Prognostic Nutritional Index, Controlling Nutritional Status (CONUT) Score, and Inflammatory Biomarkers as Predictors of Deep Vein Thrombosis, Acute Pulmonary Embolism, and Mortality in COVID-19 Patients

Abstract

Background: Numerous tools, including nutritional and inflammatory markers, have been evaluated as the predictors of poor outcomes in COVID-19 patients. This study aims to verify the predictive role of the prognostic nutritional index (PNI), CONUT Score, and inflammatory markers (monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI)) in cases of deep vein thrombosis (DVT) and acute pulmonary embolism (APE) risk, as well as mortality, in COVID-19 patients. Methods: The present study was designed as an observational, analytical, retrospective cohort study, and included 899 patients over the age of 18 who had a COVID-19 infection, confirmed through real time-polymerase chain reaction (RT-PCR), and were admitted to the County Emergency Clinical Hospital and Modular Intensive Care Unit of UMFST “George Emil Palade” of Targu Mures, Romania between January 2020 and March 20212. Results: Non-Surviving patients were associated with a higher incidence of chronic kidney disease (p = 0.01), cardiovascular disease (atrial fibrillation (AF) p = 0.01; myocardial infarction (MI) p = 0.02; peripheral arterial disease (PAD) p = 0.0003), malignancy (p = 0.0001), tobacco (p = 0.0001), obesity (p = 0.01), dyslipidemia (p = 0.004), and malnutrition (p < 0.0001). Multivariate analysis showed that both nutritional and inflammatory markers had a high baseline value and were all independent predictors of adverse outcomes for all enrolled patients (for all p < 0.0001). The presence of PAD, malignancy, and tobacco, were also independent predictors of all outcomes. Conclusions: According to our findings, higher MLR, NLR, PLR, SII, SIRI, AISI, CONUT Score, and lower PNI values at admission strongly predict DVT risk, APE risk, and mortality in COVID-19 patients. Moreover, PAD, malignancy, and tobacco, all predicted all outcomes, while CKD predicts APE risk and mortality, but not the DVT risk.

PNI-Based Nomograms to Predict Tumor Progression and Survival for Patients with Unresectable Hepatocellular Carcinoma Undergoing Transcatheter Arterial Chemoembolization

“…A low PNI means that patients have a poor immune and nutritional status, which may be related to the poor prognosis of tumor patients [ 12 , 13 , 14 , 15 , 28 ]. Meanwhile, the PNI has also been confirmed to be associated with the development and progression of multiple chronic diseases [ 29 , 30 , 31 ]. Several studies confirmed that the PNI is also closely related to the prognosis of HCC patients [ 32 , 33 ].…”

The neutrophil-to-lymphocyte and monocyte-to-lymphocyte ratios are independently associated with clinical outcomes of viral encephalitis

“…Halmaciu et al published an article in which they proved the prognostic impact of NLR > 6.97 and MLR > 0.54 in COVID-19 patients' death ( 29 ). Muresan et al concluded that NLR > 9.4 and MLR > 0.78 are associated with mortality in a study conducted in a group of 889 patients with COVID-19 ( 30 ). From the above research results, NLR and MLR can well-reflect the occurrence and development of many diseases.…”

The Dynamics of the Neutrophil-to-Lymphocyte and Platelet-to-Lymphocyte Ratios Predict Progression to Septic Shock and Death in Patients with Prolonged Intensive Care Unit Stay

“…There are also robust data reporting the predictive powers of NLR and PLR for numerous COVID-19-related outcomes in critically ill patients. Studies on similar demographics have reported good predictive value for NLR and PLR regarding the occurrence of deep vein thrombosis, acute pulmonary embolism, acute limb ischemia, need for invasive mechanical ventilation, ICU admission and mortality [ 27 , 28 , 29 ].…”