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Prognostic Impact of Vaccination, Comorbidity, and Inflammatory Biomarkers on Clinical Outcome in Hospitalized
Sandra Bižić-Radulović1, Tijana Subotički2, Olivera Mitrović Ajtić2
1Clinic of Hematology, University Clinical Centre of Serbia, 11000 Belgrade, Serbia.
Insights
COVID-19 outcomes show higher mortality in men. Vaccination reduces COVID-19 severity and mortality, though it does not prevent it entirely. Inflammatory biomarkers and comorbidities impact outcomes differently by sex.
Area of Science:
- Immunology
- Virology
- Public Health
Background:
- COVID-19 exhibits higher mortality and severity in males compared to females.
- Understanding prognostic factors like vaccination, comorbidities, and inflammatory markers is crucial for hospitalized patients.
Purpose of the Study:
- To compare the prognostic impact of vaccination, comorbidities, and inflammatory biomarkers on clinical outcomes in hospitalized COVID-19 patients, analyzing sex differences.
- To investigate sex-specific differences in COVID-19 disease progression and response to treatment.
Main Methods:
- Analysis of clinical and laboratory parameters from 702 hospitalized COVID-19 patients (June 2020-April 2022).
- Sex-based comparative analysis of clinical outcomes, RT-qPCR, and SARS-CoV-2-specific IgM and IgG antibody levels.
- Assessment of inflammatory biomarkers (CRP, IL-6, etc.) and liver enzymes (AST, ALT, GGT).
Main Results:
- Males showed higher levels of pro-inflammatory biomarkers and liver enzymes, correlating with clinical outcome severity.
- Higher viral load (lower RT-qPCR Ct values) correlated with elevated IL-6 in males.
- Comorbidities were more frequent in females and severe outcomes; vaccination correlated with reduced severity, lower inflammatory markers, and reduced pneumonia risk.
- Vaccination decreased the need for corticosteroids but increased the need for antiviral treatments.
Conclusions:
- Inflammatory biomarkers are critical indicators of COVID-19 severity, particularly in males.
- Vaccination significantly reduces COVID-19 severity and mortality risk, but does not offer complete protection.
- Anti-inflammatory therapy is important for vaccinated patients, and sex-specific differences in disease progression warrant further investigation.
Abstract:
Background/Objectives: The coronavirus disease 2019 (COVID-19) has more severe symptoms and increased mortality among men than women. To address the prognostic impact of vaccination, comorbidities, and inflammatory biomarkers on classified clinical outcomes in hospitalized COVID-19 patients, we compared common and sex differences. Methods: Besides laboratory and clinical parameters at hospital admission, we performed a common and sex-based comparative analysis for the clinical outcomes, RT-qPCR analyses, and measured severe acute respiratory syndrome coronavirus (SARS-CoV-2)-specific IgM and IgG antibody levels of 702 COVID-19 patients in a single centre from June 2020 to April 2022. Results: Pro-inflammatory biomarkers (C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen, lactate dehydrogenase (LDH), D-dimer, ferritin), and liver enzymes (AST, ALT, GGT) were significantly more increased in COVID-19 male patients and generally elevated with the severity of clinical outcome, regardless of the SARS-CoV-2 variant. Cycle threshold (Ct) values of RT-qPCR testing were in negative correlation with IL-6 in COVID-19 male patients, indicating that higher viral load largely increased IL-6 levels in parallel with the severity of clinical outcome and regardless of vaccination. IgG levels were higher in early post-COVID-19 male patients. Comorbidities were more frequent in COVID-19 female patients and generally more common in the severe clinical outcomes. Vaccination was negatively correlated with the severity of clinical outcome, liver enzymes, LDH, and inflammatory parameters in hospitalized COVID-19 patients, while the risk of pneumonia was reduced. Vaccination reduced the need for corticosteroid and anti-inflammatory therapies, but increased the need for antiviral drug treatment. Conclusions: In addition to confirming inflammatory biomarkers and the importance of anti-inflammatory therapy in vaccinated patients, this study showed that vaccination reduces, but does not prevent, mortality in patients with COVID-19.
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