Predictive factors of poor outcomes in the COVID-19 epidemic: Consider the inflammatory response

Razanamahery, J.; Malinowski, Léa; Humbert, S.; Brunel, Anne Sophie; Lepiller, Quentin; Chirouze, Catherine; Bouiller, Kévin

doi:10.1016/j.medmal.2020.04.016

Cited by 8 publications

(12 citation statements)

References 9 publications

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“…This limitation is intrinsic to the retrospective character of the study. These results, already shown previously [2,111,13,14,16,25,[29][30][31], suggest a more important systemic inflammation in severe evolutions.…”

Section: Discussionsupporting

confidence: 85%

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Covid-19: contribution of clinical characteristics and laboratory features for early detection of patients with high risk of severe evolution

Sepulchre

Pittie

Stojkovic

et al. 2020

Acta Clinica Belgica

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Background: The aim of this study was to identify early clinical and laboratory predictive factors of a severe coronavirus disease 2019 (COVID-19). Methods: A retrospective study was conducted on adult patients hospitalized for COVID-19 in our hospital. Diagnosis was based on a positive real-time reverse transcription-polymerase chain reaction (RT-PCR) on nasopharyngeal samples. The cohort was divided into two groups, i. e. a favorable evolution (FE) group and an unfavorable evolution (UFE) group, including intensive care unit (ICU) and deceased patients. Results: A total of 198 patients were enrolled in the study, with 138 FE (70%) and 60 UFE (30%). Older age, male gender, comorbidities and dyspnea at admission constituted significantly worse prognosis factors. Among laboratory features, lymphocyte and platelet counts as well as corrected glomerular filtration rate were significantly lower in UFE patients, while neutrophil to lymphocyte ratio, inflammation biomarkers, creatinine, aspartate aminotransferase, lactate dehydrogenase (LDH), glycemia and D-dimer were significantly higher. Procalcitonin and LDH appeared as the most accurate variables according to receiver operating characteristic curves. Conclusions: This Belgian study revealed clinical and laboratory features able to predict high risk of ICU requirement, or even death, at admission time. These results provide a potential tool for patient's triage in a context of pandemic.

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Section: Discussionsupporting

confidence: 85%

“…A high level of LDH and impaired hepatic functions also appeared to be indicators of severe evolution, as it was already suggested by other authors [11][12][13][15][16][17]21,22,29].…”

Section: Discussionsupporting

confidence: 69%

Covid-19: contribution of clinical characteristics and laboratory features for early detection of patients with high risk of severe evolution

Sepulchre

Pittie

Stojkovic

et al. 2020

Acta Clinica Belgica

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“…This is similar to our observation in which patients with underlying hypertension showed no significant difference in mortality (68.6% vs 71.1%, P = 0.70). In another study in France, age was not found to be a prognostic factor for poor outcome but this study, much like ours, reflected the significant inflammatory markers such as CRP levels being a predictor of poor outcome [12]. Interestingly, studies from China and here in the United States have highlighted obesity as a risk factor for disease severity [7,9,13].…”

Section: Discussionsupporting

confidence: 54%

“…All inflammatory markers, except for ferritin, were noted to be statistically significant (Table 1 ). Other studies also reported the significance of the inflammatory response as a poor prognostic factor [ 11 , 12 ]. Our facility did not assess fibrinogen levels frequently.…”

Section: Discussionmentioning

confidence: 99%

“…Few studies have looked at prognosticators of poor outcomes in varying patient populations across the world [ 12 , 13 ]. A nationwide analysis of 1,590 patients hospitalized with COVID-19 infection in China, demonstrated that fatal outcomes were more prevalent in individuals 65 years and older (similar to our study) and associated co-morbidities of coronary heart disease and cerebrovascular disease [ 12 , 13 ]. In addition, it was noted that, although hypertension was a risk factor for hospitalization, it had no impact on mortality.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Poor Outcomes for COVID-19-Associated Pneumonia in a Minority Population

