Systemic inflammation indices predict mortality in patients with COVID-19

Year 2022, Volume: 5 Issue: 4, 1086 - 1091, 20.07.2022

Şaziye Melike Işık

https://doi.org/10.32322/jhsm.1106023

Cited By: 1

Abstract

Aim: In recent years, inflammation-based indices obtained from hematologic parameters have been shown to have prognostic value in various inflammatory diseases and cancer types. In this study, we aimed to investigate whether inflammation indices could be used to predict mortality in patients with COVID-19.
Material and Method: A total of 295 patients with a proven diagnosis of COVID-19 who were followed up in the intensive care unit were included in this retrospective, cross-sectional study. The patients were divided into two groups, survivors and non-survivors.
Results: D-dimer (HR:1.001, 95% CI:1-1.001) and troponin (HR: 1.001 95% CI: 1-1.001) levels of non-survivors were significantly higher in univariate analyses (p<0.05). Procalcitonin levels of whom were found to be high in univariate (HR: 1.018 95% CI: 1.003 – 1.034) and multivariate (HR:1.02 95% CI: 1.004-1.037) analyses (p<0.05). There was no significant difference between the groups in terms of median values of PLR, SIRI, and AISI indices (p>0.05). The median NLR value of the survivors was 7.45, while it was 11.39 in the non-survivors, and this difference was statistically significant (p<0.001). The median value of the SII index of the non-survivors was found as 2421.02, which was significantly higher than the survivors (p<0.001). The value of NLR and SII indices in predicting mortality in COVID-19 was evaluated using ROC analysis (NLR: AUC=0.644, 95%CI: 0.581-0.708, p<0.001; SII: AUC=0.584, 95%CI: 0.517-0.651, p=0.017). When the cut-off value for NLR was accepted as 9.574, the sensitivity was 59.3% and the specificity was 67% in predicting mortality. When the cut-off value for SII was accepted as 2285,846, it was found that it could predict mortality with a sensitivity of 52.38% and specificity of 66.04%.
Conclusion: SII and NLR indices can predict mortality in patients with COVID-19 followed up in the intensive care unit.

