Comparative effectiveness of anti-inflammatory and antiviral therapies on NLR and survival outcomes in severe COVID-19: multicenter retrospective study Article Swipe
Abbas Al Mutair
,
Muhammad Daniyal
,
Sameer A. Alkubati
,
Hamdan Albaqawi
,
Awatif Alrasheeday
,
Bushra Alshammari
,
Kawthar Alsaleh
,
Richard Mottershead
,
Hanan Alyami
,
Hanan Fahad Alharbi
,
Awad Al‐Omari
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.7717/peerj.20003
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.7717/peerj.20003
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.
Related Topics
Concepts
Medicine
Coronavirus disease 2019 (COVID-19)
Retrospective cohort study
2019-20 coronavirus outbreak
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Internal medicine
Intensive care medicine
Virology
Disease
Infectious disease (medical specialty)
Outbreak
Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.7717/peerj.20003
- https://peerj.com/articles/20003.pdf
- OA Status
- gold
- References
- 43
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4413994468
All OpenAlex metadata
Raw OpenAlex JSON
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https://openalex.org/W4413994468Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.7717/peerj.20003Digital Object Identifier
- Title
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Comparative effectiveness of anti-inflammatory and antiviral therapies on NLR and survival outcomes in severe COVID-19: multicenter retrospective studyWork title
- Type
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articleOpenAlex work type
- Language
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enPrimary language
- Publication year
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2025Year of publication
- Publication date
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2025-09-04Full publication date if available
- Authors
-
Abbas Al Mutair, Muhammad Daniyal, Sameer A. Alkubati, Hamdan Albaqawi, Awatif Alrasheeday, Bushra Alshammari, Kawthar Alsaleh, Richard Mottershead, Hanan Alyami, Hanan Fahad Alharbi, Awad Al‐OmariList of authors in order
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https://doi.org/10.7717/peerj.20003Publisher landing page
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https://peerj.com/articles/20003.pdfDirect link to full text PDF
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YesWhether a free full text is available
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goldOpen access status per OpenAlex
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https://peerj.com/articles/20003.pdfDirect OA link when available
- Concepts
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Medicine, Coronavirus disease 2019 (COVID-19), Retrospective cohort study, 2019-20 coronavirus outbreak, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Internal medicine, Intensive care medicine, Virology, Disease, Infectious disease (medical specialty), OutbreakTop concepts (fields/topics) attached by OpenAlex
- Cited by
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0Total citation count in OpenAlex
- References (count)
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43Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.compared | 214, 290 |
| abstract_inverted_index.critical | 7 |
| abstract_inverted_index.efficacy | 307 |
| abstract_inverted_index.enrolled | 48 |
| abstract_inverted_index.evaluate | 66 |
| abstract_inverted_index.findings | 298 |
| abstract_inverted_index.illness. | 24 |
| abstract_inverted_index.measured | 313 |
| abstract_inverted_index.observed | 323 |
| abstract_inverted_index.outcomes | 119 |
| abstract_inverted_index.pandemic | 3 |
| abstract_inverted_index.patients | 20, 51, 101, 152, 169, 224 |
| abstract_inverted_index.positive | 246 |
| abstract_inverted_index.response | 311 |
| abstract_inverted_index.results, | 116 |
| abstract_inverted_index.survival | 209, 233 |
| abstract_inverted_index.systemic | 13, 183 |
| abstract_inverted_index.tertiary | 92 |
| abstract_inverted_index.utilized | 150 |
| abstract_inverted_index.biomarker | 349 |
| abstract_inverted_index.collected | 121 |
| abstract_inverted_index.conducted | 89 |
| abstract_inverted_index.different | 70, 136 |
| abstract_inverted_index.efficacy. | 240 |
| abstract_inverted_index.evaluated | 132, 272 |
| abstract_inverted_index.hospitals | 93 |
| abstract_inverted_index.improving | 265, 318 |
| abstract_inverted_index.including | 62 |
| abstract_inverted_index.intestive | 57 |
| abstract_inverted_index.involving | 97 |
| abstract_inverted_index.linezolid | 196, 216, 227 |
| abstract_inverted_index.outcomes. | 45, 319 |
| abstract_inverted_index.potential | 236 |
| abstract_inverted_index.receiving | 294 |
| abstract_inverted_index.requiring | 56 |
| abstract_inverted_index.severity, | 17 |
| abstract_inverted_index.survivors | 287 |
| abstract_inverted_index.treatment | 118, 342 |
| abstract_inverted_index.Background | 0 |
| abstract_inverted_index.Conclusion | 269 |
| abstract_inverted_index.Electronic | 125 |
| abstract_inverted_index.SARS-CoV-2 | 50 |
| abstract_inverted_index.admission, | 61 |
| abstract_inverted_index.associated | 42 |
| abstract_inverted_index.biomarkers | 34 |
| abstract_inverted_index.consistent | 279 |
| abstract_inverted_index.cytokines, | 29 |
| abstract_inverted_index.laboratory | 115 |
| abstract_inverted_index.lymphocyte | 78, 144 |
| abstract_inverted_index.mechanical | 63 |
| abstract_inverted_index.modulating | 262, 309 |
| abstract_inverted_index.mortality, | 336 |
| abstract_inverted_index.multimodal | 341 |
| abstract_inverted_index.neutrophil | 74, 140 |
| abstract_inverted_index.strategies | 343 |
| abstract_inverted_index.sufficient | 331 |
| abstract_inverted_index.suggesting | 235 |
| abstract_inverted_index.supporting | 258 |
| abstract_inverted_index.therapies, | 273 |
| abstract_inverted_index.treatments | 71, 137 |
| abstract_inverted_index.Tocilizumab | 185, 204, 241 |
| abstract_inverted_index.correlation | 247 |
| abstract_inverted_index.emphasizing | 337 |
| abstract_inverted_index.highlighted | 5 |
| abstract_inverted_index.limitations | 237 |
| abstract_inverted_index.oseltamivir | 190, 276, 303 |
| abstract_inverted_index.ostilomavir | 220, 229 |
| abstract_inverted_index.potentially | 317 |
| abstract_inverted_index.respiratory | 23, 54 |
| abstract_inverted_index.significant | 182, 200 |
| abstract_inverted_index.tocilizumab | 274, 301 |
| abstract_inverted_index.treatments. | 296 |
| abstract_inverted_index.ICU-admitted | 99 |
| abstract_inverted_index.correlations | 325 |
| abstract_inverted_index.demonstrated | 205 |
| abstract_inverted_index.inflammation | 14, 263 |
| abstract_inverted_index.multicenter, | 84 |
| abstract_inverted_index.particularly | 18 |
| abstract_inverted_index.ventilation, | 64 |
| abstract_inverted_index.demographics, | 113 |
| abstract_inverted_index.dysregulation | 11 |
| abstract_inverted_index.inflammation. | 184 |
| abstract_inverted_index.investigation | 346 |
| abstract_inverted_index.observational | 85 |
| abstract_inverted_index.statistically | 199 |
| abstract_inverted_index.comorbidities, | 114 |
| abstract_inverted_index.non-survivors, | 289 |
| abstract_inverted_index.retrospective, | 83 |
| abstract_inverted_index.pro-inflammatory | 28 |
| abstract_inverted_index.laboratory-confirmed | 49 |
| abstract_inverted_index.neutrophil-to-lymphocyte | 37 |
| cited_by_percentile_year | |
| countries_distinct_count | 3 |
| institutions_distinct_count | 11 |
| citation_normalized_percentile.value | 0.46395023 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |