Résumé
Resumen Introducción: El COVID-19 genera respuestas inflamatorias graves que pueden terminar en la muerte. En pandemia resulta fundamental tener instrumentos de fácil acceso que estimen su evolu ción. El índice linfocito proteína C reactiva (LPCR) es un marcador pronóstico estudiado en patología oncológica que podría mostrar ventajas en la etapa precoz de la enfermedad por COVID-19. Objetivo: estimar los niveles de LPCR < 100 y su riesgo de mortalidad en pacientes internados con COVID-19. Métodos: Se incluyeron pacientes con COVID 19 que ingresaron a la sala de internación general desde marzo hasta octubre de 2020. Se realizó un modelo de regresión de Cox para estimar la relación entre el LPCR < 100 y mortalidad. Resulta dos: Se incluyeron 730 pacientes. La edad media de presentación fue 49.9 años (DE 16.8) y 401 (55%) fueron hombres. La mediana de días de internación fue 8 (RIC 6). El modelo de regresión de Cox evidenció asociación entre LPCR <100 y mortalidad (HR 6.2; IC95% 1.6 a 23.5; p 0.008) ajustado por edad, neumonía grave, pases a terapia intensiva, hipertensión arterial, y comorbilidades. Discusión: El LPCR <100 en la evaluación inicial de los pacientes que se internan con COVID-19 podría sugerir mayor riesgo de mortalidad.
Abstract Background: COVID-19 develops severe inflammatory responses that can lead to death. It is es sential in a pandemic to have accessible instruments to estimate the prognosis of the disease. The lymphocyte-to- C-reactive protein ratio (LCR) is a predictive biomarker studied in oncology, which could have some advantages in COVID-19 patients in the early stages of the disease. Our objective was to estimate the risk of LCR < 100 and mortality in hospitalized patients with COVID-19. Methods: hospitalized patients with COVID-19 seen between March to October 2020 were included. The patients were grouped according to LCR < 100 and LCR > 100. A Cox regression model was performed to estimate the association between LCR < 100 and mortality. Results: we included 730 patients with COVID-19. The mean age at diagnosis was 49.9 years (SD 16.8) and 401 (55%) were men. Cox regression model showed an association between LCR <100 and mortality (HR 6.2; 95% CI 1.6 to 23.5; p 0.008), adjusting by age. severe pneumonia, intensive care requirements, and comorbidities. Conclusion: LPCR <100 in the initial assessment of hospitalized patients with COVID-19 suggests a higher risk of mortality.
Résumé
ABSTRACT Background: Severe pneumonia is the most common cause of intensive care unit (ICU) admission and death due to novel coronavirus (SARS-CoV-2) respiratory disease (COVID-19). Due to its rapid outbreak, units for the evaluation of febrile patients in the pre-hospital setting were created. Objective: The objective of the study was to develop a sensitive and simple tool to assess the risk of pneumonia in COVID-19 patients and thus select which patients would require a chest imaging study. Materials and Methods: We conducted a cross-sectional study in a cohort of individuals with suspected COVID-19 evaluated in a public academic healthcare center in Buenos Aires city. All adult patients with positive RT-PCR assay for SARS-COV2 between April 24 and May 19 of 2020 were included in the study. Pneumonia was defined as the presence of compatible signs and symptoms with imaging confirmation. Univariate and multivariate logistic regression was performed. A risk indicator score was developed. Results: One hundred and forty-eight patients were included, 71 (48%) received the diagnosis of pneumonia. The final clinical model included four variables: age ≥ 40 years, cough, absence of sore throat, and respiratory rate ≥ 22. To create the score, we assigned values to the variables according to their ORs: 2 points for respiratory rate ≥ 22 and 1 point to the other variables. The AUC of the ROC curve was 0.80 (CI 95% 0.73-0.86). A cutoff value of 2 showed a sensitivity of 95.7% and a specificity of 43.24%. Conclusion: This sensible score may improve the risk stratification of COVID-19 patients in the pre-hospital setting. (REV INVEST CLIN. 2021;73(1):52-8)