Inflammatory phenotypes may be more important than age and comorbidities in predicting clinical outcomes in hospitalised patients with COVID-19

Ngiam, Jinghao Nicholas; Koh, Matthew CY; Liong, Tze Sian; Sim, Meng Ying; Chhabra, Srishti; Goh, Wilson; Chew, Nicholas; Sia, Ching‐Hui; Goon, Peter; Soong, John; Tambyah, Paul A; Cove, Matthew E.

doi:10.1016/j.ijregi.2023.06.003

IJID Regions

2023

DOI: 10.1016/j.ijregi.2023.06.003

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Inflammatory phenotypes may be more important than age and comorbidities in predicting clinical outcomes in hospitalised patients with COVID-19

Jinghao Nicholas Ngiam

Matthew CY Koh

Tze Sian Liong

et al.

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2024

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Adding Hyponatremia to the “Rule-of-6” Prediction Tool Improves Performance in Identifying Hospitalised Patients with COVID-19 at Risk of Adverse Clinical Outcomes

Sim,

Ngiam,

Koh

et al. 2024

Pathogens

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The ‘rule-of-6’ prediction tool was shown to be able to identify COVID-19 patients at risk of adverse outcomes. During the pandemic, we frequently observed hyponatremia at presentation. We sought to evaluate if adding hyponatremia at presentation could improve the ‘rule-of-6’ prediction tool. We retrospectively analysed 1781 consecutive patients admitted to a single tertiary academic institution in Singapore with COVID-19 infection from February 2020 to October 2021. A total of 161 (9.0%) patients had hyponatremia. These patients were significantly older, with more co-morbidities and more likely to be admitted during the Delta wave (2021). They were more likely to have radiographic evidence of pneumonia (46.0% versus 13.0%, p < 0.001) and more adverse outcomes (25.5% vs. 4.1%, p < 0.001). Hyponatremia remained independently associated with adverse outcomes after adjusting for age, lack of medical co-morbidities, vaccination status, year of admission, CRP, LDH, and ferritin. The optimised cut-off for serum sodium in predicting adverse outcomes was approximately <135 mmol/L as determined by the Youden index. Although derived in early 2020, the ‘rule-of-6’ prediction tool continued to perform well in our later cohort (AUC: 0.72, 95%CI: 0.66–0.78). Adding hyponatremia to the ‘rule-of-6’ improved its performance (AUC: 0.76, 95%CI: 0.71–0.82). Patients with hyponatremia at presentation for COVID-19 had poorer outcomes even as new variants emerged.

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Adding Hyponatremia to the “Rule-of-6” Prediction Tool Improves Performance in Identifying Hospitalised Patients with COVID-19 at Risk of Adverse Clinical Outcomes

Sim,

Ngiam,

Koh

et al. 2024

Pathogens

View full text Add to dashboard Cite

show abstract

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Inflammatory phenotypes may be more important than age and comorbidities in predicting clinical outcomes in hospitalised patients with COVID-19

Cited by 1 publication

References 31 publications

Adding Hyponatremia to the “Rule-of-6” Prediction Tool Improves Performance in Identifying Hospitalised Patients with COVID-19 at Risk of Adverse Clinical Outcomes

Adding Hyponatremia to the “Rule-of-6” Prediction Tool Improves Performance in Identifying Hospitalised Patients with COVID-19 at Risk of Adverse Clinical Outcomes

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