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Risk Categories in COVID-19 Based on Degrees of Inflammation: Data on More Than 17,000 Patients from the Spanish
Manuel Rubio-Rivas1, Xavier Corbella1,2, Francesc Formiga1
1Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, 08907 Barcelona, Spain.
Insights
This study identified three risk categories for COVID-19 patients based on inflammatory markers and lymphocyte counts. High-risk patients had worse outcomes, including increased need for mechanical ventilation and higher mortality.
Area of Science:
- COVID-19 Research
- Inflammatory Markers
- Patient Stratification
Background:
- COVID-19 prognosis is significantly influenced by the inflammatory response, often termed a cytokine storm.
- Early identification of patients at risk for severe outcomes is crucial for timely intervention.
Purpose of the Study:
- To establish three distinct risk categories for COVID-19 patients upon admission.
- To utilize inflammatory parameters and lymphocyte counts for risk stratification.
Main Methods:
- A retrospective cohort study involving 17,122 COVID-19 patients from the Spanish SEMI-COVID-19 Registry.
- Risk categories (low, intermediate, high) were defined using terciles of total lymphocyte count and admission values of C-reactive protein, lactate dehydrogenase, ferritin, and D-dimer.
Main Results:
- The high-risk group was older, predominantly male, and exhibited higher rates of pre-existing conditions like hypertension, diabetes, and heart disease.
- High-risk patients more frequently required advanced respiratory support (high flow nasal cannula, mechanical ventilation), ICU admission, and experienced significantly higher in-hospital mortality.
- Lymphopenia and elevated inflammatory markers were independent predictors of adverse outcomes.
Conclusions:
- Three risk categories can be effectively identified using admission lymphopenia and inflammatory markers.
- This stratification aids in predicting the need for intensive respiratory support, ICU admission, and in-hospital mortality in COVID-19 patients.
Abstract:
(1) Background: The inflammation or cytokine storm that accompanies COVID-19 marks the prognosis. This study aimed to identify three risk categories based on inflammatory parameters on admission. (2) Methods: Retrospective cohort study of patients diagnosed with COVID-19, collected and followed-up from 1 March to 31 July 2020, from the nationwide Spanish SEMI-COVID-19 Registry. The three categories of low, intermediate, and high risk were determined by taking into consideration the terciles of the total lymphocyte count and the values of C-reactive protein, lactate dehydrogenase, ferritin, and D-dimer taken at the time of admission. (3) Results: A total of 17,122 patients were included in the study. The high-risk group was older (57.9 vs. 64.2 vs. 70.4 years; p < 0.001) and predominantly male (37.5% vs. 46.9% vs. 60.1%; p < 0.001). They had a higher degree of dependence in daily tasks prior to admission (moderate-severe dependency in 10.8% vs. 14.1% vs. 17%; p < 0.001), arterial hypertension (36.9% vs. 45.2% vs. 52.8%; p < 0.001), dyslipidemia (28.4% vs. 37% vs. 40.6%; p < 0.001), diabetes mellitus (11.9% vs. 17.1% vs. 20.5%; p < 0.001), ischemic heart disease (3.7% vs. 6.5% vs. 8.4%; p < 0.001), heart failure (3.4% vs. 5.2% vs. 7.6%; p < 0.001), liver disease (1.1% vs. 3% vs. 3.9%; p = 0.002), chronic renal failure (2.3% vs. 3.6% vs. 6.7%; p < 0.001), cancer (6.5% vs. 7.2% vs. 11.1%; p < 0.001), and chronic obstructive pulmonary disease (5.7% vs. 5.4% vs. 7.1%; p < 0.001). They presented more frequently with fever, dyspnea, and vomiting. These patients more frequently required high flow nasal cannula (3.1% vs. 4.4% vs. 9.7%; p < 0.001), non-invasive mechanical ventilation (0.9% vs. 3% vs. 6.3%; p < 0.001), invasive mechanical ventilation (0.6% vs. 2.7% vs. 8.7%; p < 0.001), and ICU admission (0.9% vs. 3.6% vs. 10.6%; p < 0.001), and had a higher percentage of in-hospital mortality (2.3% vs. 6.2% vs. 23.9%; p < 0.001). The three risk categories proved to be an independent risk factor in multivariate analyses. (4) Conclusion: The present study identifies three risk categories for the requirement of high flow nasal cannula, mechanical ventilation, ICU admission, and in-hospital mortality based on lymphopenia and inflammatory parameters.
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