A Simple Prognostic Score for Critical COVID-19 Derived from Patients without Comorbidities Performs Well in Unselected Patients
We aimed to search for laboratory predictors of critical COVID-19 in consecutive adults admitted in an academic center between 16 September 2020–20 December 2021. Patients were uniformly treated with low-molecular-weight heparin, and dexamethasone plus remdesivir when SpO2 < 94%. Among consecutiv...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-03-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/7/1810 |
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| author | Vasiliki E. Georgakopoulou Nikolaos I. Vlachogiannis Dimitrios Basoulis Irene Eliadi Georgios Georgiopoulos Georgios Karamanakos Sotiria Makrodimitri Stamatia Samara Maria Triantafyllou Pantazis M. Voutsinas Fotinie Ntziora Mina Psichogiou Michael Samarkos Petros P. Sfikakis Nikolaos V. Sipsas |
| author_facet | Vasiliki E. Georgakopoulou Nikolaos I. Vlachogiannis Dimitrios Basoulis Irene Eliadi Georgios Georgiopoulos Georgios Karamanakos Sotiria Makrodimitri Stamatia Samara Maria Triantafyllou Pantazis M. Voutsinas Fotinie Ntziora Mina Psichogiou Michael Samarkos Petros P. Sfikakis Nikolaos V. Sipsas |
| author_sort | Vasiliki E. Georgakopoulou |
| collection | DOAJ |
| description | We aimed to search for laboratory predictors of critical COVID-19 in consecutive adults admitted in an academic center between 16 September 2020–20 December 2021. Patients were uniformly treated with low-molecular-weight heparin, and dexamethasone plus remdesivir when SpO2 < 94%. Among consecutive unvaccinated patients without underlying medical conditions (<i>n</i> = 241, 49 year-old median, 71% males), 22 (9.1%) developed critical disease and 2 died (0.8%). White-blood-cell counts, neutrophils, neutrophil-to-lymphocyte ratio, CRP, fibrinogen, ferritin, LDH and γ-GT at admission were each univariably associated with critical disease. ROC-defined cutoffs revealed that CRP > 61.8 mg/L, fibrinogen > 616.5 mg/dL and LDH > 380.5 U/L were each associated with critical disease development, independently of age, sex and days from symptom-onset. A score combining higher-than-cutoff CRP (0/2), LDH (0/1) and fibrinogen (0/1) predicted critical disease (AUC: 0.873, 95% CI: 0.820–0.926). This score performed well in an unselected patient cohort (<i>n</i> = 1228, 100% unvaccinated) predominantly infected by the alpha variant (AUC: 0.718, 95% CI: 0.683–0.753), as well as in a mixed cohort (<i>n</i> = 527, 65% unvaccinated) predominantly infected by the delta variant (AUC: 0.708, 95% CI: 0.656–0.760). Therefore, we propose that a combination of standard biomarkers of acute inflammatory response, cell death and hypercoagulability reflects the severity of COVID-19 per se independently of comorbidities, age and sex, being of value for risk stratification in unselected patients. |
| first_indexed | 2024-03-09T11:43:35Z |
| format | Article |
| id | doaj.art-778f1a5d126c4124a4e1b09f2d0df635 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T11:43:35Z |
| publishDate | 2022-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-778f1a5d126c4124a4e1b09f2d0df6352023-11-30T23:27:11ZengMDPI AGJournal of Clinical Medicine2077-03832022-03-01117181010.3390/jcm11071810A Simple Prognostic Score for Critical COVID-19 Derived from Patients without Comorbidities Performs Well in Unselected PatientsVasiliki E. Georgakopoulou0Nikolaos I. Vlachogiannis1Dimitrios Basoulis2Irene Eliadi3Georgios Georgiopoulos4Georgios Karamanakos5Sotiria Makrodimitri6Stamatia Samara7Maria Triantafyllou8Pantazis M. Voutsinas9Fotinie Ntziora10Mina Psichogiou11Michael Samarkos12Petros P. Sfikakis13Nikolaos V. Sipsas14Infectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceFirst Department of Propaedeutic Internal Medicine and Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceInfectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceInfectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceDepartment of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, 11528 