Hematologic predictors of mortality in hospitalized patients with COVID-19: a comparative study

Mousavi, S. Hossein; Rad, Soroush; Rostami, Tahereh; Rostami, Mohammad Reza; Mousavi, Seyed Ali; Mirhoseini, Seied Amirhosein; Kiumarsi, Azadeh

doi:10.1080/16078454.2020.1833435

Cited by 60 publications

(68 citation statements)

References 31 publications

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“…The fact that only a minority of patients had some of these values available at admission provides a suitable explanation for this. After multivariate analysis, increase serum creatinine >1.1 mg/dL (with each additional 1.0 mg increase raising the OR of death 3.2 times) and LDH >500 IU/L values were revealed as independent predictors of mortality, together with thrombocytopenia <150,000/µL and lymphopenia <1000 cells/µL, thus confirming previous observations associating severe COVID-19 infection with decreased number of platelets [ 38 ] and lymphocytes [ 39 , 40 ]. Whether cytopenias results in disease severity or the severity of COVID-19 decreases cells counts is still open to debate.…”

Section: Discussionsupporting

confidence: 86%

Prognostic Factors at Admission for In-Hospital Mortality from COVID-19 Infection in an Older Rural Population in Central Spain

Maestre-Muñiz

Arias

Arias-González

et al. 2021

JCM

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Background: Risk factors for in-hospital mortality from severe coronavirus disease 2019 (COVID-19) infection have been identified in studies mainly carried out in urban-based teaching hospitals. However, there is little data for rural populations attending community hospitals during the first wave of the pandemic. Methods: A retrospective, single-center cohort study was undertaken among inpatients at a rural community hospital in Spain. Electronic medical records of the 444 patients (56.5% males) admitted due to severe SARS-CoV-2 infection during 26 February 2020–31 May 2020 were reviewed. Results: Mean age was 71.2 ± 14.6 years (rank 22–98), with 69.8% over 65. At least one comorbidity was present in 410 patients (92.3%), with chronic obstructive pulmonary disease (COPD) present in 21.7%. Overall in-hospital mortality was 32%. Multivariate analysis of factors associated with death identified patients’ age (with a cumulative effect per decade), COPD as a comorbidity, and respiratory insufficiency at the point of admission. No additional comorbid conditions proved significant. Among analytical values, increased serum creatinine, LDH > 500 mg/dL, thrombocytopenia (<150 × 109/per L), and lymphopenia (<1000 cells/µL) were all independently associated with mortality during admission. Conclusions: Age remained the major determinant for COVID-19-caused mortality; COPD was the only comorbidity independently associated with in-hospital death, together with respiratory insufficiency and analytical markers at admission.

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Section: Discussionsupporting

confidence: 86%

Prognostic Factors at Admission for In-Hospital Mortality from COVID-19 Infection in an Older Rural Population in Central Spain

Maestre-Muñiz

Arias

Arias-González

et al. 2021

JCM

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“…In patients with severe forms of COVID, severe lymphopaenia is commonly observed [15]. In our study, it was associated with overall reduced survival and inversely correlated with the intra-thymic proliferation of T-cell precursors.…”

Section: Discussionsupporting

confidence: 57%

“…Enlargement of the thymus region, especially in the elderly, is mostly observed in autoimmune conditions and tumours, or in response to profound lymphopaenia [14], whether or not associated with sepsis. Such lymphopaenia is frequently observed in patients with severe COVID [15]. However, thymic volume is not directly related to the extent of thymic function, which consists of producing and exporting mature T-cells into the blood.…”

Section: Introductionmentioning

confidence: 99%

Protective reactive thymus hyperplasia in COVID-19 acute respiratory distress syndrome

Cuvelier

Roux

Couëdel-Courteille

et al. 2020

Preprint

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Background. Patients with COVID-19 (COVID) may develop acute respiratory distress syndrome with or without sepsis, coagulopathy and visceral damage. While chest CT-scans are routinely performed in the initial assessment of patients with severe pulmonary forms, thymus involvement and reactivation have not been investigated so far.Methods. In this observational study, we systematically scored the enlargement of the thymus and the lung involvement, using CT-scans, in all adult patients admitted to the ICU for COVID or any other cause (control group) at one centre between March and April 2020. Initial biological investigations included nasal detection of SARS-CoV-2 ribonucleic acid by polymerase chain reaction (PCR). In a subgroup of 24 patients with different degrees of pulmonary involvement and thymus hypertrophy, plasma cytokine concentrations were measured and the export of mature T-cells from the thymus was estimated simultaneously by PCR quantification of T-cell receptor excision circles (TRECs).Results. Eighty-seven patients were studied: 50 COVID patients and 37 controls. Non-atrophic or enlarged thymus was more commonly observed in COVID patients than in controls (66% vs. 24%, p<0.0001). Thymus enlargement in COVID patients was associated with more extensive lung injury score on CT-scans (4 [3-5] vs. 2 [1.5-4], p=0.01), but a lower mortality rate (8.6% vs. 41.2%, p<0.001). Other factors associated with mortality were age, lymphopaenia, high CRP and co-morbidities. COVID patients had higher concentrations of IL-7 (6.00 [3.72-9.25] vs. 2.17 [1.76-4.4] pg/mL; p=0.04), and higher thymic production of new lymphocytes (sj/bTREC ratio = 2.88 [1.98-4.51] vs. 0.23 [0.15-0.60]; p=0.004). Thymic production was also correlated with the CT-scan thymic score (r = 0.38, p=0.03) and inversely correlated with the number of lymphocytes (r=0.56, p=0.007).Conclusions. In COVID patients, thymus enlargement was frequent and associated with increased T-lymphocyte production, which appears to be a beneficial adaptation to virus-induced lymphopaenia. The lack of thymic activity/reactivation in older SARS-CoV-2 infected patients could contribute to a worse prognosis. Trial registration: N/A

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“…10 Except for clinical symptoms and pulmonary computed tomography (CT) findings, most confirmed COVID-19 patients revealed laboratory fluctuations in different serological parameters, including renal and liver function tests, coagulation parameters, and inflammatory, biochemical and hemocytometric parameters. 9,11,12 To show the prognosis and hyperinflammation state, a combination of laboratory tests has been evaluated. The combination of the various test includes platelet-to-lymphocyte (PLR) and neutrophils to lymphocyte ratio (NLR).…”

Section: Introductionmentioning

confidence: 99%

“…Lymphopenia has been previously reported in about 35%-85% of patients and was the most common blood count abnormality. [10][11][12] Moreover, knowledge about the risk of infections along with other comorbid conditions would provide valuable insights on risk stratification and making a clinical decision in severe COVID-19 patients. 15 According to different studies, NLR in severe patients was raised as compared to those with mild or moderate disease.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of hematological parameters as an indicator of disease severity in Covid‐19 patients: Pakistan's experience

Waris

Din

Khalid

et al. 2021

Clinical Laboratory Analysis

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Hematologic predictors of mortality in hospitalized patients with COVID-19: a comparative study

Cited by 60 publications

References 31 publications

Prognostic Factors at Admission for In-Hospital Mortality from COVID-19 Infection in an Older Rural Population in Central Spain

Prognostic Factors at Admission for In-Hospital Mortality from COVID-19 Infection in an Older Rural Population in Central Spain

Protective reactive thymus hyperplasia in COVID-19 acute respiratory distress syndrome

Evaluation of hematological parameters as an indicator of disease severity in Covid‐19 patients: Pakistan's experience

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