Potentials of Varied Inflammatory Indices in the Prediction of COVID-19 Severity Among Nigerians

Abstract

<i>Background: </i>The coronavirus disease of 2019 (COVID-19) is theorized to be associated with significant inflammatory episodes. This tends to define the severity and culminates in adverse consequences of the disease. Therefore, the current study evaluated the potentials of varied inflammatory markers/indices that define the COVID-19 severity. <i>Methods: </i>This was a retrospective analysis of pre-treatment data obtained from patients with positive real-time polymerase chain reaction (RT-PCR)-confirmed COVID-19 disease in one of the treatment centers in Port Harcourt, South-south Nigeria. Data were obtained from case notes, medical review charts, nurses’ charts, and laboratory records by trained research assistants in the treatment center using pretested data acquisition templates. Abstracted data were compared between the severe positive and severe negative subgroups and the potentials of varied inflammatory indices were evaluated among the severe positive subgroup using standard protocols. <i>Results: </i>A total of 600 eligible cases were studied. Among the eligible cases, 543 (90.5%) had severe negative disease, while 57 (9.5%) had severe positive disease. The severe positive COVID-19 patients had higher mean blood levels of urea, creatinine, pro-calcitonin, C-reactive protein (CRP), ferritin, higher Glasgow prognostic scores (GPS), fibrinogen, D-dimer, fibrinogen-albumin ratio, total white cell count, neutrophil counts, composite neutrophil/lymphocyte ratio (NLR), composite platelet to lymphocyte ratio but lower potassium, albumin, hemoglobin levels, and isolated lymphocyte and platelet counts compared to the severe positive COVID-19 subjects (p<0.05). The C-reactive protein, GPS, D-dimer, and the composite NLR ratio indices significantly predicted COVID-19 severity on the crude regression model which was maintained in the adjusted model. However, serum CRP concentrations (AUC: 0.95; 95% CI: 0.82-1.00; p<0.001) maintained a more robust predictive potential compared to the GPS (AUC: 0.94; 95% CI: 0.84-1.00; p<0.001), D-dimer levels (AUC: 0.89; 95% CI: 0.79-0.94; p=0.004), and the composite NLR (AUC: 0.87; 95% CI: 0.77-0.92). <i>Conclusion: </i>The current study corroborates the role of inflammation in the COVID-19 disease severity. The clinical utility of these inflammation-induced markers/indices especially the CRP, GPS, D-dimer, and the NLR should be prioritized among Nigerians during the management of the disease.