Influence of laboratory biomarkers on inflammatory indices for assessing severity progression in COVID-19 cases

Abstract

Background and Objective: This study explored the role of various laboratory biomarkers on inflammatory indices for predicting disease progression toward severity in COVID-19 patients. Methods: This retrospective study was conducted on 1233 adults confirmed for COVID-19. The participants were grouped undermild, moderate, and severe grade disease. Serum bio-inflammatory index (SBII) and systemic inflammatory index (SII) were calculated and correlated with disease severity. The study variables, including clinical details and laboratory variables, were analyzed for impact on the inflammatory indices and severity status using a sequential multiple regression model to determine the predictors for mortality. Receiver operating characteristics defined the cut-off values for severity Results: Among the study population, 56.2%, 20.7%, and 23.1% were categorized as mild, moderate, and severe COVID-19 cases. Diabetes with hypertension was the most prevalent comorbid condition. The odds for males to have the severe form of the disease was 1.6 times (95% CI = 1.18–2.18, P = 0.002). The median (inter-quartile-range) of SBII was 549 (387.84–741.34) and SII was 2097.6 (1113.9–4153.73) in severe cases. Serum urea, electrolytes, gamma-glutamyl transferase, red-cell distribution width-to-hematocrit ratio, monocytopenia, and eosinopenia exhibited a significant influence on the SpO 2 , SBII, and SII. Both SBII (r = −0.582, P < 0.001) and SII (r = −0.52, P < 0.001) strongly correlated inversely with SpO 2 values [Figures 3a and 3b ]. More than 80% of individuals admitted with severe grade COVID-19 had values of more than 50 th percentile of SBII and SII. The sensitivity and specificity of SBII at 343.67 for severity were 81.4% and 70.1%, respectively. SII exhibited 77.2% sensitivity and 70.8% specificity at 998.72 Conclusion: Serial monitoring of the routinely available biomarkers would provide considerable input regarding inflammatory status and severity progression in COVID-19.

Systemic inflammation index, disease severity, and mortality in patients with COVID-19: a systematic review and meta-analysis

“…The study design was prospective in three studies ( 50 , 67 , 68 ), unclear in one ( 66 ), and retrospective in the remaining 36 ( 21 , 36 – 49 , 51 – 65 , 69 – 74 ). The clinical endpoints included mortality in 19 studies ( 36 , 37 , 39 , 41 , 43 , 45 , 48 , 49 , 51 , 52 , 55 , 56 , 58 , 60 , 61 , 65 , 66 , 68 , 73 ), and measures of severe disease as follows: disease severity based on existing guidelines in eight ( 42 , 44 , 63 , 64 , 67 , 70 , 72 , 74 ), transfer to the intensive care unit (ICU) in eight ( 38 , 40 , 45 , 50 , 53 , 62 , 68 , 69 ), invasive mechanical ventilation in two ( 46 , 52 ), disease progression in two ( 57 , 71 ), prolonged hospital stay in one ( 21 ), intubation in one ( 37 ), deep vein thrombosis in one ( 54 ), acute pulmonary embolism in one ( 54 ), and acute limb ischemia in one ( 39 ). All studies reported the SII on hospital admission.…”

“…The risk of bias was low in 29 studies ( 21 , 36 , 37 , 39 – 41 , 43 – 45 , 47 , 49 , 51 – 53 , 55 – 61 , 64 , 65 , 67 , 69 , 71 – 74 ) and high in the remaining ten ( 38 , 42 , 46 , 48 , 50 , 62 , 63 , 66 , 68 , 70 ) ( Supplementary Table 3 ).…”

“…Twenty-one studies (28 patient groups) in 17,863 COVID-19 patients (60% males, mean age 66 years), all retrospective, reported sensitivity and specificity of the ability of the SII to predict severe disease or mortality ( 36 – 40 , 42 , 45 , 47 , 48 , 51 , 53 , 54 , 56 , 58 , 61 , 64 , 68 – 70 , 72 , 74 ). Twelve studies were performed in Asia ( 36 , 38 , 40 , 42 , 48 , 51 , 54 , 64 , 68 , 70 , 72 , 74 ), six in Europe ( 39 , 47 , 56 , 58 , 61 , 69 ), two in America ( 37 , 45 ), and one in Africa ( 53 ).…”

“…Twenty-one studies (28 patient groups) in 17,863 COVID-19 patients (60% males, mean age 66 years), all retrospective, reported sensitivity and specificity of the ability of the SII to predict severe disease or mortality ( 36 – 40 , 42 , 45 , 47 , 48 , 51 , 53 , 54 , 56 , 58 , 61 , 64 , 68 – 70 , 72 , 74 ). Twelve studies were performed in Asia ( 36 , 38 , 40 , 42 , 48 , 51 , 54 , 64 , 68 , 70 , 72 , 74 ), six in Europe ( 39 , 47 , 56 , 58 , 61 , 69 ), two in America ( 37 , 45 ), and one in Africa ( 53 ). The studied endpoint was mortality in 12 studies ( 36 , 37 , 39 , 45 , 47 , 48 , 51 , 54 , 56 , 58 , 61 , 68 ), ICU admission in seven ( 38 – 40 , 45 , 53 , 68 , 69 ), disease severity based on existing guidelines in five ( 42 , 64 , 70 , 72 , 74 ), acute pulmonary embolism in one ( 61 ), acute limb ischemia in one ( ...…”

“…Twelve studies were performed in Asia ( 36 , 38 , 40 , 42 , 48 , 51 , 54 , 64 , 68 , 70 , 72 , 74 ), six in Europe ( 39 , 47 , 56 , 58 , 61 , 69 ), two in America ( 37 , 45 ), and one in Africa ( 53 ). The studied endpoint was mortality in 12 studies ( 36 , 37 , 39 , 45 , 47 , 48 , 51 , 54 , 56 , 58 , 61 , 68 ), ICU admission in seven ( 38 – 40 , 45 , 53 , 68 , 69 ), disease severity based on existing guidelines in five ( 42 , 64 , 70 , 72 , 74 ), acute pulmonary embolism in one ( 61 ), acute limb ischemia in one ( 39 ), and deep vein thrombosis in one ( 61 ) ( Table 4 ).…”