{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T20:46:10Z","timestamp":1786999570160,"version":"build-2736575974"},"reference-count":22,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T00:00:00Z","timestamp":1594252800000},"content-version":"unspecified","delay-in-days":190,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[2020]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>In December 2019, cases of severe coronavirus 2019 (COVID-19) infection rapidly progressed to acute respiratory failure. This study aims to assess the association between the neutrophil-to-lymphocyte ratio (NLR) and the incidence of severe COVID-19 infection. A retrospective cohort study was conducted on 210 patients with COVID-19 infection who were admitted to the Central Hospital of Wuhan from 27 January 2020 to 9 March 2020. Peripheral blood samples were collected and examined for lymphocyte subsets by flow cytometry. Associations between tertiles of NLR and the incidence of severe illness were analysed by logistic regression.<\/jats:p>\n                  <jats:p>\n                    Of the 210 patients with COVID-19, 87 were diagnosed as severe cases. The mean NLR of the severe group was higher than that of the mild group (6.6\n                    <jats:italic>vs.<\/jats:italic>\n                    3.3,\n                    <jats:italic>P<\/jats:italic>\n                    &lt; 0.001). The highest tertile of NLR (5.1\u201319.7) exhibited a 5.9-fold (95% CI 1.3\u201328.5) increased incidence of severity relative to that of the lowest tertile (0.6\u20132.5) after adjustments for age, diabetes, hypertension and other confounders. The number of T cells significantly decreased in the severe group (0.5\n                    <jats:italic>vs.<\/jats:italic>\n                    0.9,\n                    <jats:italic>P<\/jats:italic>\n                    &lt; 0.001). COVID-19 might mainly act on lymphocytes, particularly T lymphocytes. NLR was identified as an early risk factor for severe COVID-19 illness. Patients with increased NLR should be admitted to an isolation ward with respiratory monitoring and supportive care.\n                  <\/jats:p>","DOI":"10.1017\/s0950268820001557","type":"journal-article","created":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T02:08:56Z","timestamp":1594260536000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":133,"title":["Higher level of neutrophil-to-lymphocyte is associated with severe COVID-19"],"prefix":"10.1017","volume":"148","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9960-1556","authenticated-orcid":false,"given":"Man","family":"Kong","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongmei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaocui","family":"Cao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoli","family":"Mao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhongxin","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2020,7,9]]},"reference":[{"key":"S0950268820001557_ref21","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.1323279111"},{"key":"S0950268820001557_ref19","doi-asserted-by":"publisher","DOI":"10.1038\/nri1270"},{"key":"S0950268820001557_ref18","doi-asserted-by":"publisher","DOI":"10.1615\/CritRevImmunol.v18.i6.50"},{"key":"S0950268820001557_ref13","doi-asserted-by":"publisher","DOI":"10.1186\/cc11157"},{"key":"S0950268820001557_ref12","article-title":"Dysregulation of immune response in patients with COVID-19 in Wuhan, China","author":"Qin","year":"2020","journal-title":"Clinical Infectious Diseases"},{"key":"S0950268820001557_ref17","first-page":"119","article-title":"Immunological responses against SARS-coronavirus infection in humans","volume":"1","author":"Xu","year":"2004","journal-title":"Cellular Molecular Immunology"},{"key":"S0950268820001557_ref11","doi-asserted-by":"publisher","DOI":"10.1101\/2020.02.10.20021584"},{"key":"S0950268820001557_ref4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30211-7"},{"key":"S0950268820001557_ref15","doi-asserted-by":"publisher","DOI":"10.1172\/JCI137244"},{"key":"S0950268820001557_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30154-9"},{"key":"S0950268820001557_ref2","unstructured":"2. World Health Organization (2020) A public health emergency of international concern over the global outbreak of novel coronavirus declared by WHO. Available at https:\/\/www.who.int\/dg\/speeches\/detail\/who-director-general-s-statement-on-ihr-emergency-committee-on-novel-coronavirus-(2019-ncov)."},{"key":"S0950268820001557_ref14","doi-asserted-by":"publisher","DOI":"10.1038\/nri3547"},{"key":"S0950268820001557_ref8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0173947"},{"key":"S0950268820001557_ref16","doi-asserted-by":"publisher","DOI":"10.7326\/M13-2486"},{"key":"S0950268820001557_ref1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30183-5"},{"key":"S0950268820001557_ref20","doi-asserted-by":"publisher","DOI":"10.2353\/ajpath.2007.061088"},{"key":"S0950268820001557_ref5","doi-asserted-by":"publisher","DOI":"10.1111\/all.14238"},{"key":"S0950268820001557_ref6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2002032"},{"key":"S0950268820001557_ref22","doi-asserted-by":"publisher","DOI":"10.1007\/s00281-017-0629-x"},{"key":"S0950268820001557_ref9","doi-asserted-by":"publisher","DOI":"10.1155\/2016\/8191254"},{"key":"S0950268820001557_ref7","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2020.1585"},{"key":"S0950268820001557_ref10","doi-asserted-by":"publisher","DOI":"10.7754\/Clin.Lab.2018.180833"}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268820001557","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,7,15]],"date-time":"2020-07-15T00:50:07Z","timestamp":1594774207000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268820001557\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020]]},"references-count":22,"alternative-id":["S0950268820001557"],"URL":"https:\/\/doi.org\/10.1017\/s0950268820001557","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020]]},"assertion":[{"value":"Copyright \u00a9 The Author(s), 2020. Published by Cambridge University Press","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}],"article-number":"e139"}}