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Volume 32, 12 Issues, 2022
  Clinical Practice Article     September 2022  

Association of C-reactive Protein/Albumin, Procalcitonin/Albumin, Platelet/Lymphocyte, and Lymphocyte/Monocyte Ratio with Mortality in Hospitalised COVID-19 Patients

By Deniz Cekic1, Kubilay Issever2, Ahmed Cihad Genc1, Selcuk Yaylaci1, Ahmed Bilal Genc1, Ali Tamer1


  1. Department of Internal Medicine, Faculty of Medicine, Sakarya University Training and Research Hospital, Sakarya, Turkey
  2. Department of Internal Medicine, Toyota State Hospital, Sakarya, Turkey
doi: 10.29271/jcpsp.2022.09.1191

Objective: To investigate and compare complete blood count and biochemistry parameters such as c-reactive protein/albumin (CRP/ALB) ratio, procalcitonin/albumin (PRO/ALB) ratio, lymphocyte/monocyte (LYM/MON) ratio, platelet/lymphocyte (PLT/LYM) ratio of the recovered/deceased, and ICU (intensive care unit) /ward patients with COVID-19.
Study Design: An observational study.
Place and Duration of Study: Department of Internal Medicine, Sakarya University Training and Research Hospital, Turkey, from April 2020 to January 2021.
Methodology: The study was conducted with 590 diagnosed patients with COVID-19. The patients were divided into 2 groups as deceased (n = 294) /survivor (n = 296) and those in need of ICU (n= 418) /ward (n = 172). The information was obtained from the hospital information system and analysed retrospectively. The relationships of crp/alb, pro/alb, lym/mon, and PLT/LYM ratios with patient groups were investigated. 
Results: Of the total 590 patients in the study, 358 (60.6%) were males. The total mean age was 65.63 ±14.9 years. The mean age of survivor and deceased groups was 71.32±10.9 and 59.97±16.2 years, respectively (p


Although coronavirus is a zoonotic RNA virus, it has made shifts between species a few times to date. Coronaviridea, known to cause infectious diseases since 1949, caused an outbreak as “Middle Eastern Respiratory Syndrome (MERS)” in 2012.1,2 SARS CoV-2 outbreak, which has been going on since December 2019, have caused more than 3 million people to lose their lives to date.3

The most common complaints of the infected people are cough, fever, sputum, shortness of breath, fatigue, loss of smell, and known clinical symptoms usually start to present 3-4 days after the encounter with the virus.4 One of the most serious complications of the disease is stated as acute respiratory disease syndrome (ARDS), which can especially be seen in 8-12 days after the diagnosis. Another phenomenon was seen in COVID-19 is hypercoagulation. The high levels of D-dimer, a fibrin degradation product, are associated with disease severity and mortality. Moreover, thrombosis-related findings were detected, especially in the pulmonary vascular beds in the autopsy series of COVID-19 patients.5,6 Besides, high levels of acute-phase reactants, such as interleukin (IL)-1, IL-6, CRP, ferritin, and ldh, are linked with ICU requirements and mortality in patients with COVID-19.7 This study aimed to determine the relationship between the above laboratory parameters and outcomes of patients with COVID-19.


Approval of the Sakarya University Medical Faculty Ethics Committee was obtained for this study (27/04/2020-E.4266) This study was conducted on 590 confirmed COVID-19 patients who were hospitalised in the internal medicine clinic due to symptomatic pneumonia between April 15, 2020 and January 15, 2021. The patients were divided into the 2 groups i.e. deceased (n = 294) /survivor (n = 296) and those in need of ICU (n = 418) /ward (n = 172). Both groups were compared according to the demographic features, comorbid conditions, and measurements of the CRP/ALBratio, PRO/ALBratio, LYM/MONratio, and PLT/LYM ratio of the patients. The ROC analysis was performed for ICU-ward and survivor-deceased groups to determine the cut-off value of statistically significant findings. Information was recorded from the hospital’s electronic system. The World Health Organisation’s definition for critical illness was used to evaluate the ICU requirement of the patients. According to this criteria: patients with SpO2: