The systemic inflammatory response and clinicopathological characteristics in patients admitted to hospital with COVID-19 infection: Comparison of 2 consecutive cohorts

Abstract

Background: In order to manage the COVID-19 systemic inflammatory response, it is important to identify clinicopathological characteristics across multiple cohorts.Methods: Electronic patient records for 2 consecutive cohorts of patients admitted to two urban teaching hospitals with COVID-19 during two 7-week periods of the COVID-19 pandemic in Glasgow, U.K. (cohort 1: 17th March 2020 - 1st May 2020) and (cohort 2: 18th May 2020 - 6th July 2020) were examined for routine clinical, laboratory and clinical outcome data. Results: Compared with cohort 1, cohort 2 were older (p<0.001), more likely to be female (p<0.05) and have less independent living circumstances (p<0.001). More patients in cohort 2 were PCR positive, CXR negative (both p<0.001) and had low serum albumin concentrations (p<0.001). 30-day mortality was similar between both cohorts (23% and 22%). Over the 2 cohorts, age >70 (p<0.001), male gender (p<0.05), hypertension (p<0.01), heart failure (p<0.05), cognitive impairment (p<0.001), frailty (p<0.001), COPD (p<0.05), delirium (p<0.001), elevated peri-operative Glasgow Prognostic Score (p<0.001), elevated neutrophil-lymphocyte ratio (p<0.001), low haematocrit (p<0.01), elevated urea (p<0.001), creatinine (p<0.001), glucose (p<0.05) and lactate (p<0.01); and the 4C score were associated with 30-day mortality. When compared with the 4C score, greater frailty (OR 10.2, 95% C.I. 3.4 to 30.6, p<0.01) and low albumin (OR 5.6, 95% C.I. 2.0 to 15.6, p<0.01) were strongly independently associated with 30-day mortality. Conclusion: In addition to the 4C mortality score, frailty score and a low albumin were strongly independently associated with 30-day mortality in two consecutive cohorts of patients admitted to hospital with COVID-19. Article summary: In two consecutive cohorts of patients with COVID-19 infection admitted to two urban teaching hospitals in Glasgow, UK, there were variations in a number of clinicopathological characteristics despite similar mortality (23 and 22%). In these two cohorts, in a multivariate analysis that included the 4C mortality score, clinical frailty score >3, low serum albumin concentration (<35 g/L), high neutrophil-lymphocyte ratio (>5), and abnormal serum sodium concentration (<133/>145 mmol/L) remained independently associated with 30-day mortality.

The relationship between frailty, nutritional status, co-morbidity, CT-body composition and systemic inflammation in patients with COVID-19

“…Furthermore, large multi-centre cohort studies have shown that a high CFS was independently associated with 30-day mortality [5]. These observations are consistent with recent cohort studies from our own population, that have shown a CFS > 3 was independently associated with 30-day mortality in patients admitted to hospital with COVID-19 [6,7].…”

Iron related biomarkers predict disease severity in a cohort of Portuguese adult patients during COVID-19 acute infection

“…Despite the reduction of serum iron in COVID-19-positive patients in this cohort, we did not find important alterations in RBC, hemoglobin or hematocrit, in accordance with previous studies [6][7][8]13,21]. Increased heme was observed in sepsis patients [22] and in murine models of infection [23].…”

Association of hypernatremia with outcomes of COVID-19 patients: A systematic review and meta-analysis

“…[13] Insensible fluid loss is mainly from cutaneous that is due to constant pyrexia and respiratory that is increased respiratory rates or during intubation due to loss of fluid from mucous and the periciliary fluid by evaporation. [34,35] Dehydration occurring following acute respiratory distress (ARDS) treatment along with the virus disturbs the endocrine function, Wang et al [12] 2021 China 45 64 ± 17.78 66.7 Retrospective ≥146 mmol/L Tzoulis et al [13] 2021 UK 488 68 ± 17.78 56.8 Retrospective ≥146 mmol/L Trecarichi et al [14] 2020 Italy 50 80 ± 12 57.1 Retrospective >145 mmol/L Sjöström et al [31] 2021 Sweden 406 59 ± 12.3 75 Retrospective ≥145 mmol/L Sjöström et al [32] 2020 Sweden 223 59 ± 2.37 79.37 Retrospective ≥145 mmol/L Ruiz-Sanchez et al [15] 2020 Spain, Italy Cuba, Ecuador Germany, China, and Canada 4664 66 ± 18.51 58 Retrospective >145 mmol/L Maniero et al [16] 2021 UK 124 83 ± 7.22 50.8 Retrospective NA Maguire et al [17] 2021 UK 261 66%>70 46 Prospective >146 mmol/L Asghar et al [18] 2020 Pakistan 373 52.78 ± 15.76 67.02 Prospective >145 mEq/L Atila et al [19] 2021 Switzerland Cases: 172 Control:849 59 ± 22.96 55 Prospective >147 mmol/L Berni et al [20] 2021 Italy 380 67.53 ± 15.48 61.57 Prospective >145 mEq/L Duan et al [21] 2020 China 348 44.8 ± 15 47.12 Retrospective >138 mmol/L Hirsch et al [22] 2021 USA 9946 71 ± 14.07 59.39 Retrospective >144 mEq/L Hu et al [23] 2021 China 1254 56 ± 55.5 51.1 Retrospective >145 mmol/L Longhitano et al [24] 2021 Italy 115 73 ± 60.74 55 Prospective >145 mmol/L Wu et al [26] 2020 China 125 55 52.8 Retrospective >145 mmol/l Sarvazad et al [25] 2020 Iran 58 56 57 Prospective >146 meq/L like Renin-angiotensin-aldosterone system, expecting to shift the electrolyte pattern to hypernatremia. [31] Contrary to physiological phenomena, despite the administration of diuretics (leading to sodium excretion) and despite the administration of free water, plasma sodium level remains raised.…”

“…Recent studies have shown a more pronounced and much higher incidence of hypernatremia in COVID-19 patients, pointing to the fact that hypernatremia can be a manifestation of COVID-19, generally seen to be associated with adverse outcomes. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] With a surge in such publications related to the prevalence and impact of hypernatremia in COVID-19 patients, our primary objective was to examine the association of elevated serum sodium with key clinical outcomes, including mortality, ventilation, intensive care unit (ICU) admission and prolonged hospital stay.…”