Risk of Death in Comorbidity Subgroups of Hospitalized COVID-19 Patients Inferred by Routine Laboratory Markers of Systemic Inflammation on Admission: A Retrospective Study

Abstract

Our study objective was to construct models using 20 routine laboratory parameters on admission to predict disease severity and mortality risk in a group of 254 hospitalized COVID-19 patients. Considering the influence of confounding factors in this single-center study, we also retrospectively assessed the correlations between the risk of death and the routine laboratory parameters within individual comorbidity subgroups. In multivariate regression models and by ROC curve analysis, a model of three routine laboratory parameters (AUC 0.85; 95% CI: 0.79–0.91) and a model of six laboratory factors (AUC 0.86; 95% CI: 0.81–0.91) were able to predict severity and mortality of COVID-19, respectively, compared with any other individual parameter. Hierarchical cluster analysis showed that inflammatory laboratory markers grouped together in three distinct clusters including positive correlations: WBC with NEU, NEU with neutrophil-to-lymphocyte ratio (NLR), NEU with systemic immune-inflammation index (SII), NLR with SII and platelet-to-lymphocyte ratio (PLR) with SII. When analyzing the routine laboratory parameters in the subgroups of comorbidities, the risk of death was associated with a common set of laboratory markers of systemic inflammation. Our results have shown that a panel of several routine laboratory parameters recorded on admission could be helpful for early evaluation of the risk of disease severity and mortality in COVID-19 patients. Inflammatory markers for mortality risk were similar in the subgroups of comorbidities, suggesting the limited effect of confounding factors in predicting COVID-19 mortality at admission.

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

“…Numerous research studies have been published in the last two years on the predictive significance of inflammatory markers and the mortality of COVID-19 patients [ 45 , 46 , 48 , 49 , 50 , 51 , 58 , 59 , 60 , 61 , 62 ]. Among the analyzed markers, NLR has the greatest interest for researchers, whose optimal cut-off value varies between 6.883 and 11.57 [ 48 , 50 , 51 , 58 , 59 , 60 ].…”

“…Furthermore, the predictive role of these markers has been proven in the cases of renal pathologies [ 32 , 33 , 34 ], cardiovascular pathologies [ 35 , 36 , 37 , 38 , 39 , 40 ], oncological pathologies [ 41 , 42 , 43 , 44 ], and, most recently, for COVID-19 patients [ 45 , 46 , 47 , 48 , 49 , 50 , 51 ].…”

Inflammatory Biomarkers as Prognostic Factors of Acute Deep Vein Thrombosis Following the Total Knee Arthroplasty

“…Hematological reports, based on neutrophil, monocyte, lymphocyte, and platelets total number: 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), are routine inflammatory biomarkers, easy to use, with low costs. Moreover, the predictive role of these reports has been recently demonstrated in the literature in the case of cardiovascular pathology [ 24 , 25 , 26 , 27 ], pulmonary embolism [ 28 , 29 ], chronic kidney disease [ 30 , 31 , 32 ], the case of COVID-19 patients [ 33 , 34 , 35 , 36 , 37 , 38 ], as well as in the case of peri-prosthetic infection after total joint arthroplasty [ 39 , 40 , 41 ].…”

Carotid Plaque Features and Inflammatory Biomarkers as Predictors of Restenosis and Mortality Following Carotid Endarterectomy

“…Among the systemic inflammatory biomarkers, the most accessible and easy to implement in current medical practice are hematological reports based on the total number of monocytes, neutrophils, lymphocytes, and platelets, respectively: 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), whose predictive role has been demonstrated in the case of cardiovascular pathologies [ 17 , 18 , 19 , 20 , 21 , 22 , 23 ], oncological pathologies [ 24 , 25 , 26 , 27 ], chronic kidney disease [ 28 , 29 , 30 ], and, more recently, in the case of COVID-19 patients [ 31 , 32 , 33 , 34 , 35 , 36 , 37 ].…”