Table 6.
Assessment of certainty of evidence using GRADE criteria
| Question: Can neutrophil-to-lymphocyte ratio at admission predict severity in COVID-19? | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Sensitivity | 0.75 (95% CI: 0.69–0.80) | Prevalences | 20%, | 30%, | 50% | ||||||
| Specificity | 0.74 (95% CI: 0.70–0.78) | ||||||||||
| Factors that may decrease certainty of evidence | Effect per 1,000 patients tested | ||||||||||
| Outcome | No. of studies (No. of patients) | Study design | Risk of bias | Indirectness | Inconsistency | Imprecision | Publication bias | pretest probability of 20% | pretest probability of 30% | pretest probability of 50% | Test accuracy CoE |
| True-positives (patients with severity) | 24 studies 1,638 patients | Cohort and case-control type studies | Not serious | seriousa | Seriousb | Not serious | All plausible residual confounding would reduce the demonstrated effect | 150 (138–160) |
225 (207–240) |
375 (345–400) |
⨁⨁⨁◯ MODERATE |
| False-negatives (patients incorrectly classified as not having severity) | 50 (40–62) | 75 (60–93) | 125 (100–155) |
||||||||
| True-negatives (patients without severity) | 24 studies 2,442 patients | Cohort and case-control type studies | Not serious | seriousa | Seriousb | Not serious | All plausible residual confounding would reduce the demonstrated effect | 592 (560–624) |
518 (490–546) |
370 (350–390) |
⨁⨁⨁◯ MODERATE |
| False-positives (patients incorrectly classified as having severity) | 208 (176–240) | 182 (154–210) | 130 (110–150) | ||||||||
| True positives (patients with mortality) | 15 studies 564 patients | Cohort and case-control type studies | Not serious | Not serious | seriousa | Not serious | All plausible residual confounding would reduce the demonstrated effect | 80 (72–85) | 160 (144–170) | 240 (216–255) |
⨁⨁⨁⨁ HIGH |
| False negatives (patients incorrectly classified as not having mortality) | 20 (15–28) | 40 (30–56) | 60 (45–84) | ||||||||
| True negatives (patients without mortality) | 15 studies 3276 patients | Cohort and case-control type studies | Not serious | Not serious | seriousa | Not serious | All plausible residual confounding would reduce the demonstrated effect | 702 (630–765) | 624 (560–680) | 546 (490–595) | ⨁⨁⨁⨁ HIGH |
| False positives (patients incorrectly classified as having mortality) | 198 (135–270) | 176 (120–240) | 154 (105–210) | ||||||||