Associations of procalcitonin, C-reaction protein and neutrophil-to-lymphocyte ratio with mortality in hospitalized COVID-19 patients in China

Abstract

Coronavirus disease 2019 (COVID-19) is an important and urgent threat to global health. Inflammation factors are important for COVID-19 mortality, and we aim to explore whether the baseline levels of procalcitonin (PCT), C-reaction protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) are associated with an increased risk of mortality in patients with COVID-19. A retrospective study was conducted and a total of 76 patients with confirmed COVID-19 were included between January 17, 2020 to March 2, 2020, of these cases, 17 patients were dead. After adjusting covariates, PCT (≥ 0.10 ng/mL) and CRP (≥ 52.14 mg/L) exhibited independent increasing risks of mortality were used hazard ratio (HR) of 52.68 (95% confidence interval [CI]: 1.77-1571.66) and 5.47 (95% CI: 1.04-28.72), respectively. However, NRL (≥ 3.59) was not found to be an independent risk factor for death in our study. Furthermore, the elevated PCT levels were still associated with increasing risk of mortality in the old age group (age ≥ 60 y), and in the critically severe and severe patients after adjustment for complications. Thu Baseline levels of PCT and CRP have been addressed as independent predictors of mortality in patients with COVID-19.

Figure 1

The violin plots of PCT, CRP and NLR levels in patients with COVID-19 in critically severe group, severe group and moderate group in China. The white dot in the violin was the median value of inflammatory factor, and the black rectangle was the percentile 25th and 75th.

Figure 2

ROC analysis of the PCT, CRP, NLR and combined effect for prediction of COVID-19 mortality. The reference line was coloured with grey; the ROC of CRP was coloured with light-green; ROC of PCT was coloured with light-purple; ROC of NLR was coloured with light-blue; and ROC of combined PCT, CRP and NLR together was coloured with light-pink.

Figure 3

Kaplan–Meier plot for probability of survival for PCT, CRP, NLR and combined effect for prediction of COVID-19 mortality. The blue lines were the patients with COVID-19 with lower levels of inflammatory factors, and the red lines were the patients with COVID-19 with higher levels of inflammatory factors.