Prognostic Markers in Hospitalized COVID-19 Patients: The Role of IP-10 and C-Reactive Protein

Abstract

Background: SARS-CoV-2 is responsible for COVID-19, a clinically heterogeneous disease, ranging from being completely asymptomatic to life-threating manifestations. An unmet clinical need is the identification at disease onset or during its course of reliable biomarkers allowing patients' stratification according to disease severity. In this observational prospective cohort study, patients' immunologic and laboratory signatures were analyzed to identify independent predictors of unfavorable (either death or intensive care unit admission need) or favorable (discharge and/or clinical resolution within the first 14 days of hospitalization) outcome.

Methods: Between January and May 2021 (third wave of the pandemic), we enrolled 139 consecutive SARS-CoV-2 positive patients hospitalized in Northern Italy to study their immunological and laboratory signatures. Multiplex cytokine, chemokine, and growth factor analysis, along with routine laboratory tests, were performed at baseline and after 7 days of hospital stay.

Results: According to their baseline characteristics, the majority of our patients experienced a moderate to severe illness. At multivariate analysis, the only independent predictors of disease evolution were the serum concentrations of IP-10 (at baseline) and of C-reactive protein (CRP) after 7 days of hospitalization. Receiver-operating characteristic (ROC) curve analysis confirmed that baseline IP - 10 > 4271 pg/mL and CRP > 2.3 mg/dL at 7 days predict a worsening in clinical conditions (87% sensitivity, 66% specificity, area under the curve (AUC) 0.772, p < 0.001 and 83% sensitivity, 73% specificity, AUC 0.826, p < 0.001, respectively).

Conclusions: According to our results, baseline IP-10 and CRP after 7 days of hospitalization could be useful in driving clinical decisions tailored to the expected disease trajectory in hospitalized COVID-19 patients.

Figure 1

ROC curves for IP-10 at the time of hospital admission. (a) ROC curve predicting severe disease evolution; (b) ROC curve predicting shorter hospital stay. AUC : area under the curve.

Figure 2

ROC curves for CRP after 7 days hospitalization. (a) ROC curve predicting severe disease evolution; (b) ROC curve predicting shorter hospital stay. AUC: area under the curve.

Figure 3

ROC curves for RDW-CV, platelet count, glomerular filtration rate, and neutrophil to lymphocyte ratio at the time of hospital admission. (a) RDW-CV ROC curve predicting severe disease evolution; (b) platelet count ROC curve predicting severe disease evolution; (c) glomerular filtration rate ROC curve predicting a shorter hospital stay; (d) neutrophil to lymphocyte ratio ROC curve predicting a shorter hospital stay. AUC: area under the curve.