Charlson comorbidity index, neutrophil-to-lymphocyte ratio and undertreatment with renin-angiotensin-aldosterone system inhibitors predict in-hospital mortality of hospitalized COVID-19 patients during the omicron dominant period

Abstract

PurposeTo investigate the clinical predictors of in-hospital mortality in hospitalized patients with Coronavirus disease 2019 (COVID-19) infection during the Omicron period.MethodsAll consecutive hospitalized laboratory‐confirmed COVID-19 patients between January and May 2022 were retrospectively analyzed. All patients underwent accurate physical, laboratory, radiographic and echocardiographic examination. Primary endpoint was in-hospital mortality.Results74 consecutive COVID-19 patients (80.0 ± 12.6 yrs, 45.9% males) were included. Patients who died during hospitalization (27%) and those who were discharged alive (73%) were separately analyzed. Compared to patients discharged alive, those who died were significantly older, with higher comorbidity burden and greater prevalence of laboratory, radiographic and echographic signs of pulmonary and systemic congestion. Charlson comorbidity index (CCI) (OR 1.76, 95%CI 1.07-2.92), neutrophil-to-lymphocyte ratio (NLR) (OR 1.24, 95%CI 1.10-1.39) and absence of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARBs) therapy (OR 0.01, 95%CI 0.00-0.22) independently predicted the primary endpoint. CCI ≥7 and NLR ≥9 were the best cut-off values for predicting mortality. The mortality risk for patients with CCI ≥7, NLR ≥9 and not in ACEI/ARBs therapy was high (86%); for patients with CCI <7, NLR ≥9, with (16.6%) or without (25%) ACEI/ARBs therapy was intermediate; for patients with CCI <7, NLR <9 and in ACEI/ARBs therapy was of 0%.ConclusionsHigh comorbidity burden, high levels of NLR and the undertreatment with ACEI/ARBs were the main prognostic indicators of in-hospital mortality. The risk stratification of COVID-19 patients at hospital admission would help the clinicians to take care of the high-risk patients and reduce the mortality.

The Value of Early and Follow-Up Elevated Scores Based on Peripheral Complete Blood Cell Count for Predicting Adverse Outcomes in COVID-19 Patients

“…A CCI score ≥ 3 was prognostically associated with mortality in hospitalized COVID-19 patients [36]. Moreover, a CCI ≥ 7 and an NLR ≥ 9 were among the main prognostic indicators for in-hospital mortality in patients with COVID-19 during the Omicron period [37]. We likewise observed a correlation between the NLR and CCI in hospitalized COVID-19 patients with associated medical comorbidities.…”

Association between the overall burden of comorbidity and Ct values among the older patients with Omicron infection: Mediated by inflammation

“…Additionally, the results highlighted that the overall burden of comorbidity assessed by the age-adjusted Charlson comorbidity index was an independent risk factor for the Ct values. It has been reported that the Charlson comorbidity index predicted poor clinical outcomes and mortality in COVID-19 patients ( 7 , 32 ). Therefore the Charlson Comorbidity index might contribute to the management of the older patients with COVID-19.…”

“…On the other hand, Omicron infection was associated with a lower rate of hospital admission and mortality ( 5 , 6 ). However, the elderly were more likely to be infected with Omicron due to immunosenescence and high comorbidity burden ( 7 , 8 ). The rate of severe Omicron infections were increased in the older patients and in individuals with comorbidities such as hypertension, diabetes, cardiovascular disease, and chronic respiratory disease ( 9 , 10 ).…”

The prognostic value of the Barthel Index for mortality in patients with COVID-19: A cross-sectional study

“…For other significant factors in model 4, they were either unstable or only partially reflected the patient's physical condition. In addition, the most frequently reported predictors of prognosis in COVID-19 patients were age, symptoms, comorbidities, and features derived from CT ( 15 , 16 , 37 – 40 ). A high proportion of severe cases and high mortality were observed in elderly COVID-19 patients ( 41 , 42 ).…”

“…Patients showed various symptoms, and some symptoms would also change over time, indicating that they were not appropriate or reliable indicators for all patients. Comorbidities or the relevant evaluation indicator, Charlson's Index, was associated with mortality ( 40 ). However, Charlson's Index was always concerned with long-term prognosis and could not provide a real-time view of a patient's functional state after being affected by COVID-19 like the Barthel Index.…”