The systemic inflammatory response and clinicopathological characteristics in patients admitted to hospital with COVID-19 infection: Comparison of 2 consecutive cohorts

  1. Donogh Maguire
  2. Conor Richards
  3. Marylynne Woods
  4. Ross Dolan
  5. Jesse Wilson Veitch
  6. Wei M. J. Sim
  7. Olivia E. H. Kemmett
  8. David C. Milton
  9. Sophie L. W. Randall
  10. Ly D. Bui
  11. Nicola Goldmann
  12. Amy Brown
  13. Eilidh Gillen
  14. Allan Cameron
  15. Barry Laird
  16. Dinesh Talwar
  17. Ian M. Godber
  18. John Wadsworth
  19. Anthony Catchpole
  20. Alan Davidson
  21. Donald C. McMillan

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Abstract

In order to manage the COVID-19 systemic inflammatory response, it is important to identify clinicopathological characteristics across multiple cohorts.

Methods

The aim of the present study was to compare the 4C mortality score, other measures of the systemic inflammatory response and clinicopathological characteristics in two consecutive cohorts of patients on admission with COVID-19. Electronic patient records for 2 consecutive cohorts of patients admitted to two urban teaching hospitals with COVID-19 during two 7-week periods of the COVID-19 pandemic in Glasgow, U.K. (cohort 1: 17/3/2020–1/5/2020) and (cohort 2: 18/5/2020–6/7/2020) were examined for routine clinical, laboratory and clinical outcome data.

Results

Compared with cohort 1, cohort 2 were older (p<0.001), more likely to be female (p<0.05) and have less independent living circumstances (p<0.001). More patients in cohort 2 were PCR positive, CXR negative (both p<0.001) and had low serum albumin concentrations (p<0.001). 30-day mortality was similar between both cohorts (23% and 22%). In cohort 2, age >70 (p<0.05), male gender (p<0.05), COPD (p<0.05), cognitive impairment (p<0.05), frailty (p<0.001), delirium (p = 0.001), CRP>150mg/L (p<0.05), albumin <30 g/L (p<0.01), elevated perioperative Glasgow Prognostic Score (p<0.05), elevated neutrophil-lymphocyte ratio (p<0.001), low haematocrit (p<0.01), elevated PT (p<0.05), sodium <133 mmol/L (p<0.01) elevated urea (p<0.001), creatinine (p<0.001), glucose (p<0.05) and lactate (p<0.001) and the 4C score (p<0.001) were associated with 30-day mortality. In multivariate analysis, greater frailty (CFS>3) (OR 11.3, 95% C.I. 2.3–96.7, p<0.05), low albumin (<30g/L) (OR 2.5, 95% C.I. 1.0–6.2, p<0.05), high NLR (≥3) (OR 2.2, 95% C.I. 1.5–4.5, p<0.05) and the 4C score (OR 2.4, 95% C.I. 1.0–5.6, p<0.05) remained independently associated with 30-day mortality.

Conclusion

In addition to the 4C mortality score, frailty score and a low albumin were strongly independently associated with 30-day mortality in two consecutive cohorts of patients admitted to hospital with COVID-19.

Trial registration

clinicaltrials.gov: NCT04484545 .

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  1. Version published to 10.1371/journal.pone.0251924
  2. ScreenIT

    SciScore for 10.1101/2021.02.04.21250932: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study protocol (GN20AE307) was approved by the North West England – Preston research ethics committee (20/NW/0336) and registered with clinicaltrials.gov (NCT04484545).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04484545Active, not recruitingPrognostic Factors in Patients Admitted to an Urban Teaching…

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  3. Version published to 10.1101/2021.02.04.21250932v1 on medRxiv