Outcome predictors in COVID-19: An analysis of emergent systemic inflammation indices in Mexican population

Abstract

IntroductionThe systemic viral disease caused by the SARS-CoV-2 called coronavirus disease 2019 (COVID-19) continues to be a public health problem worldwide.ObjectiveThis study is aimed to evaluate the association and predictive value of indices of systemic inflammation with severity and non-survival of COVID-19 in Mexican patients.Materials and MethodsA retrospective study was carried out on 807 subjects with a confirmed diagnosis of COVID-19. Clinical characteristics, acute respiratory distress syndrome (ARDS), severity according to PaO2/FiO2 ratio, invasive mechanical ventilation (IMV), and non-survival outcome were considered to assess the predictive value and the association of 11 systemic inflammatory indices derived from hematological parameters analyzed at the hospital admission of patients. The receiver operating characteristics curve was applied to determine the thresholds for 11 biomarkers, and their prognostic values were assessed via the Kaplan-Meier method.Results26% of the studied subjects showed COVID-19 severe (PaO2/FiO2 ratio ≤ 100), 82.4% required IMV, and 39.2% were non-survival. The indices NHL, NLR, RDW, dNLR, and SIRI displayed predictive values for severe COVID-19 and non-survival. NHL, SIRI, and NLR showed predictive value for IMV. The cut-off values for RDW (OR = 1.85, p < 0.001), NHL (OR = 1.67, p = 0.004) and NLR (OR = 1.56, p = 0.012) were mainly associated with severe COVID-19. NHL (OR = 3.07, p < 0.001), AISI (OR = 2.64, p < 0.001) and SIRI (OR = 2.51, p < 0.001) were associated with IMV support, while for non-survival the main indices associated were NHL (OR = 2.65, p < 0.001), NLR (OR = 2.26, p < 0.001), dNLR (OR = 1.92, p < 0.001), SIRI (OR = 1.67, p = 0.002) and SII (OR = 1.50, p = 0.010). The patients with an RDW, PLR, NLR, dNLR, MLR, SII, and NHL above the cut-off had a survival probability of COVID-19 50% lower, with an estimated mean survival time of 40 days.ConclusionThe emergent systemic inflammation indices NHL, NLR, RDW, SII, and SIRI have a predictive power of severe COVID-19, IMV support, and low survival probability during hospitalization by COVID-19 in Mexican patients.

Predictive Role of Biomarkers in COVID-19 Mortality

“…The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for one of the longest pandemics in world history [1]. Studies continue to reveal correlations between coronavirus disease 2019 (COVID- 19) infection and diseases such as hypertension, diabetes, cardiovascular diseases, and cancer [2]. Furthermore, it has been reported that the virus affects cellular responses and has direct effects on mortality rates and causes [3].…”

“…a retrospective study of 807 people in Mexico with COVID-19 and acute respiratory distress syndrome, Gutiérrez-Pérez et al found that the neutrophil to hemoglobin and lymphocyte ratio, red blood cell distribution width, as well as NLR, SII, and SIRI values, could predict severe COVID-19, the need for invasive mechanical ventilation support, and a low survival rate during hospitalization[19]. Another study by Halmaciu et al assessed disease progression and the predictive value of the Inflammation Index (AISI) and total system score (TSS) for invasive mechanical ventilation and mortality in patients with high levels of serum interleukin 6 (IL-6) and COVID-19; they found that high MLR, NLR, SII, SIRI, AISI, IL-6, and TSS values were strong predictors of invasive mechanical ventilation and mortality[20].…”

Systemic inflammation index, disease severity, and mortality in patients with COVID-19: a systematic review and meta-analysis

“…The study design was prospective in three studies ( 50 , 67 , 68 ), unclear in one ( 66 ), and retrospective in the remaining 36 ( 21 , 36 – 49 , 51 – 65 , 69 – 74 ). The clinical endpoints included mortality in 19 studies ( 36 , 37 , 39 , 41 , 43 , 45 , 48 , 49 , 51 , 52 , 55 , 56 , 58 , 60 , 61 , 65 , 66 , 68 , 73 ), and measures of severe disease as follows: disease severity based on existing guidelines in eight ( 42 , 44 , 63 , 64 , 67 , 70 , 72 , 74 ), transfer to the intensive care unit (ICU) in eight ( 38 , 40 , 45 , 50 , 53 , 62 , 68 , 69 ), invasive mechanical ventilation in two ( 46 , 52 ), disease progression in two ( 57 , 71 ), prolonged hospital stay in one ( 21 ), intubation in one ( 37 ), deep vein thrombosis in one ( 54 ), acute pulmonary embolism in one ( 54 ), and acute limb ischemia in one ( 39 ). All studies reported the SII on hospital admission.…”

“…Thirty-nine studies (with 45 patient groups) reported the SII in 19,352 patients (mean age 61 years, 55% males) with a non-severe disease/survivor status and 5,524 patients (mean age 69 years, 60% males) with a severe disease/non-survivor status. Twenty-three studies were conducted in Asia ( 36 , 38 , 40 – 42 , 48 – 51 , 57 , 59 , 62 – 68 , 70 – 74 ), eleven in Europe ( 21 , 39 , 43 , 44 , 47 , 55 , 56 , 58 , 60 , 61 , 69 ), four in America ( 37 , 45 , 46 , 52 ), and one in Africa ( 53 ) ( Table 1 ).…”

“…Ten studies (13 patient groups) in 9,851 COVID-19 patients (56% males, mean age 67 years), all retrospective, reported associations between the SII and disease severity or survival status expressed as ORs in multivariate logistic regression analysis ( 36 , 44 , 52 – 54 , 58 , 61 , 69 , 72 , 74 ). The study endpoint was mortality in five studies ( 36 , 52 , 54 , 58 , 61 ), disease severity based on existing clinical guidelines in three ( 44 , 72 , 74 ), transfer to ICU in two ( 53 , 69 ), invasive mechanical ventilation in one ( 52 ), deep vein thrombosis in one ( 61 ), and acute pulmonary embolism in one ( 61 ). Four studies were conducted in Europe ( 44 , 58 , 61 , 69 ), four in Asia ( 36 , 54 , 72 , 74 ), one in America ( 52 ), and one in Africa ( 53 ) ( Table 2 ).…”