Athens, GreeceInfectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceInfectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceInfectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceInfectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceInfectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceFirst Department of Propaedeutic Internal Medicine and Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceInfectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceInfectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceFirst Department of Propaedeutic Internal Medicine and Joint Academic Rheumatology Program, Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceInfectious Diseases and COVID-19 Unit, General Hospital of Athens Laiko, Medical School, National and Kapodistrian University of Athens, 11527 Athens, GreeceWe aimed to search for laboratory predictors of critical COVID-19 in consecutive adults admitted in an academic center between 16 September 2020–20 December 2021. Patients were uniformly treated with low-molecular-weight heparin, and dexamethasone plus remdesivir when SpO2 < 94%. Among consecutive unvaccinated patients without underlying medical conditions (<i>n</i> = 241, 49 year-old median, 71% males), 22 (9.1%) developed critical disease and 2 died (0.8%). White-blood-cell counts, neutrophils, neutrophil-to-lymphocyte ratio, CRP, fibrinogen, ferritin, LDH and γ-GT at admission were each univariably associated with critical disease. ROC-defined cutoffs revealed that CRP > 61.8 mg/L, fibrinogen > 616.5 mg/dL and LDH > 380.5 U/L were each associated with critical disease development, independently of age, sex and days from symptom-onset. A score combining higher-than-cutoff CRP (0/2), LDH (0/1) and fibrinogen (0/1) predicted critical disease (AUC: 0.873, 95% CI: 0.820–0.926). This score performed well in an unselected patient cohort (<i>n</i> = 1228, 100% unvaccinated) predominantly infected by the alpha variant (AUC: 0.718, 95% CI: 0.683–0.753), as well as in a mixed cohort (<i>n</i> = 527, 65% unvaccinated) predominantly infected by the delta variant (AUC: 0.708, 95% CI: 0.656–0.760). Therefore, we propose that a combination of standard biomarkers of acute inflammatory response, cell death and hypercoagulability reflects the severity of COVID-19 per se independently of comorbidities, age and sex, being of value for risk stratification in unselected patients.https://www.mdpi.com/2077-0383/11/7/1810COVID-19comorbiditiesprognosisvaccinationcritical disease |
| spellingShingle | Vasiliki E. Georgakopoulou Nikolaos I. Vlachogiannis Dimitrios Basoulis Irene Eliadi Georgios Georgiopoulos Georgios Karamanakos Sotiria Makrodimitri Stamatia Samara Maria Triantafyllou Pantazis M. Voutsinas Fotinie Ntziora Mina Psichogiou Michael Samarkos Petros P. Sfikakis Nikolaos V. Sipsas A Simple Prognostic Score for Critical COVID-19 Derived from Patients without Comorbidities Performs Well in Unselected Patients Journal of Clinical Medicine COVID-19 comorbidities prognosis vaccination critical disease |
| title | A Simple Prognostic Score for Critical COVID-19 Derived from Patients without Comorbidities Performs Well in Unselected Patients |
| title_full | A Simple Prognostic Score for Critical COVID-19 Derived from Patients without Comorbidities Performs Well in Unselected Patients |
| title_fullStr | A Simple Prognostic Score for Critical COVID-19 Derived from Patients without Comorbidities Performs Well in Unselected Patients |
| title_full_unstemmed | A Simple Prognostic Score for Critical COVID-19 Derived from Patients without Comorbidities Performs Well in Unselected Patients |
| title_short | A Simple Prognostic Score for Critical COVID-19 Derived from Patients without Comorbidities Performs Well in Unselected Patients |
| title_sort | simple prognostic score for critical covid 19 derived from patients without comorbidities performs well in unselected patients |
| topic | COVID-19 comorbidities prognosis vaccination critical disease |
| url | https://www.mdpi.com/2077-0383/11/7/1810 |
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