Elevated Monocyte to Lymphocyte Ratio and Increased Mortality among Patients with Chronic Kidney Disease Hospitalized for COVID-19

Abstract

Chronic kidney disease (CKD) constitutes a major health problem and one of the leading causes of death worldwide. Patients with CKD have impaired immune functions that predispose them to an increased risk of infections, as well as virus-associated cancers and a diminished vaccine response. In this study, we aimed to identify clinical and laboratory parameters associated with in-hospital mortality in patients evaluated in the department of emergency (ER) and admitted with the diagnosis of severe acute respiratory syndrome (SARS) caused by coronavirus disease 2019 (COVID-19) at the Baptist Hospital of Nicaragua (BHN). There were 37 patients with CKD, mean age 58.3 ± 14.1 years, admitted to BHN due to COVID-19, and among them, 24 (65.7%) were males (p = 0.016). During hospitalization, 23 patients with CKD (62.1%) died of complications associated with COVID-19 disease, which was a higher proportion (odds ratio (OR) 5.6, confidence interval (CI) 2.1–15.7, p = 0.001) compared to a group of 70 patients (64.8% males, mean age 57.5 ± 13.7 years) without CKD admitted during the same period in whom 28.5% died of COVID-19. In the entire cohort, the majority of patients presented with bilateral pneumonia, and the most common symptoms at admission were dyspnea, cough, and fever. Serum levels of D-dimer, ferritin and procalcitonin were significantly higher in patients with CKD compared with those without CKD. Multivariate analysis revealed that CKD, age (>60 years), and hypoxia measured in the ER were factors associated with increased in-hospital mortality. Among patients with CKD but not in those without CKD (OR 36.8, CI 1.5–88.3, p = 0.026), an increased monocytes-to-lymphocyte ratio (MLR) was associated with higher mortality and remained statistically significant after adjusting for confounders. The MLR measured in the ER may be useful for predicting in-hospital mortality in patients with CKD and COVID-19 and could contribute to early risk stratification in this group.

Comparing Humoral and Cellular Adaptive Immunity during Convalescent Phase of COVID-19 in Hemodialysis Patients and Kidney Transplant Recipients

“…Generally, hemodialysis patients are characterized by uremia-related immunological abnormalities, such as decreased general blood counts and malfunction of immune cells [ 40 ]. Blood morphology-derived parameters obtained from five-part differential blood count were shown to be altered in various inflammatory states, including COVID-19 [ 41 ], which was also observed for CKD COVID-19 patients [ 42 , 43 , 44 ]. Renal dysfunction is associated with an increase in endothelial injury-related BNP and NT-pro-BNP markers that were found to be associated with disease severity and mortality in COVID-19 patients [ 45 ].…”

Humoral and cellular immune response to severe acute respiratory syndrome coronavirus‐2 vaccination in haemodialysis and kidney transplant patients

“…5 Race/ ethnicity (non-Hispanic Black, Hispanic and Asian), age >60 years, obesity and type-2-diabetes increase the risk of adverse outcomes. 6,7 In addition, kidney transplant patients with COVID-19 are 1.28 times more likely to die than matched-haemodialysis patients. 5 In less than 2 years since the declaration as a pandemic, breakthroughs in the management of COVID-19 have transpired.…”

“… 5 Race/ethnicity (non‐Hispanic Black, Hispanic and Asian), age >60 years, obesity and type‐2‐diabetes increase the risk of adverse outcomes. 6 , 7 In addition, kidney transplant patients with COVID‐19 are 1.28 times more likely to die than matched‐haemodialysis patients. 5 …”

Deep autoencoder for interpretable tissue-adaptive deconvolution and cell-type-specific gene analysis

“…We used the estimated MLR value predicted from different models to compare the tendency between different severity (Figure 3c). Only TAPE predicted the increasing tendency of MLR value, and the value range is suitable with the clinical report (0.29-0.88) [21].…”