Abstract
Several studies of patients with COVID-19 have evaluated biological markers for predicting outcomes, most of them retrospectively and with a wide scope of clinical severity. We followed a prospective cohort of patients admitted in hospital wards with moderate COVID-19 disease, including those with a history of kidney transplantation, and examined the ability of changes in routine hematologic laboratory parameters to predict and mirror the patients' clinical course regarding the severity of their condition (classified as critical vs. non-critical) and in-hospital mortality or hospital discharge. Among the 68 patients, 20 (29%) were kidney transplanted patients (KT), and they had much higher mortality than non-kidney transplanted patients in this cohort (40% X 8.3%). Lymphocytes, neutrophils and neutrophils/lymphocytes ratio (NLR) at admission and platelets as well as the red blood cells parameters hemoglobin, hematocrit, and RDW by the time of hospital discharge or death clearly differentiated patients progressing to critical disease and those with clinical recovery. Patients with deteriorating clinical courses presented elevated and similar NLRs during the first week of hospitalization. However, they were dramatically different at hospital discharge, with a decrease in the survivors (NLR around 5.5) and sustained elevation in non-survivors (NLR around 21). Platelets also could distinguish survivors from non-survivors among the critical patients. In conclusion, routine hematologic tests are useful to monitor the clinical course of COVID-19 patients admitted with moderate disease. Unexpectedly, changes in hematologic tests, including lymphopenia, were not predictive of complicated outcomes among KT recipients.
Highlights
In December 2019, the city of Wuhan became the center of an outbreak of pneumonia of unknown origin, rapidly identified as caused by a new coronavirus, the SARS-CoV-2
In the first months of the pandemic, our affiliated kidney transplant center had observed 491 patients with Covid-19 among the 11,8975 kidney transplants (KT) recipients who were in follow-up in that period (4.1%)
Data collected at admission included age, sex, pregnancy, time since the initiation of symptoms, the symptoms experienced by the patients, contact with SARS-CoV-2 infected individuals, comorbidities, and patient’s body mass index (BMI)
Summary
In December 2019, the city of Wuhan became the center of an outbreak of pneumonia of unknown origin, rapidly identified as caused by a new coronavirus, the SARS-CoV-2 (from “severe acute respiratory syndrome coronavirus 2”). The disease was characterized as COVID19 (an acronym for "coronavirus disease") by the World Health Organization (WHO) on February 11th, 2020, and in just one month, on March 11, was declared as a global pandemic [1]. After more than one year from the description of the first case, the world still faces great challenges in the management of COVID-19 patients mainly among fragile populations. The university affiliated Hospital São Paulo (site of this study) treated 1658 cases from March 2020 to April 2021 of whom 498 passed away (a mortality rate of 30,03%). In the first months of the pandemic (between March and July 2020), our affiliated kidney transplant center had observed 491 patients with Covid-19 among the 11,8975 kidney transplants (KT) recipients who were in follow-up in that period (4.1%). 61% needed intensive care and 41% died [6]
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