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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Evaluation of Inflammatory Status in COVID-19 Patients with Chronic Kidney Disease: A Comparative Analysis Based on
Andreea Banta1, Daniela Rosca1, Ovidiu Rosca2
1Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
Insights
Patients with chronic kidney disease (CKD) experience heightened inflammation during COVID-19, particularly those with lower creatinine clearance (CrCl). Inflammatory scores like CAR and PNI can predict severe outcomes and mortality in these vulnerable individuals.
Area of Science:
- Nephrology
- Infectious Diseases
- Immunology
Background:
- Chronic kidney disease (CKD) compromises immune function, increasing COVID-19 severity risk.
- Inflammatory status is a key factor in COVID-19 outcomes for CKD patients.
Purpose of the Study:
- To compare inflammatory markers and scores in COVID-19 patients with varying degrees of CKD.
- To evaluate the utility of novel and established inflammatory scores for predicting COVID-19 severity in CKD.
Main Methods:
- Retrospective cohort study of 223 COVID-19 patients stratified by creatinine clearance (CrCl < 30, 30-60, > 60 mL/min).
- Analysis of laboratory parameters (CRP, IL-6, NLR, ferritin, etc.) and calculation of multiple inflammatory scores (SII, CAR, LCR, PNI, etc.).
Main Results:
- Patients with CrCl < 30 mL/min showed significantly higher inflammatory markers and scores.
- The C-reactive protein-to-albumin ratio (CAR) strongly correlated with COVID-19 severity, while the prognostic nutritional index (PNI) inversely correlated with mortality.
- Lower CrCl, higher IS3, higher CAR, and lower PNI were independent predictors of severe COVID-19 outcomes.
Conclusions:
- CKD patients with reduced CrCl exhibit an amplified inflammatory response during COVID-19.
- CAR and PNI are valuable tools for risk stratification and management of COVID-19 in CKD patients.
- Early identification of high CAR and low PNI can guide interventions to improve clinical outcomes.
Background And Objectives:
Patients with chronic kidney disease (CKD) are at increased risk of severe COVID-19 outcomes due to their compromised immune systems and chronic inflammatory state. This study aimed to evaluate and compare the inflammatory status of COVID-19 patients with CKD, stratified by creatinine clearance (CrCl) levels: CrCl < 30 mL/min, CrCl 30-60 mL/min, and CrCl > 60 mL/min. Multiple inflammatory scores combining laboratory parameters were assessed, including novel scores and established indices.
Methods:
In this retrospective cohort study, 223 patients admitted with confirmed COVID-19 were included and divided into three groups based on CrCl levels: CrCl < 30 (n = 41), CrCl 30-60 (n = 78), and CrCl > 60 (n = 104). Laboratory parameters including C-reactive protein (CRP), interleukin-6 (IL-6), neutrophil-to-lymphocyte ratio (NLR), ferritin, platelet count, absolute neutrophil count (ANC), absolute lymphocyte count (ALC), and serum albumin were collected. Multiple inflammatory scores were calculated, including inflammation scores (IS1-IS4), the systemic inflammatory index (SII), the C-reactive protein-to-albumin ratio (CAR), the lymphocyte-to-C-reactive protein ratio (LCR), and the prognostic nutritional index (PNI). Statistical analyses were performed to compare inflammatory scores among groups and assess correlations with clinical outcomes.
Results:
The CrCl < 30 group exhibited significantly higher levels of inflammatory markers and inflammatory scores compared with the other groups (p < 0.001). Among the additional scores, CAR and SII were significantly elevated in patients with lower CrCl levels, while LCR and PNI were decreased. CAR showed a strong positive correlation with COVID-19 severity (r = 0.65, p < 0.001), and PNI was inversely correlated with mortality (r = -0.58, p < 0.001). Multivariate regression analysis indicated that lower CrCl levels, higher IS3 and CAR, and lower PNI were independent predictors of severe COVID-19 outcomes.
Conclusions:
CKD patients with lower CrCl levels have an amplified inflammatory response during COVID-19 infection, as evidenced by elevated inflammatory scores. The additional inflammatory scores, particularly CAR and PNI, may serve as valuable tools for risk stratification and management of COVID-19 in CKD patients. Early identification of patients with high CAR and low PNI could improve clinical outcomes through timely therapeutic interventions.
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