Hemogram as Marker of In-Hospital Mortality in Covid-19

Abstract

The clinical impact of COVID-19 disease calls for the identification of routine variables to identify patients at increased risk of death. Current understanding of moderate-to-severe COVID-19 pathophysiology points toward an underlying cytokine release driving a hyperinflammatory and procoagulant state. In this scenario, white blood cells and platelets play a direct role as effectors of such inflammation and thrombotic response. We investigate whether hemogram-derived ratios such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio and the systemic immune-inflammation index may help to identify patients at risk of fatal outcomes. Activated platelets and neutrophils may be playing a decisive role during the thromboinflammatory phase of COVID-19 so, in addition, we introduce and validate a novel marker, the neutrophil-to-platelet ratio (NPR).Two thousand and eighty-eight hospitalized patients with COVID-19 admitted at any of the hospitals of HM Hospitales group in Spain, from March 1 to June 10, 2020, were categorized according to the primary outcome of in-hospital death.Baseline values, as well as the rate of increase of the four ratios analyzed were significantly higher at hospital admission in patients who died than in those who were discharged (p<0.0001). In multivariable logistic regression models, NLR (OR 1.05; 95% CI 1.02 to 1.08, p=0.00035) and NPR (OR 1.23; 95% CI 1.12 to 1.36, p<0.0001) were significantly and independently associated with in-hospital mortality.According to our results, hemogram-derived ratios obtained at hospital admission, as well as the rate of change during hospitalization, may easily detect, primarily using NLR and the novel NPR, patients with COVID-19 at high risk of in-hospital mortality.

Melatonin as adjunctive therapy in patients admitted to the Covid-19

“…NLR displayed a disproportion of the inflammatory response in COVID-19 patients, and some studies found that high NLR is independently related with disease severity and mortality [ 33 , 34 ]. Also, serial NLR measurements in hospitalized patient with COVID-19 is a good predictor for mortality, as well as, some studies found that increase in NLR is associated with mortality [ [35] , [36] , [37] , [38] , [39] ]. Our findings showed that high dose melatonin significantly reduced NLR when added to standard treatment and ultimately decline mortality risk.…”

“…Activated platelets and neutrophils had important effects on the thrombo-inflammatory phase of COVID-19 [ 35 ]. Studies have confirmed that lower total platelets count and decrease in platelets was detected in severe COVID-19 cases and non-survived group [ 35 , 36 ]. Our study showed that there is a significant difference between the two groups in terms of platelet depletion.…”

Iron dysregulation in COVID‐19 and reciprocal evolution of SARS‐CoV‐2: Natura nihil frustra facit

“…Lung fibrosis observed in COVID‐19 patients and resulting hypoxia is the main reason for mortality in severe cases which can also be complicated by secondary bacterial and fungal infections 77 . COVID‐19 infection in humans is primarily asymptomatic or exhibiting a mild disease unless it manifests with the onset of hypoxemia from pneumonitis which may progress to ARDS with similarities to toxic shock syndrome (TSS) 78 . There is still a lack of understanding as to why some individuals are asymptomatic, some require low‐oxygen supplementation to then recover, while others rapidly decompensate into ARDS 79 .…”

“…77 COVID-19 infection in humans is primarily asymptomatic or exhibiting a mild disease unless it manifests with the onset of hypoxemia from pneumonitis which may progress to ARDS with similarities to toxic shock syndrome (TSS). 78 There is still a lack of understanding as to why some individuals are asymptomatic, some require low-oxygen supplementation to then recover, while others rapidly decompensate into ARDS. 79 It is possible that once a threshold is crossed by either uncontrolled hyperinflammation Both Hepcidin and Covidin bind strongly to the central pore from the extracellular space of a host iron transporter "ferroportin" and the resulting complex has similar interaction features and binding space as the natural hormone Hepcidin and/or stimulation of the signaling pathways comodulated by hypoxia and the result is ARDS.…”

New Discovery of Myeloid-Derived Suppressor Cell’s Tale on Viral Infection and COVID-19

“…Although more research is needed, one of the markers that can predict the correct mortality rate among COVID-19 ICU patients is mid-regional pro-adrenomedullin (MR-proADM): it presented as high levels in non-survivors (113). In addition, several recent studies have shown new markers such as neutrophil-to-lymphocyte ratio, neutrophil-to-platelet ratio, uric acid level, total antioxidant capacity, eosinophil/PMN ratio, high-density lipoprotein, and apoprotein A1 (114)(115)(116)(117)(118)(119).…”