Acute Inflammatory Mediators in Young Adult Patients with COVID-19 in Mexico

Abstract

Young adults (18-40 years old) are an active population with high risk of infection and transmission of COVID-19. They are considered a low-risk population due to its low 1.0% case fatality rate (CFR). Despite their high clinical usefulness to prevent fatal cases, inflammatory and coagulation biomarkers studies are limited. For this reason, we performed a retrospective cohort study with COVID-19 patients in Hermosillo, Mexico, to assess inflammation, coagulopathy profile, and severity outcomes in young adults. We analyzed blood samples to determine the neutrophil/lymphocyte ratio (NLR), neutrophil/monocyte ratio (NMR), lymphocyte/monocyte ratio (LMR), platelet/lymphocyte ratio (PLR), and C-reactive protein (C-RP). We included epidemiological features and comorbidities, and compared them to the severity status. Only 359 COVID-19-confirmed young adults were included in the ambulatory (44.8%), hospitalized (42.9%), and death (12%) severity groups. Laboratory results showed an increase in NMR, LMR, and C-RP associated with the aggravated patients. Additionally, obesity, arterial hypertension, and type-2 diabetes mellitus (T2DM) were associated with the COVID-19 severity outcome. We found that 9.1% and 30.3% of young adults presented the novel COVID-19-associated coagulopathy (CAC) and the risk of CAC, respectively. These parameters can be considered independent biomarkers reflecting an enhanced inflammatory process related to the COVID-19 prognosis.

Keywords: COVID-19; coagulopathy; hematological profiles; young adults.

Figure 1

Suspected COVID-19 cases in Hermosillo, Sonora from March 2020 to March 2021. (A) Age distribution of all suspected COVID-19 cases. (B) RT-PCR or antigen test results of young adult patients.

Figure 2

Dynamic analysis of leukocytes during the first four weeks after the onset of symptoms (n = 267). Leukocyte reference value: 4.6–10.2 × 10⁹/L [17]. The dotted line indicates a reference value.

Figure 3

Ratio of biomarkers of leukocyte cellular lines of the ambulatory, hospitalized, and death patient groups. (A) Neutrophil/monocyte ratio (NMR) (n = 169; reference value: 7.2) [18]. (B) Lymphocyte/monocyte ratio (LMR) (n = 171; reference value: 3) [19,20]. (C) Neutrophil/lymphocyte ratio (NLR) (n = 173; reference value: 4.5) [19,20]. (D) Platelet/lymphocyte ratio (PLR) (n = 172; reference value: 120) [19,20]. (E) Eosinophil/lymphocyte ratio (ELR) (n = 174; reference value: 0.2) [21]. The dotted line indicates the reference value for each parameter. Statistical analysis was performed using one-way ANOVA and Kruskal–Wallis test: ** p < 0.01; *** p < 0.001.

Figure 4

Acute inflammatory and coagulation biomarker analysis of the ambulatory hospitalized and death groups. (A) D-dimer (n = 112; reference value: 500 ng/dL) [17]. (B) Fibrinogen (n = 83; reference value: 471 mg/dL) [17]. (C) C-reactive protein C-RP (n = 119; reference value: 10 mg/L) [17]. (D) CPK (n = 64; reference value: 294 ng/dL) [17]. (E) CPK-MB (n = 55; reference value: 25 ng/dL) [17]. (F) LDH (n = 133; reference value: 333 UI/L) [17]. Dotted line indicates reference value for each parameter. One-way ANOVA and Kruskal–Wallis test: ** p < 0.01; *** p < 0.001.