Abstract
Several reports highlighted the central role of inflammation in the pathogenesis of corona virus disease-19 (COVID-19) disease. Also, the hyper-inflammatory response that is triggered by severe acute respiratory syndrom-Covid-2 (SARS-CoV-2) infection was believed to play an essential role in disease severity and adverse clinical course. For that reason, the classical inflammatory markers were proposed as a possible indicator for COVID-19 severity. However, an extensive analysis of the predictive value of inflammatory biomarkers in large patients’ cohorts is still limited and critically needed. In this study we investigated the predictive value of the classical inflammatory biomarkers in a patient cohort consists of 541 COVID-19 patients admitted to Al Kuwait Hospital, Dubai, UAE. A detailed analysis of the association between the essential inflammatory markers and clinical characteristics as well as clinical outcome of the patients were made. In addition, the correlation between those markers and a wide range of laboratory biomarkers and incidence of acute organs injury were investigated. Our results showed a significant elevation of many inflammatory markers including white cell count (WBC) count, neutrophils count, C-reactive protein (CRP), D-Dimer, ferritin, procalcitonin (PCT), and lactate dehydrogenase (LDH) levels in patients with more severe illness. Also, our results highlighted that higher levels of those markers can predict worse patient outcome including the need of ventilation, intensive care unit (ICU) admission, multiple organs dysfunction as well as death. In addition, Our results showed that the presence of lymphopenia and lower absolute lymphocyte count (ALC) at the time of admission were associated with severe to critical COVID-19 illness (P<0.0001), presence of acute respiratory distress syndrome (ARDS) (P<0.0001) and the need for ventilation and ICU admission., Moreover, our results showed a strong association between lower ALC count and multiple organs dysfunction and patient’s death (P<0.0001). In conclusion, our results highlighted the possible use of classical inflammatory biomarkers at time of admission as a potential predictive marker for more severe clinical course in COVID-19 patients that might need more aggressive therapeutic approach including the need of ventilators and ICU admission. The presence of such predictive markers might improve patient’s stratification and help in the direction of the available resources to patients in need, which in turn help in improving our response to the disease pandemic.
Highlights
While approximately 80% of corona virus disease-19 (COVID-19) patients usually suffer from mild/moderate symptoms that needs minimal medical intervention, around 20% of COVID19 patient progress to more severe form of the disease that require hospitalization with the need for ventilation and intensive care unit (ICU) admission [1,2,3]
white blood cells (WBC) count was significantly elevated in the critical COVID-19 patients (10.0±4.73 103 cells/μL) compared to 8.92±11.50 103 cells/μL in the severe and only 7.30±3.41 103 cells/μL in patients who suffer from mild form of the COVID-19 infection
We investigated the association between key inflammatory markers and a wide range of clinical characteristics and laboratory variables as well as patient outcome, in a large COVID19 patients’ cohort
Summary
While approximately 80% of corona virus disease-19 (COVID-19) patients usually suffer from mild/moderate symptoms that needs minimal medical intervention, around 20% of COVID19 patient progress to more severe form of the disease that require hospitalization with the need for ventilation and intensive care unit (ICU) admission [1,2,3]. Enormous efforts were made to improve our understanding of COVID-19 pathogenesis as well as risk factors involved in adverse clinical outcome of the disease in some patients. This might lead to the discovery of predictive markers that can identify patients with severe/critical disease who need more aggressive medical interference [4,5,6,7,8,9,10,11]. Higher levels of inflammatory markers including C-reactive protein (CRP), neutrophil-to-lymphocyte ratio as well as various inflammatory cytokines and chemokines were found to be linked to more severe clinical course in COVID-19 patients [17,18,19,20]
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