The Prognostic Value of Eosinophil Recovery in COVID-19: A Multicentre, Retrospective Cohort Study on Patients Hospitalised in Spanish Hospitals
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Abstract
Objectives: A decrease in blood cell counts, especially lymphocytes and eosinophils, has been described in patients with serious Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), but there is no knowledge of their potential role of the recovery in these patients’ prognosis. This article aims to analyse the effect of blood cell depletion and blood cell recovery on mortality due to COVID-19. Design: This work was a retrospective, multicentre cohort study of 9644 hospitalised patients with confirmed COVID-19 from the Spanish Society of Internal Medicine’s SEMI-COVID-19 Registry. Setting: This study examined patients hospitalised in 147 hospitals throughout Spain. Participants: This work analysed 9644 patients (57.12% male) out of a cohort of 12,826 patients ≥18 years of age hospitalised with COVID-19 in Spain included in the SEMI-COVID-19 Registry as of 29 May 2020. Main outcome measures: The main outcome measure of this work is the effect of blood cell depletion and blood cell recovery on mortality due to COVID-19. Univariate analysis was performed to determine possible predictors of death, and then multivariate analysis was carried out to control for potential confounders. Results: An increase in the eosinophil count on the seventh day of hospitalisation was associated with a better prognosis, including lower mortality rates (5.2% vs. 22.6% in non-recoverers, OR 0.234; 95% CI, 0.154 to 0.354) and lower complication rates, especially regarding the development of acute respiratory distress syndrome (8% vs. 20.1%, p = 0.000) and ICU admission (5.4% vs. 10.8%, p = 0.000). Lymphocyte recovery was found to have no effect on prognosis. Treatment with inhaled or systemic glucocorticoids was not found to be a confounding factor. Conclusion: Eosinophil recovery in patients with COVID-19 who required hospitalisation had an independent prognostic value for all-cause mortality and a milder course.
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SciScore for 10.1101/2020.08.18.20172874: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Exclusion criteria are subsequent admissions of the same patient and denial or withdrawal of informed consent.
IRB: This study was carried out in accordance with the Declaration of Helsinki and was approved by the Institutional Research Ethics Committees of each participating hospital.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources We used SPSS (v. 25, IBM Corporation, 2017) for all analyses. SPSSsuggested: (SPSS, RRID:SCR_002865)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are …
SciScore for 10.1101/2020.08.18.20172874: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Exclusion criteria are subsequent admissions of the same patient and denial or withdrawal of informed consent.
IRB: This study was carried out in accordance with the Declaration of Helsinki and was approved by the Institutional Research Ethics Committees of each participating hospital.Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources We used SPSS (v. 25, IBM Corporation, 2017) for all analyses. SPSSsuggested: (SPSS, RRID:SCR_002865)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: We detected the following sentences addressing limitations in the study:However, for the same reason, all the studies based on the SEMI-COVID-19 Registry have common limitations. As only inpatients were included, it is not possible to extrapolate our results to outpatients. Information bias could be introduced by either the large number of researchers involved or variability in the availability of data from each hospital. Finally, selection bias could be introduced given the voluntary participation of each centre. Our study was designed to control for possible confounding factors for abnormal eosinophil values, but some of them could not be controlled for due to the nature of the data available in the registry. Transfusion of blood products was not recorded and thus this information is not available for study. The influence of the stress response and hormonal treatment were also not recorded, but should be taken into account when assessing haematological parameters. Bacterial coinfection during or superinfection after contracting SARS - CoV-2 could have led to different immune responses. Neither thorough cytokine profiles nor lymphocyte subset panels were obtained, as this registry reflects usual clinical practice and not basic research, so inflammatory pathways were not studied. Further research is needed to overcome these limitations. In conclusion, eosinophil recovery at the seventh day of hospitalisation is a predictor of a good prognosis in COVID-19 and warrants further research.
Results from TrialIdentifier: No clinical trial numbers were referenced.
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 rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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