Neutrophilia during hospitalization predicts ARDS and risk of death in COVID-19 patients

Abstract

Background Coronavirus disease 2019 (COVID-19), poses a threat to the global public health. Early identification of critical cases is crucial to providing timely treatment to patients. Here, we investigated whether white immune cell levels could predict respiratory decline, complications and mortality. Methods We performed a retrospective study including 119 patients presenting with COVID-19. We divided our cohort into two categories, using two different classifications. Comparison tests, prediction analysis and the logistic regression analysis were used in this study. Results The study revealed that a rise in neutrophils levels was associated with respiratory deterioration and intubation. In contrast, neutrophils levels plateaued in patients who remained stable. Neutrophils levels, during the first 5 days of hospitalization, positively correlated with the procalcitonin and C-reactive protein levels. Interestingly, neutrophils levels at day 5 proved to be a better predictor of intubation and acute respiratory distress syndrome than initial neutrophils counts, C-reactive protein or procalcitonin. Neutrophils counts at day 5 higher than 7,7 (109/l) (normal range: 1,4–7,7 (109/L) also effectively predicted patient mortality, independently of usual clinical classifications. Moreover, binary logistic regression with stratified revealed that neutrophils at day5 > 7,7 (109/l) was an independent risk factor of mortality and acute respiratory distress syndrome. Finally, neutrophils levels at day 5 and the proinflammatory cytokine IL-6 were correlated, which suggested a mechanistic link. Conclusions Our data showed that neutrophils count at day 5, rather than at admission, proved to be an excellent predictor of complications and mortality during hospitalization and could be used to improve COVID-19 patients’management.