A Simple Prognostic Score for Critical COVID-19 Derived from Patients without Comorbidities Performs Well in Unselected Patients

Abstract

We aimed to search for laboratory predictors of critical COVID-19 in consecutive adults admitted in an academic center between 16 September 2020–20 December 2021. Patients were uniformly treated with low-molecular-weight heparin, and dexamethasone plus remdesivir when SpO2 < 94%. Among consecutive unvaccinated patients without underlying medical conditions (n = 241, 49 year-old median, 71% males), 22 (9.1%) developed critical disease and 2 died (0.8%). White-blood-cell counts, neutrophils, neutrophil-to-lymphocyte ratio, CRP, fibrinogen, ferritin, LDH and γ-GT at admission were each univariably associated with critical disease. ROC-defined cutoffs revealed that CRP > 61.8 mg/L, fibrinogen > 616.5 mg/dL and LDH > 380.5 U/L were each associated with critical disease development, independently of age, sex and days from symptom-onset. A score combining higher-than-cutoff CRP (0/2), LDH (0/1) and fibrinogen (0/1) predicted critical disease (AUC: 0.873, 95% CI: 0.820–0.926). This score performed well in an unselected patient cohort (n = 1228, 100% unvaccinated) predominantly infected by the alpha variant (AUC: 0.718, 95% CI: 0.683–0.753), as well as in a mixed cohort (n = 527, 65% unvaccinated) predominantly infected by the delta variant (AUC: 0.708, 95% CI: 0.656–0.760). Therefore, we propose that a combination of standard biomarkers of acute inflammatory response, cell death and hypercoagulability reflects the severity of COVID-19 per se independently of comorbidities, age and sex, being of value for risk stratification in unselected patients.

Effectiveness of Oral Nirmatrelvir/Ritonavir vs. Intravenous Three-Day Remdesivir in Preventing Progression to Severe COVID-19: A Single-Center, Prospective, Comparative, Real-Life Study

“…We used only clinical data and medical history since full laboratory investigations were not available for a large portion of patients included in the study. It is possible that known predictors of adverse outcomes, such as ferritin, lactate dehydrogenase, or neutrophil to lymphocyte ratio, could improve our models [ 40 ]. Even though we have data regarding the number of individual vaccine doses, we do not have information with regard to the distance from the last dose.…”

Distinct type I interferon responses between younger women and older men contribute to the variability of COVID-19 outcomes: Hypothesis generating insights from COVID-19 convalescent individuals

“…These data indirectly imply that women of premenopausal age were less likely to seek medical attention in a hospital setting, presumably due to less severe disease. Along the same lines, in a parallel study from our group in consecutive unvaccinated patients without underlying medical conditions, it was shown that the number of female patients was half than men across all age groups [56] . Unfortunately we were not able to directly prove that basal type I IFN responses could predict a more robust immune response during viral infection due to the study design; however it is counterintuitive that higher constitutive type I IFN responses are associated with more robust type I IFN and IL-6 responses during active infection.…”

Factors predicting poor outcomes of patients treated with tocilizumab for COVID‑19‑associated pneumonia: A retrospective study

“…For example, the existence of monoallelic vs. biallelic ACE2 and Toll-like receptor 7 genes on the X chromosome may help to explain the greater risk of COVID-19 infection in males compared to females (37). Several studies have reported laboratory parameters, such as eosinophils, lymphocytes, PLTs, immature granulocytes, ferritin and liver enzymes as biomarkers of poor outcomes in patients with COVID-19 (36,(38)(39)(40)(41)(42). Of note, only a few studies have evaluated laboratory data as biomarkers of poor outcomes in tocilizumab-treated patients with COVID-19 (29)(30)(31)(32)(33)(34)(43)(44)(45).…”