Basic host response parameters to classify mortality risk in COVID-19 and community-acquired pneumonia

Author:

Menéndez Rosario,Méndez Raúl,González-Jiménez Paula,Latorre Ana,Reyes Soledad,Zalacain Rafael,Ruiz Luis A.,Serrano Leyre,España Pedro P.,Uranga Ane,Cillóniz Catia,Gaetano-Gil Andrea,Fernández-Félix Borja M.,Pérez-de-Llano Luis,Golpe Rafael,Torres Antoni

Abstract

AbstractImproved phenotyping in pneumonia is necessary to strengthen risk assessment. Via a feasible and multidimensional approach with basic parameters, we aimed to evaluate the effect of host response at admission on severity stratification in COVID-19 and community-acquired pneumonia (CAP). Three COVID-19 and one CAP multicenter cohorts including hospitalized patients were recruited. Three easily available variables reflecting different pathophysiologic mechanisms—immune, inflammation, and respiratory—were selected (absolute lymphocyte count [ALC], C-reactive protein [CRP] and, SpO2/FiO2). In-hospital mortality and intensive care unit (ICU) admission were analyzed as outcomes. A multivariable, penalized maximum likelihood logistic regression was performed with ALC (< 724 lymphocytes/mm3), CRP (> 60 mg/L), and, SpO2/FiO2 (< 450). A total of 1452, 1222 and 462 patients were included in the three COVID-19 and 1292 in the CAP cohort for the analysis. Mortality ranged between 4 and 32% (0 to 3 abnormal biomarkers) and 0–9% in SARS-CoV-2 pneumonia and CAP, respectively. In the first COVID-19 cohort, adjusted for age and sex, we observed an increased odds ratio for in-hospital mortality in COVID-19 with elevated biomarkers altered (OR 1.8, 3, and 6.3 with 1, 2, and 3 abnormal biomarkers, respectively). The model had an AUROC of 0.83. Comparable findings were found for ICU admission, with an AUROC of 0.76. These results were confirmed in the other COVID-19 cohorts Similar OR trends were reported in the CAP cohort; however, results were not statistically significant. Assessing the host response via accessible biomarkers is a simple and rapidly applicable approach for pneumonia.

Funder

Instituto de Salud Carlos III

Sociedad Española de Neumología y Cirugía Torácica

Health Research Institute La Fe

Publisher

Springer Science and Business Media LLC

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