Longitudinal Profile of Laboratory Parameters and Their Application in the Prediction for Fatal Outcome Among Patients Infected With SARS-CoV-2: A Retrospective Cohort Study

Abstract

Background Patients with coronavirus disease 2019 (COVID-19) experience a wide clinical spectrum, with over 2% developing fatal outcome. The prognostic factors for fatal outcome remain sparsely investigated. Methods A retrospective cohort study was performed in a cohort of patients with confirmed COVID-19 in one designated hospital in Wuhan, China, from 17 January–5 March 2020. The laboratory parameters and a panel of cytokines were consecutively evaluated until patients’ discharge or death. The laboratory features that could be used to predict fatal outcome were identified. Results Consecutively collected data on 55 laboratory parameters and cytokines from 642 patients with COVID-19 were profiled along the entire disease course, based on which 3 clinical stages (acute stage, days 1–9; critical stage, days 10–15; and convalescence stage, day 15 to observation end) were determined. Laboratory findings based on 75 deceased and 357 discharged patients revealed that, at the acute stage, fatality could be predicted by older age and abnormal lactate dehydrogenase (LDH), urea, lymphocyte count, and procalcitonin (PCT) level. At the critical stage, the fatal outcome could be predicted by age and abnormal PCT, LDH, cholinesterase, lymphocyte count, and monocyte percentage. Interleukin 6 (IL-6) was remarkably elevated, with fatal cases having a more robust production than discharged cases across the whole observation period. LDH, PCT, lymphocytes, and IL-6 were considered highly important prognostic factors for COVID-19–related death. Conclusions The identification of predictors that were routinely tested might allow early identification of patients at high risk of death for early aggressive intervention.

Dynamic changes in lymphocyte subsets and parallel cytokine levels in patients with severe and critical COVID-19

“…There was a strong negative correlation between IL-6, IL-10 and total lymphocytes, T lymphocytes, CD4 + T cells, CD8 + T cells and NK cells. Lymphopenia was observed in most of the critical cases with COVID-19 on admission and could be a potential predictor for prognosis, as reported in recently published studies [8,[16][17][18]. Further analysis of the lymphocyte subsets also showed a significant decline in T lymphocytes, CD4 + T cells, CD8 + T cells, B cells, and [1], up-regulation of apoptosis and autophagy in lymphocytes [19], lung tissue recruitment of immune cells [20] and destruction of lymphatic organs, including the spleen and lymph nodes [21].…”

Role of a lower cutoff of high sensitivity troponin I in identification of early cardiac damage in non-severe patients with COVID-19

“…This result is in accord with Zhou et al’ 8 study indicating that the level of hs-cTnI increased significantly from 10 to 13 days after symptoms onset in COVID-19 patients. Similar to the results of a longitudinal study 17 , the patients in the second week after symptoms onset had the highest levels of CRP and LDH, which could be considered as the signs of the systemic inflammatory response. Moreover, in line with a previous study 3 , our results demonstrated that the cardiac biomarkers were highly related to lymphocyte count and CRP, suggesting that cardiac damage of COVID-19 was related to viral response and hyperinflammation.…”

Development and validation of a nomogram using on admission routine laboratory parameters to predict in‐hospital survival of patients with COVID‐19

“…Later, Zhang et al 17 and Levy et al 18 concluded that NEU and CRP were predictive factors of in‐hospital death. Furthermore, IL‐6 was considered to be an incredibly important prognostic factor for COVID‐19‐related death 19–21 . Herein, we integrated the three indicators into a nomogram, resulting in satisfactory performance.…”