Omore¹,

Brimah²,

Tijani³

et al. 2021

Cureus

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Background In December 2019, an unprecedented outbreak of pneumonia of unknown etiology emerged in Wuhan City, Hubei province in China. A novel coronavirus was identified as the causative agent and was subsequently termed COVID-19 by the World Health Organization (WHO). It rapidly became a pandemic, and it has been a significant challenge to healthcare providers to predict outcomes of the infected patients. Objective The aim of this study was to investigate the clinical characteristics of patients admitted for COVID-19 infection in an Inner-City Hospital in New York City, to assess the correlation between inflammatory markers and outcomes prediction in a high-risk population. Methods We identified 235 patients who were admitted to our Hospital in NYC between March 19th and April 25th, 2020 with laboratory confirmed COVID-19 diagnosis with associated pneumonia and who also had documented inflammatory markers (D-dimer, C-reactive protein, lactate dehydrogenase, ferritin, procalcitonin) during their hospital stay. Results The study population was predominantly non-Hispanic black. There was no statistically significant difference between survivors and non-survivors by race and/or ethnicity (P = 0.69). Thirty-five percent of the patient population had died by the end of this study and those that died had a higher mean age compared to survivors (69.5 ± 13.6 vs 63.8 ± 15.2, P = 0.004). There is a significant difference in the D-dimer levels in patients who survivedwhen compared to those who died (P = 0.002). A higher proportion of patients that died were admitted to the ICU, (23.7% vs 55.4%, P < 0.0001) and/or intubated (18.4% vs 51.8%, P < 0.0001). Conclusion Our study demonstrated that patients who died had a significantly higher D-dimer (>3,000) when compared with survivors. Higher mean age was associated with increased mortality and admission to ICU and/or intubation.

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Simple prognostic factors and change of inflammatory markers in patients with severe coronavirus disease 2019: a single‐center observational study

Domi¹,

Mizunuma²,

Kuroda³

et al. 2021

Acute Medicine & Surgery

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Aim The aim of this study was to investigate the prognostic factors and evaluate the change in inflammatory markers of patients with coronavirus disease 2019 (COVID‐19) requiring mechanical ventilation. Methods This retrospective observational study conducted from April 1, 2020, to February 18, 2021, included 97 adult patients who required mechanical ventilation for severe COVID‐19 pneumonia and excluded nonintubated patients with a positive COVID‐19 polymerase chain reaction test and those who had any obvious bacterial infection on admission. All patients were followed up to discharge or death. We obtained clinical information and laboratory data including levels of presepsin, interleukin‐6, procalcitonin, and severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antibody every day. Poor outcome was defined as death or receiving a tracheostomy during hospitalization, and favorable outcome was defined as discharge after extubation. Results Differences (median [interquartile range]) were detected in age (76 [70–82] versus 66 [55–74] years), day from the onset of first symptoms to admission for mechanical ventilation (5 [3–7] versus 10 [8–12] days), and P/F ratio (i.e., ratio of arterial oxygen concentration to the fraction of inspired oxygen) after intubation (186 [149–251] versus 236 [180–296]) in patients with poor outcome versus those with favorable outcome on admission. Serum SARS‐CoV‐2 antibody levels had already increased on admission in patients with favorable outcome. We determined the day from the onset of first symptoms to admission for mechanical ventilation to be one of the independent prognostic factors of patients with COVID‐19 (adjusted odds ratio 0.69, confidence interval 0.56–0.85). Conclusion These results may contribute to understanding the mechanism of progression in severe COVID‐19 and may be helpful in devising an effective therapeutic strategy.

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Predictive factors of poor outcomes in the COVID-19 epidemic: Consider the inflammatory response

Cited by 8 publications

References 9 publications

Covid-19: contribution of clinical characteristics and laboratory features for early detection of patients with high risk of severe evolution

Covid-19: contribution of clinical characteristics and laboratory features for early detection of patients with high risk of severe evolution

Predictors of Poor Outcomes for COVID-19-Associated Pneumonia in a Minority Population

Simple prognostic factors and change of inflammatory markers in patients with severe coronavirus disease 2019: a single‐center observational study

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