Keywords

COVID-19, inflammatory index, SII, NLR

References

• WHO COVID-19 Dashboard. Geneva: World Health Organization Aohcwi.
• Merad M, Martin JC. Pathological inflammation in patients with COVID-19: a key role for monocytes and macrophages. Nature Rew Immunol 2020; 20: 355-62.
• Del Valle DM, Kim-Schulze S, Huang HH, et al. An inflammatory cytokine signature predicts COVID-19 severity and survival. Nat Med 2020; 26: 1636-43.
• Ali N. Elevated level of C-reactive protein may be an early marker to predict risk for severity of COVID-19. J Med Virol 2020; 92: 2409-11.
• Ghahramani S, Tabrizi R, Lankarani KB, et al. Laboratory features of severe vs. non-severe COVID-19 patients in Asian populations: a systematic review and meta-analysis. Eur J Med Res 2020; 25: 30.
• Hirahara T, Arigami T, Yanagita S, et al. Combined neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predicts chemotherapy response and prognosis in patients with advanced gastric cancer. BMC Cancer 2019; 19: 672.
• Bartl T, Bekos C, Postl M, et al. The systemic immune-inflammation index (SII) is an independent prognostic parameter of survival in patients with invasive vulvar cancer. J Gynecol Oncol 2021; 32: e1.
• Mori K, Resch I, Miura N, et al. Prognostic role of the systemic immune-inflammation index in upper tract urothelial carcinoma treated with radical nephroureterectomy: results from a large multicenter international collaboration. Cancer Immunol Immunother 2021; 70: 2641-50.
• Zhang MH, Wang H, Wang HG, Wen X, Yang XZ. Effective immune-inflammation index for ulcerative colitis and activity assessments. World J Clin Cases 2021; 9: 334-43.
• Usul E, Şan İ, Bekgöz B, Şahin A. Role of hematological parameters in COVID-19 patients in the emergency room. Biomark Med 2020; 14: 1207-15.
• Peng J, Qi D, Yuan G, et al. Diagnostic value of peripheral hematologic markers for coronavirus disease 2019 (COVID-19): A multicenter, cross-sectional study. J Clin Lab Anal 2020; 34: e23475.
• Smits SL, de Lang A, van den Brand JM, et al. Exacerbated innate host response to SARS-CoV in aged non-human primates. PLoS Pathog 2010; 6: e1000756.
• Opal SM, Girard TD, Ely EW. The immunopathogenesis of sepsis in elderly patients. Clin Infect Dis 2005;41 Suppl 7: S504-12.
• Alharthy A, Aletreby W, Faqihi F, et al. Clinical Characteristics and Predictors of 28-Day Mortality in 352 Critically Ill Patients with COVID-19: A Retrospective Study. J Epidemiol Glob Health 2021; 11: 98-104.
• Cummings MJ, Baldwin MR, Abrams D, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet 2020; 395: 1763-70.
• Li X, Xu S, Yu M, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol 2020; 146: 110-8.
• Zhang L, Yan X, Fan Q, et al. D-dimer levels on admission to predict in-hospital mortality in patients with COVID-19. J Thromb Haemost 2020; 18: 1324-9.
• Okuyan DY, Gölen MK. Comparison of patients with acute ischemic stroke with and without COVID-19. Authorea Preprints 2021.
• Okuyan DY, Gölen MK. Clinical and laboratory characteristics of patients with COVID-19 followed up due to acute ischemic stroke. J Surg Med 2021; 5: 1135-8.
• Merad M, Martin JC. Pathological inflammation in patients with COVID-19: a key role for monocytes and macrophages. Nat Rev Immunol 2020; 20: 355-62.
• Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst 2014; 106: dju124.
• Balta S, Celik T, Mikhailidis DP, et al. The relation between atherosclerosis and the neutrophil-lymphocyte ratio. Clin Appl Thromb Hemost 2016; 22: 405-11.
• Karaman M, Balta S, Seyit Ahmet AY, et al. The comparative effects of valsartan and amlodipine on vWf levels and N/L ratio in patients with newly diagnosed hypertension. Clin Exp Hypertens 2013; 35: 516-22.
• Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol 2020; 84: 106504.
• Tatum D, Taghavi S, Houghton A, Stover J, Toraih E, Duchesne J. Neutrophil-to-Lymphocyte Ratio and Outcomes in Louisiana COVID-19 Patients. Shock 2020; 54: 652-8.
• Zhang B, Zhou X, Zhu C, et al. Immune Phenotyping Based on the Neutrophil-to-Lymphocyte Ratio and IgG Level Predicts Disease Severity and Outcome for Patients With COVID-19. Front Mol Biosci 2020; 7: 157.
• Liu J, Liu Y, Xiang P, et al. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. J Transl Med 2020; 18: 206.
• Chen FF, Zhong M, Liu Y, et al. The characteristics and outcomes of 681 severe cases with COVID-19 in China. J Crit Care 2020; 60: 32-7.
• Yıldırım Ö, Bayram M, Özmen RS, et al. Evaluation of hematological indices in terms of COVID-19 related mortality and ICU admission. J Health Sci Med 2021; 4: 666-670.
• Xue G, Gan X, Wu Z, et al. Novel serological biomarkers for inflammation in predicting disease severity in patients with COVID-19. Int Immunopharmacol 2020; 89: 107065.
• Doganci S, Ince ME, Ors N, et al. A new COVID-19 prediction scoring model for in-hospital mortality: experiences from Turkey, single center retrospective cohort analysis. Eur Rev Med Pharmacol Sci 2020; 24: 10247-57.
• Fois AG, Paliogiannis P, Scano V, et al. The systemic inflammation index on admission predicts in-hospital mortality in COVID-19 patients. Molecules 2020; 25.