The Systemic Inflammation Index on Admission Predicts In-Hospital Mortality in COVID-19 Patients

Abstract

Background. The rapid onset of a systemic pro-inflammatory state followed by acute respiratory distress syndrome is the leading cause of mortality in patients with COVID-19. We performed a retrospective observational study to explore the capacity of different complete blood cell count (CBC)-derived inflammation indexes to predict in-hospital mortality in this group. Methods. The neutrophil to lymphocyte ratio (NLR), derived NLR (dNLR), platelet to lymphocyte ratio (PLR), mean platelet volume to platelet ratio (MPR), neutrophil to lymphocyte × platelet ratio (NLPR), monocyte to lymphocyte ratio (MLR), systemic inflammation response index (SIRI), systemic inflammation index (SII), and the aggregate index of systemic inflammation (AISI) were calculated on hospital admission in 119 patients with laboratory confirmed COVID-19. Results. Non-survivors had significantly higher AISI, dNLR, NLPR, NLR, SII, and SIRI values when compared to survivors. Similarly, Kaplan–Meier survival curves showed significantly lower survival in patients with higher AISI, dNLR, MLR, NLPR, NLR, SII, and SIRI. However, after adjusting for confounders, only the SII remained significantly associated with survival (HR = 1.0001; 95% CI, 1.0000–1.0001, p = 0.029) in multivariate Cox regression analysis. Conclusions. The SII on admission independently predicts in-hospital mortality in COVID-19 patients and may assist with early risk stratification in this group.

Elevated Monocyte to Lymphocyte Ratio and Increased Mortality among Patients with Chronic Kidney Disease Hospitalized for COVID-19

“…In a cohort of 119 Italian patients, higher values of NLR, NLPR, NLR, and the systemic immune-inflammation index (SII) were associated with in-hospital mortality due to COVID-19. However, after adjusting for confounders, only the SII, which is based on neutrophil, platelet, and lymphocyte counts, remained significantly associated with survival [ 41 ]. Another study conducted in Turkey assessed the predictive value of blood markers obtained in the ER from 233 COVID-19 patients.…”

Neurological Complications of COVID-19: Underlying Mechanisms and Management

“…The increased risk of these events is believed to be due to a hyperinflammatory/hypercoagulable state, and altered endothelial cell function resulting from the SARS-CoV-2 infection ( Figure 2 ) [ 77 , 78 , 79 , 80 , 81 ]. Several studies have reported a significant increase in neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), and serum ferritin in COVID-19 patients with ischemic stroke, which could predict mortality in these patients [ 82 , 83 , 84 , 85 , 86 , 87 ]. Neutrophilia (increase in neutrophils) described in these patients results in the overproduction of neutrophil extracellular traps (NETs), which has been shown to increase thrombi formation [ 88 , 89 , 90 ].…”

“…Severe inflammation in COVID-19 patients, the infection of endothelial cells, and the activation of coagulation cascade could lead to hypercoagulability and disseminated intravascular coagulation (DIC) that is commonly seen in COVID-19 patients ( Figure 2 ) [ 77 , 78 , 79 , 80 , 81 ]. The severe systemic inflammation on hospital admission could predict mortality in COVID-19 patients [ 87 ]. Stroke could be a consequence if anticoagulants are not administered [ 234 , 235 ].…”

Mental health in COVID-19 survivors from a general hospital: association with sociodemographic, clinical, and inflammatory variables

“…It is rated according to the Likert scale that ranges from 0 ("not at all") to 4 ("extremely"). The IES-R scores re ect 5 categories of distress severity: normal (0-8), mild (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), moderate (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43), and severe . This scale has been translated into Spanish and validated (25).…”

“…This scale consists of 9 items that evaluated the frequency of depressive symptoms in the previous two weeks, which are rated on a Likert scale ranging from 0 ("not at all") to 3 ("nearly every day"). The PHQ-9 scores re ect 5 categories of severity of depressive disorders: None (0-4), mild (5)(6)(7)(8)(9), moderate (10)(11)(12)(13)(14), moderately severe (15- 19), and severe (20)(21)(22)(23)(24)(25)(26)(27). In studies carried out in Latin America, PHQ-9 has been proven to be a valid and reliable tool for detecting depressive symptoms in various types of populations (17,18).…”