Prognostic value of inflammatory markers in patients with COVID-19 in Indonesia

Abstract

Background & aims: Coronavirus disease 2019 (COVID-19) has a wide clinical spectrum, ranging from asymptomatic infection to severe diseases with high mortality rate. Early identification of high-risk COVID-19 patients may be beneficial to reduce morbidity and in-hospital mortality. This study aimed to investigate whether baseline levels of inflammatory markers such as C-reactive protein (CRP) and immune-cell-based inflammatory indices, neutrophil to lymphocyte ratio (NLR), derived-NLR (d-NLR), and platelet to lymphocyte ratio (PLR) at hospital admission are associated with adverse disease outcomes in COVID-19 patients.

Methods: Clinical data from 391 hospitalized COVID-19 patients in three Siloam Hospitals in Indonesia were retrospectively collected and analysed from March 20 to October 30, 2020.

Results: Fifty-four (13.8%) hospitalized patients had clinical deterioration and required ICU treatment, categorizing them as severe COVID-19 cases. Older age, presence of underlying diseases, and increased inflammatory markers values at admission were significantly associated with severe cases. After adjustment of sociodemographic and comorbidities factors, CRP, NLR, and d-NLR values, but not PLRs, were identified as independent risk factors for disease severity and death in COVID-19 patients. The area under curve (AUC) of CRP, NLR, and d-NLR were 0.854, 0.848, and 0.854, respectively. The optimal cut-off points for CRP, NLR, and d-NLR for identification of COVID-19 patients with potential worse disease outcomes were 47 mg/L, 6, and 4, respectively.

Conclusion: Initial assessment of CRP, NLR, and d-NLR values at hospital admission may be important predictors for adverse disease outcomes in COVID-19 patients.

Keywords: C-reactive protein; COVID-19; Neutrophil to lymphocyte ratio; Risk factors.

Fig. 1

Flow chart of patient inclusion.

Fig. 2

Receiver Operator Characteristic (ROC) curves of inflammatory markers for prediction of severe COVID-19. The capacity of inflammatory markers CRP, NLR, d-NLR, and PLR values at hospital admission to predict severe outcomes of COVID-19 (n = 391). CRP, C-reactive protein; NLR, neutrophil to lymphocyte ratio; d-NLR, derived neutrophil to lymphocyte ratio; PLR, platelet to lymphocyte ratio; AUC, area under the curve; CI, confidence interval.