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Prognostic value of inflammatory markers in patients with COVID-19 in Indonesia
Ignatius Bima Prasetya1, Cucunawangsih2, Jane Olivia Lorens1
1Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Tangerang, Indonesia.
Insights
Initial C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR), and derived-NLR (d-NLR) levels predict severe COVID-19 outcomes. These inflammatory markers at hospital admission help identify high-risk patients for timely intervention.
Area of Science:
- Infectious Diseases
- Immunology
- Clinical Medicine
Background:
- Coronavirus disease 2019 (COVID-19) presents a wide clinical spectrum, from asymptomatic to severe, with high mortality.
- Early identification of high-risk COVID-19 patients is crucial for reducing morbidity and mortality.
- Baseline inflammatory markers may predict adverse COVID-19 outcomes.
Purpose of the Study:
- To investigate the association between baseline inflammatory markers and adverse disease outcomes in hospitalized COVID-19 patients.
- To determine if C-reactive protein (CRP), neutrophil to lymphocyte ratio (NLR), derived-NLR (d-NLR), and platelet to lymphocyte ratio (PLR) predict COVID-19 severity.
- To identify optimal cut-off points for predictive inflammatory markers.
Main Methods:
- Retrospective analysis of clinical data from 391 hospitalized COVID-19 patients in Indonesia.
- Data collected from March 20 to October 30, 2020.
- Statistical analysis to assess the association between inflammatory markers and disease severity (ICU admission).
Main Results:
- Fifty-four (13.8%) patients experienced clinical deterioration requiring ICU treatment.
- Older age, comorbidities, and elevated CRP, NLR, and d-NLR were significantly associated with severe COVID-19.
- CRP, NLR, and d-NLR, but not PLR, were independent predictors of severity and death, with AUCs of 0.854, 0.848, and 0.854 respectively.
- Optimal cut-off points identified: CRP 47 mg/L, NLR 6, and d-NLR 4.
Conclusions:
- Baseline CRP, NLR, and d-NLR values are important predictors of adverse COVID-19 outcomes.
- These markers can aid in the initial assessment of hospitalized COVID-19 patients.
- Early identification of high-risk patients using these inflammatory indices can guide clinical management.
Background & Aims:
Coronavirus disease 2019 (COVID-19) has a wide clinical spectrum, ranging from asymptomatic infection to severe diseases with high mortality rate. Early identification of high-risk COVID-19 patients may be beneficial to reduce morbidity and in-hospital mortality. This study aimed to investigate whether baseline levels of inflammatory markers such as C-reactive protein (CRP) and immune-cell-based inflammatory indices, neutrophil to lymphocyte ratio (NLR), derived-NLR (d-NLR), and platelet to lymphocyte ratio (PLR) at hospital admission are associated with adverse disease outcomes in COVID-19 patients.
Methods:
Clinical data from 391 hospitalized COVID-19 patients in three Siloam Hospitals in Indonesia were retrospectively collected and analysed from March 20 to October 30, 2020.
Results:
Fifty-four (13.8%) hospitalized patients had clinical deterioration and required ICU treatment, categorizing them as severe COVID-19 cases. Older age, presence of underlying diseases, and increased inflammatory markers values at admission were significantly associated with severe cases. After adjustment of sociodemographic and comorbidities factors, CRP, NLR, and d-NLR values, but not PLRs, were identified as independent risk factors for disease severity and death in COVID-19 patients. The area under curve (AUC) of CRP, NLR, and d-NLR were 0.854, 0.848, and 0.854, respectively. The optimal cut-off points for CRP, NLR, and d-NLR for identification of COVID-19 patients with potential worse disease outcomes were 47 mg/L, 6, and 4, respectively.
Conclusion:
Initial assessment of CRP, NLR, and d-NLR values at hospital admission may be important predictors for adverse disease outcomes in COVID-19 patients.
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