Serial Changes in Blood-Cell-Count-Derived and CRP-Derived Inflammatory Indices of COVID-19 Patients

Abstract

The aim of the study was to investigate the serial changes in inflammatory indices derived from blood cell counts and C-reactive protein (CRP) levels in COVID-19 patients with good and poor outcomes. We retrospectively analyzed the serial changes in the inflammatory indices in 169 COVID-19 patients. Comparative analyses were performed on the first and last days of a hospital stay or death and serially from day 1 to day 30 from the symptom onset. On admission, non-survivors had higher CRP to lymphocytes ratio (CLR) and multi-inflammatory index (MII) values than survivors, while at the time of discharge/death, the largest differences were found for the neutrophil to lymphocyte ratio (NLR), systemic inflammation response index (SIRI), and MII. A significant decrease in NLR, CLR, and MII by the time of discharge was documented in the survivors, and a significant increase in NLR was documented in the non-survivors. The NLR was the only one that remained significant from days 7–30 of disease in intergroup comparisons. The correlation between the indices and the outcome was observed starting from days 13–15. The changes in the index values over time proved to be more helpful in predicting COVID-19 outcomes than those measured on admission. The values of the inflammatory indices could reliably predict the outcome no earlier than days 13–15 of the disease.

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.…”

“…Thirty-nine studies (with 45 patient groups) reported the SII in 19,352 patients (mean age 61 years, 55% males) with a non-severe disease/survivor status and 5,524 patients (mean age 69 years, 60% males) with a severe disease/non-survivor status. Twenty-three studies were conducted in Asia ( 36 , 38 , 40 – 42 , 48 – 51 , 57 , 59 , 62 – 68 , 70 – 74 ), eleven in Europe ( 21 , 39 , 43 , 44 , 47 , 55 , 56 , 58 , 60 , 61 , 69 ), four in America ( 37 , 45 , 46 , 52 ), and one in Africa ( 53 ) ( Table 1 ).…”

“…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 ).…”

The Role of Sequentially Monitored Laboratory Values and Inflammatory Biomarkers in Assessing the Severity of COVID-19

“…Notably, upon admission, individuals who did not survive exhibited elevated CLR and MII values compared to those who survived. However, at the point of discharge or death, the most notable distinctions were observed concerning the NLR, Systemic Inflammation Response Index (SIRI), and MII [ 3 ]. Consistent with the literature, in this study, the MII value was significantly higher upon admission and on the third day of hospitalization in the severe disease group (p=0.020 and p=0.001, respectively).…”

“…The complete blood count is a cost-effective, readily available, and efficient method for assessing inflammation in the early detection and prognosis of diseases. The dynamic nature of inflammation in COVID-19 is vital and has a direct correlation with physiological parameters [ 3 ]. Inflammatory biomarkers play a crucial role in understanding and monitoring the progression of various diseases, including COVID-19.…”