Systemic Inflammatory Biomarkers and Chest CT Findings as Predictors of Acute Limb Ischemia Risk, Intensive Care Unit Admission, and Mortality in COVID-19 Patients

Abstract

Background: Numerous tools, including inflammatory biomarkers and lung injury severity scores, have been evaluated as predictors of thromboembolic events and the requirement for intensive therapy in COVID-19 patients. This study aims to verify the predictive role of inflammatory biomarkers [monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), systemic inflammatory index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI)] and the CT Severity Score in acute limb ischemia (ALI) risk, intensive unit care (ICU) admission, and mortality in COVID-19 patients.; Methods: The present study was designed as an observational, analytical, retrospective cohort study and included all patients older than 18 years of age with a diagnosis of COVID-19 infection, confirmed through real time-polymerase chain reaction (RT-PCR), and admitted to the County Emergency Clinical Hospital of Targu-Mureș, Romania, and Modular Intensive Care Unit of UMFST “George Emil Palade” of Targu Mures, Romania between January 2020 and December 2021. Results: Non-Survivors and “ALI” patients were associated with higher incidence of cardiovascular disease [atrial fibrillation (AF) p = 0.0006 and p = 0.0001; peripheral arterial disease (PAD) p = 0.006 and p < 0.0001], and higher pulmonary parenchyma involvement (p < 0.0001). Multivariate analysis showed a high baseline value for MLR, NLR, PLR, SII, SIRI, AISI, and the CT Severity Score independent predictor of adverse outcomes for all recruited patients (all p < 0.0001). Moreover, the presence of AF and PAD was an independent predictor of ALI risk and mortality. Conclusions: According to our findings, higher MLR, NLR, PLR, SII, SIRI, AISI, and CT Severity Score values at admission strongly predict ALI risk, ICU admission, and mortality. Moreover, patients with AF and PAD had highly predicted ALI risk and mortality but no ICU admission.

Prognostic Nutritional Index, Controlling Nutritional Status (CONUT) Score, and Inflammatory Biomarkers as Predictors of Deep Vein Thrombosis, Acute Pulmonary Embolism, and Mortality in COVID-19 Patients

“…This work supplements the previous two studies published by our group of researchers, Arbanasi et al and Halmaciu et al, which revealed the role of inflammatory markers in the prediction of ICU admission, IMV necessity, ALI risk, and mortality [ 45 , 46 ]. The hypercoagulability status of COVID-19 patients is well known, and the unpredictable evolution of these fragile patients, as well as the presence of comorbidities and risk factors, requires the establishment of prognostic tools and stratification of patients for better management of their health.…”

“…Numerous research studies have been published in the last two years on the predictive significance of inflammatory markers and the mortality of COVID-19 patients [ 45 , 46 , 48 , 49 , 50 , 51 , 58 , 59 , 60 , 61 , 62 ]. Among the analyzed markers, NLR has the greatest interest for researchers, whose optimal cut-off value varies between 6.883 and 11.57 [ 48 , 50 , 51 , 58 , 59 , 60 ].…”

“…Additionally, Rose et al [ 58 ] concluded that NLR > 11.38 is associated with mortality (OR: 1.82; p = 0.01), in a study conducted on a group of 454 COVID-19 patients. In terms of MLR, studies by Halmaciu et al [ 45 ], Arbanasi et al [ 46 ], and Citu et al [ 48 ], resulted in the association of MLR > 0.54 (OR:6.49; p < 0.001), MLR > 0.45 (OR:5.51; p < 0.001) and MLR > 0.69 (HR:3.05; p = 0.02), respectively, with mortality.…”

“…Furthermore, the predictive role of these markers has been proven in the cases of renal pathologies [ 32 , 33 , 34 ], cardiovascular pathologies [ 35 , 36 , 37 , 38 , 39 , 40 ], oncological pathologies [ 41 , 42 , 43 , 44 ], and, most recently, for COVID-19 patients [ 45 , 46 , 47 , 48 , 49 , 50 , 51 ].…”

Carotid Plaque Features and Inflammatory Biomarkers as Predictors of Restenosis and Mortality Following Carotid Endarterectomy

“…Among the systemic inflammatory biomarkers, the most accessible and easy to implement in current medical practice are hematological reports based on the total number of monocytes, neutrophils, lymphocytes, and platelets, respectively: monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammatory index (SII), systemic Inflammation Response Index (SIRI), and aggregate index of systemic inflammation (AISI), whose predictive role has been demonstrated in the case of cardiovascular pathologies [ 17 , 18 , 19 , 20 , 21 , 22 , 23 ], oncological pathologies [ 24 , 25 , 26 , 27 ], chronic kidney disease [ 28 , 29 , 30 ], and, more recently, in the case of COVID-19 patients [ 31 , 32 , 33 , 34 , 35 , 36 , 37 ].…”