Abstract
Background: Timely assessment of COVID-19 severity is crucial for the rapid provision of appropriate treatments. Definitive criteria for the early identification of severe COVID-19 cases that require intensive care unit admission are lacking.Methods: This was a single-center, retrospective case-control study of 95 consecutive adults admitted to the intensive care unit (cases) or a medical ward (controls) for laboratory-confirmed COVID-19. Clinical data were collected and changes in laboratory test results were calculated between presentation at the emergency department and admission. Univariate and multivariable logistic regression was performed to calculate odds ratios for intensive care unit admission according to changes in laboratory variables.Results: Of the 95 adults with COVID-19, 25 were admitted to intensive care and 70 to a medical ward after a median 6 h stay in the emergency department. During this interval, neutrophil counts increased in cases and decreased in controls (median, 934 vs. −295 × 106/L; P = 0.006), while lymphocyte counts decreased in cases and increased in controls (median, −184 vs. 109 × 106/L; P < 0.001). In cases, the neutrophil-to-lymphocyte ratio increased 6-fold and the urea-to-creatinine ratio increased 20-fold during the emergency department stay, but these ratios did not change in controls (P < 0.001 for both comparisons). By multivariable logistic regression, short-term increases in the neutrophil-to-lymphocyte ratio (OR = 1.43; 95% CI, 1.16–1.76) and urea-to-creatinine ratio (OR = 1.72; 95% CI, 1.20–2.66) were independent predictors of intensive care unit admission.Conclusion: Short-time changes in neutrophil-to-lymphocyte ratio and urea-to-creatinine ratio emerged as stand-alone parameters able to identify patients with aggressive disease at an early stage.
Highlights
The first case of coronavirus disease 2019 (COVID-19) in Italy was reported on February 20, 2020
Of the 95 patients who presented to the emergency department for COVID-19 during the 20-day study period, 25 were admitted to the intensive care unit (ICU) and 70 were admitted to a non-ICU medical ward
This study identified two critical short-term changes in laboratory variables that are sufficient to sketch the identikit of a COVID-19 patient deserving close clinical monitoring and high-intensity care
Summary
The first case of coronavirus disease 2019 (COVID-19) in Italy was reported on February 20, 2020. Even patients with initially mild illness without radiographic abnormalities may suddenly worsen and require intensive care [1, 7,8,9], making it challenging to estimate disease severity in the early phase. The course of infection with the virus that causes COVID-19, namely severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), is just beginning to be studied, and early indicators of severe disease are lacking. This study investigated the ability of rapid changes on a panel of clinical variables, measured in COVID-19 patients in the emergency department, to discriminate between those who require admission to an intensive care unit (ICU) and those who can be treated in a nonintensive medical ward. Definitive criteria for the early identification of severe COVID-19 cases that require intensive care unit admission are lacking
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