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Novel Systemic Inflammation Markers to Predict COVID-19 Prognosis
Amirali Karimi1,2, Parnian Shobeiri1,2,3,4, Arutha Kulasinghe5
1School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Insights
The neutrophil to lymphocyte ratio (NLR) is a robust marker for predicting COVID-19 outcomes, including disease severity and mortality. While other inflammatory markers show promise, NLR remains the most reliable indicator for patient risk stratification.
Area of Science:
- Infectious Diseases
- Immunology
- Critical Care Medicine
Background:
- COVID-19 pandemic caused by SARS-CoV-2 has led to significant global health challenges.
- The disease is characterized by an excessive inflammatory response, impacting patient prognosis.
- Understanding inflammatory markers is crucial for managing COVID-19 patients.
Purpose of the Study:
- To review evidence on 11 groups of systemic inflammatory markers for COVID-19 risk stratification.
- To evaluate the prognostic capabilities of these markers in predicting patient outcomes.
- To compare the effectiveness of various markers against the neutrophil-to-lymphocyte ratio (NLR).
Main Methods:
- Systematic review of studies investigating systemic inflammatory markers in COVID-19 patients.
- Analysis of data on markers such as NLR, SII, PNI, CAR, hsCAR, CPAR, and hsCPAR.
- Comparison of the predictive performance of different markers for COVID-19 prognosis.
Main Results:
- Neutrophil-to-lymphocyte ratio (NLR) effectively prognosticates outcomes like severe disease, hospitalization, ICU admission, intubation, and death.
- Systemic Immune-Inflammation Index (SII), Prognostic Nutritional Index (PNI), CRP to Albumin Ratio (CAR), and CRP to Prealbumin Ratio (CPAR) also demonstrated prognostic value.
- Limited comparative studies exist for markers other than NLR, necessitating larger validation studies.
Conclusions:
- Most studied systemic inflammatory markers can predict COVID-19 prognosis.
- NLR emerges as the most consistently robust marker for assessing COVID-19 patient outcomes.
- Further research is needed to validate the comparative effectiveness of other markers against NLR.
Abstract:
Coronavirus disease 2019 (COVID-19) has resulted in a global pandemic, challenging both the medical and scientific community for the development of novel vaccines and a greater understanding of the effects of the SARS-CoV-2 virus. COVID-19 has been associated with a pronounced and out-of-control inflammatory response. Studies have sought to understand the effects of inflammatory response markers to prognosticate the disease. Herein, we aimed to review the evidence of 11 groups of systemic inflammatory markers for risk-stratifying patients and prognosticating outcomes related to COVID-19. Numerous studies have demonstrated the effectiveness of neutrophil to lymphocyte ratio (NLR) in prognosticating patient outcomes, including but not limited to severe disease, hospitalization, intensive care unit (ICU) admission, intubation, and death. A few markers outperformed NLR in predicting outcomes, including 1) systemic immune-inflammation index (SII), 2) prognostic nutritional index (PNI), 3) C-reactive protein (CRP) to albumin ratio (CAR) and high-sensitivity CAR (hsCAR), and 4) CRP to prealbumin ratio (CPAR) and high-sensitivity CPAR (hsCPAR). However, there are a limited number of studies comparing NLR with these markers, and such conclusions require larger validation studies. Overall, the evidence suggests that most of the studied markers are able to predict COVID-19 prognosis, however NLR seems to be the most robust marker.
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