Dynamics of Inflammatory Markers in Predicting Mortality in COVID-19

Abstract

IntroductionA cytokine storm is an important cause of morbidity and mortality in patients with coronavirus disease 2019 . The objective of the study was to determine the prognostic significance of pro-inflammatory cytokines with the overall final outcome of patients with COVID-19. MethodsWe conducted a retrospective study of 142 patients admitted with COVID-19 in the Department of Medicine at All India Institute of Medical Sciences, New Delhi, from May 2021 to June 2021. We obtained their demographic, clinical, and biochemical characteristics at baseline and 48-72 hours prior to the terminal event (survival/death). The data were analyzed to determine the prognostic significance of these markers on the final outcome. ResultsHigher levels of inflammatory markers were associated with a worse final outcome (ferritin p-value <0.001, c-reactive protein (CRP) p-value <0.001, interleukin 6 (IL-6) p-value 0.007, procalcitonin p-value 0.005, and lactic acid p-value 0.004). Optimal probability cut-offs for these markers for predicting mortality were:

Hematological- and Immunological-Related Biomarkers to Characterize Patients with COVID-19 from Other Viral Respiratory Diseases

“…Moreover, the mortality rates can be also useful for the evaluation and stratification of COVID-19 patients admitted to hospital into different management groups for receiving special medical attention and avoiding COVID-19 fatality as much as possible. In this sense, the mortality caused by COVID-19 could be inferred considering not only hematological determinations, but also inflammatory biomarkers such as C-reactive protein, as shown in the mortality model proposed in the current analysis [43].…”

Seven COVID-19 Patients Treated with C-Reactive Protein (CRP) Apheresis

“…Focusing on the CRP kinetics, all patients depicted maximum CRP levels over 120 mg/L. The significant correlation of the increase in CRP as well as the maximum CRP amount with mortality has been widely established so far [ 14 , 31 , 32 , 33 ]. In detail, in one study a 108 mg/L CRP cut-off led to a higher mortality of 32% vs. 18% [ 15 ].…”

“…In the context of the SARS-CoV-2-induced disease COVID-19 it is remarkable that CRP plasma levels rise to an extent similar to bacterial infections [ 13 ]. Further, CRP levels correlate with worse prognosis in COVID-19 with an odds ratio of 18.9 [ 14 ] and were proven to be a reliable marker for numerous deleterious processes, as, e.g., the need for mechanical ventilation [ 13 , 15 ]. Hence, therapeutically targeting CRP was suggested early on during the pandemic [ 16 , 17 ].…”

Can iron, zinc, copper and selenium status be a prognostic determinant in COVID-19 patients?

“…Thus, a vicious cycle is induced by ferritin and pro-inflammatory cytokines ( Franco-Martínez et al, 2021 , Pujani et al, 2021 , Ruscitti et al, 2020 ). In hospitalized patients, high serum ferritin is significantly associated with death and hyperferritinemia is an independent risk factor for ARDS in severe COVID-19 ( Parimoo et al, 2021 ). In this respect, serum Fe, ferritin, transferrin, and total Fe-binding capacity are demonstrated to be associated with elevated risk of ARDS, coagulopathy, and multi-organ damage, due to severity of COVID-19 and elevated cytokine concentrations ( Lv et al, 2021 ).…”