumab demonstrated the highest mean survival time with 60.813 days, compared to linezolid (49.359 days) and ostilomavir (40.635 days). However, patients not getting linezolid or ostilomavir had longer mean survival times, suggesting potential limitations in their efficacy. Tocilizumab also showed a weak positive correlation with NC (r = 0.086, p = 0.001), further supporting its role in modulating inflammation and improving the immune system.

Conclusion

Among the evaluated therapies, tocilizumab and oseltamivir showed a consistent trend of lower NLR values in both survivors and non-survivors, compared to those not receiving these treatments. These findings suggest that tocilizumab and oseltamivir may offer some efficacy in modulating immune response (as measured by NLR) and potentially improving outcomes. However, due to observed weak correlations no single therapy alone appears sufficient to predict or reduce mortality, emphasizing the need for multimodal treatment strategies and further investigation into combined biomarker models.

SUBMITTER: Mutair AA

PROVIDER: S-EPMC12422261 | biostudies-literature | 2025

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Comparative effectiveness of anti-inflammatory and antiviral therapies on NLR and survival outcomes in severe COVID-19: multicenter retrospective study.

Mutair Abbas Al AA Daniyal Muhammad M Alkubati Sameer A SA Albaqawi Hamdan H Alrasheeday Awatif M AM Alshammari Bushra B Alsaleh Kawthar K Mottershead Richard R Alyami Hanan H Alharbi Hanan F HF Al-Omari Awad A

PeerJ 20250904

<h4>Background</h4>The COVID-19 pandemic has highlighted the critical role of immune dysregulation and systemic inflammation in disease severity, particularly in patients with severe respiratory illness. Elevated levels of pro-inflammatory cytokines, such as IL-6, and biomarkers like the neutrophil-to-lymphocyte ratio (NLR) have been associated with worse outcomes. This study enrolled laboratory-confirmed SARS-CoV-2 patients with acute respiratory illness requiring intestive care unit (ICU) admi ...[more]

PMID: 40936775

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Project description:Background: Most children and adolescents infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) develop a mild coronavirus disease 2019 (COVID-19) that usually does not require medical intervention. However, a small proportion of pediatric patients develop a severe clinical condition, Multisystem Inflammatory Syndrome in Children (MIS-C). The involvement of epigenetics in the control of the immune response and viral activity prompted us to carry out an epigenomic study to uncover target loci regulated by DNA methylation that could be altered upon the appearance of MIS-C. Methods: Peripheral blood samples were recruited from 43 confirmed MIS-C patients with a median age of 7.7 years, most of whom were of West-Eurasian origin. Four or more organ systems were involved in the majority of patients. 69 non-COVID-19 pediatric samples and 15 COVID-19 pediatric samples without MIS-C were used as controls. The cases in the two groups were mixed and divided into discovery (MIS-C = 29 and non-MIS-C = 56) and validation (MIS-C = 14 and non-MIS-C = 28) cohorts, and balanced for age, gender and ethnic background. We interrogated 850,000 CpG sites of the human genome for DNA methylation variants. Findings: The DNA methylation content of 33 CpG loci was linked with the presence of MIS-C. Of these sites, 18 (54.5%) were located in described genes. The top candidate gene was the immune T-cell mediator ZEB2; and others highly ranked candidates included the regulator of natural killer cell functional competence SH2D1B; VWA8, which contains a domain of the Von Willebrand factor A involved in the pediatric hemostasis disease; and human leukocyte antigen complex member HLA-DRB1; in addition to pro-inflammatory genes such as CUL2 and AIM2. The identified loci were used to construct a DNA methylation profile (EPIMISC) that was associated with MIS-C in both cohorts. The EPIMISC signature was also overrepresented in Kawasaki disease patients, a childhood pathology with also a possible viral trigger, that shares many of the clinical features of MIS-C. Interpretation: We have characterized DNA methylation loci that are associated with the onset of MIS-C. The identified genes are likely contributors to the characteristic exaggerated host inflammatory response observed in these patients. The described epigenetic signature could also provide new targets for more specific therapies for the disorder.

Dataset Information

Comparative effectiveness of anti-inflammatory and antiviral therapies on NLR and survival outcomes in severe COVID-19: multicenter retrospective study.

Background

Methods

Results

Conclusion

Publications

Comparative effectiveness of anti-inflammatory and antiviral therapies on NLR and survival outcomes in severe COVID-19: multicenter retrospective study.

Similar Datasets

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