Abstract
(1) Introduction: According to recent studies, the ratio of C-reactive-protein to lymphocyte is more sensitive and specific than other biomarkers associated to systemic inflammatory processes. This study aimed to determine the prognostic value of CLR on COVID-19 severity and mortality at emergency department (ED) admission. (2) Methods: Between 1 March and 30 April 2020, we carried out a multicenter and retrospective study in six major hospitals of northeast France. The cohort was composed of patients hospitalized for a confirmed diagnosis of moderate to severe COVID-19. (3) Results: A total of 1,035 patients were included in this study. Factors associated with infection severity were the CLR (OR: 1.001, CI 95%: (1.000–1.002), p = 0.012), and the lymphocyte level (OR: 1.951, CI 95%: (1.024–3.717), p = 0.042). In multivariate analysis, the only biochemical factor significantly associated with mortality was lymphocyte rate (OR: 2.308, CI 95%: (1.286–4.141), p = 0.005). The best threshold of CLR to predict the severity of infection was 78.3 (sensitivity 79%; specificity 47%), and to predict mortality, was 159.5 (sensitivity 48%; specificity 70%). (4) Conclusion: The CLR at admission to the ED could be a helpful prognostic biomarker in the early screening and prediction of the severity and mortality associated with SARS-CoV-2 infection.
Highlights
Human coronavirus disease 2019 (COVID-19) is caused by a novel respiratory virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which first emerged in Wuhan, China, in December 2019, before resulting a global pandemic [1]
CRP elevation and lymphopenia were not specific for COVID-19 severity and mortality assessment, CLR was found more useful than CRP or lymphocytes when considered separately [14]
We have shown that CLR is a relevant marker, significantly associated with the severity and mortality of COVID-19
Summary
Human coronavirus disease 2019 (COVID-19) is caused by a novel respiratory virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which first emerged in Wuhan, China, in December 2019, before resulting a global pandemic [1]. COVID-19 is identified as a multi-systemic infection involving the hematological and immunological systems, responsible for a generalized inflammatory response due to the unregulated release of pro-inflammatory cytokines. CRP elevation and lymphopenia were not specific for COVID-19 severity and mortality assessment, CLR was found more useful than CRP or lymphocytes when considered separately [14]. Other biomarkers, such as ferritin, a protein reflecting macrophage inflammation in its acute stages, were judged more specific in current viral infections than CRP or lymphocytes alone [15,16]
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