Abstract
Background. The rapid onset of a systemic pro-inflammatory state followed by acute respiratory distress syndrome is the leading cause of mortality in patients with COVID-19. We performed a retrospective observational study to explore the capacity of different complete blood cell count (CBC)-derived inflammation indexes to predict in-hospital mortality in this group. Methods. The neutrophil to lymphocyte ratio (NLR), derived NLR (dNLR), platelet to lymphocyte ratio (PLR), mean platelet volume to platelet ratio (MPR), neutrophil to lymphocyte × platelet ratio (NLPR), monocyte to lymphocyte ratio (MLR), systemic inflammation response index (SIRI), systemic inflammation index (SII), and the aggregate index of systemic inflammation (AISI) were calculated on hospital admission in 119 patients with laboratory confirmed COVID-19. Results. Non-survivors had significantly higher AISI, dNLR, NLPR, NLR, SII, and SIRI values when compared to survivors. Similarly, Kaplan–Meier survival curves showed significantly lower survival in patients with higher AISI, dNLR, MLR, NLPR, NLR, SII, and SIRI. However, after adjusting for confounders, only the SII remained significantly associated with survival (HR = 1.0001; 95% CI, 1.0000–1.0001, p = 0.029) in multivariate Cox regression analysis. Conclusions. The SII on admission independently predicts in-hospital mortality in COVID-19 patients and may assist with early risk stratification in this group.
Highlights
In December 2019, an ongoing outbreak of unexplained pneumonia in China gained global attention [1]
The Kaplan–Meier survival curves, after classifying the patients on the basis of Youden cut-offs obtained by Receiver operating characteristics (ROC) curves (Figure 1), showed significant lower survival with higher values of aggregate index of systemic inflammation (AISI) (HR = 3.53; 95% CI 1.61–7.78, p = 0.002), derived NLR (dNLR) (HR = 7.33; 95% CI 2.94–8.30, p < 0.001), monocyte to lymphocyte ratio (MLR) (HR = 2.84; 95% CI 1.35–5.95, p = 0.006), neutrophil to lymphocyte × platelet ratio (NLPR) (HR = 4.21; 95% CI 1.94–9.13, p < 0.001), neutrophil to lymphocyte ratio (NLR) (HR = 108; 95% CI 26–450, p < 0.001), systemic inflammation index (SII) (HR = 3.29; 95% CI 1.48–7.32, p = 0.034), and systemic inflammation response index (SIRI)
This study described 119 COVID-19 patients hospitalized at four referral centers in Sardinia (Italy) from 15 March to 15 May 2020, with clinical and demographic characteristics similar to those recently described in other COVID-19 cohorts [1,6,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35]
Summary
In December 2019, an ongoing outbreak of unexplained pneumonia in China gained global attention [1]. On 30 January 2020, the associated pneumonia was referred to as coronavirus disease 2019 (COVID-19) by the World Health Organization [2]. Severity of the disease in patients is generally categorized as mild, moderate, severe, and critical based on clinical symptoms and laboratory test results [4,5]. Patients with severe symptoms and critical cases comprise only 14% and 5%, respectively, of all infected subjects, but they can develop severe pneumonia, acute respiratory distress syndrome (ARDS), and multiple organ failure that requires hospitalization and may lead to death [7]. The identification of early biomarkers of disease severity might facilitate early aggressive treatment, reducing mortality and improving hospital resource allocation. The rapid onset of a systemic pro-inflammatory state followed by acute respiratory distress syndrome is the leading cause of mortality in patients with COVID-19. We performed a retrospective observational study to explore the capacity of different complete blood cell count (CBC)-derived inflammation indexes to predict in-hospital mortality in this group
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