Evaluation of Hematological Parameters as Predictors of Disease Severity in Patients with Hematological Cancers: A Cross-Sectional Study from a Private Hospital in Baghdad City

Abstract

Background: Hematological malignancies, i.e., leukemias, lymphomas, and multiple myeloma, are known to cause significant abnormalities in the numbers of blood cells found in peripheral blood. Several parameters derived from complete blood counts (CBCs) have been proposed as inexpensive, readily available biomarkers of prognostic significance and disease severity, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV).
Objective: To investigate whether or not there is a relationship between baseline hematological indices (i.e.,hemoglobin, total white blood cell count, absolute neutrophil count, absolute lymphocyte count, platelet count, NLR, PLR, MPV) and the clinical severity of hematological malignancies in patients who had been recently diagnosed with a hematologic malignancy and were attending a private hospital in Baghdad.
Methods: This was a descriptive cross-sectional study that included 110 patients newly diagnosed with hematological malignancies (i.e., acute leukemia, chronic leukemia, non-Hodgkin lymphoma, Hodgkin lymphoma, and multiple myeloma) who were evaluated by ahematologist/oncologist at a private hospital between March 2024 and February 2025. Each patient’s disease severity was classified as mild/moderate or severe according to the clinical and laboratory staging criteria established for their specific hematological malignancy. Each patient provided a venous blood sample, which was prepared and analyzed with an automated hematologyanalyzer. Statistical comparison of hematological indices between disease severity groups was conducted using either the independent-samples t-test or the Mann-Whitney U test. Receiver operating characteristic (ROC) analysis was used to assess the strength of the relationship between patients' hematological indices and disease severity.
Results: Of the 110 patients, 46 (41.8 percent) had severe disease. The severity groups differed significantly with respect to hematological parameters, with patients with a severe disease exhibiting significantly lower hemoglobin (8.6 ± 1.9 g/dL vs. 11.2 ± 2.1 g/dL, p < 0.001), lower lymphocyte counts, and significantly higher NLR (6.8 ± 3.4 vs. 3.1 ± 1.6, p < 0.001) and PLR (215 ± 88 vs. 142 ± 61, p < 0.001) compared to patients with a mild or moderate disease. Patients with a severe disease exhibited significantly lower platelet counts (98 ± 62 × 10⁹/L vs. 186 ± 84 × 10⁹/L, p < 0.001). The NLR had the highest area under the ROC curve (0.81) for identifying patients with severe disease compared with those with mild or moderate disease. The second best predictor was hemoglobin (0.78), followed by PLR (0.74).
Conclusion: Simple, inexpensive hematological parameters, especially NLR, hemoglobin, and PLR, show a significant correlation with the severity of hematological malignancies and may serve as adjunctive tools for risk-stratifying patients in resource-constrained clinical settings, such as a private hospital in Baghdad.