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Clusters of inflammation in COVID-19: descriptive analysis and prognosis on more than 15,000 patients from the Spanish SEMI-COVID-19 Registry.
Rubio-Rivas, Manuel; Mora-Luján, José María; Formiga, Francesc; Corrales González, Miguel Ángel; García Andreu, María Del Mar; Moreno-Torres, Víctor; García García, Gema María; Alcalá Pedrajas, José N; Boixeda, Ramon; Pérez-Lluna, Leticia; Cortés-Rodríguez, Begoña; Mella-Pérez, Carmen; Navas Alcántara, María de la Sierra; López Reboiro, Manuel Lorenzo; Alfaro-Lara, Verónica; Pérez-Martín, Santiago; Martín-Oterino, José Ángel; Gracia Gutiérrez, Anyuli; Martín-Urda Díez-Canseco, Anabel; Comas Casanova, Pere; Pérez García, Cristina; Varona, José F; Gómez-Huelgas, Ricardo; Antón-Santos, Juan-Miguel; Lumbreras-Bermejo, Carlos.
  • Rubio-Rivas M; Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, 08907, Barcelona, Spain. mrubio@bellvitgehospital.cat.
  • Mora-Luján JM; Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
  • Formiga F; Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
  • Corrales González MÁ; Department of Internal Medicine, Costa del Sol Hospital. Marbella, Málaga, Spain.
  • García Andreu MDM; Department of Internal Medicine, Royo Villanova Hospital, Zaragoza, Spain.
  • Moreno-Torres V; Department of Internal Medicine, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain.
  • García García GM; Department of Internal Medicine, Badajoz University Hospital, Badajoz, Spain.
  • Alcalá Pedrajas JN; Department of Internal Medicine, Pozoblanco Hospital. Pozoblanco, Córdoba, Spain.
  • Boixeda R; Department of Internal Medicine, Mataró Hospital, Barcelona, Spain.
  • Pérez-Lluna L; Department of Internal Medicine, Sagunto Hospital. Sagunto, Valencia, Spain.
  • Cortés-Rodríguez B; Department of Internal Medicine, Alto Guadalquivir Hospital. Andújar, Jaén, Spain.
  • Mella-Pérez C; Department of Internal Medicine, Ferrol Clinical University Hospital, El Ferrol, La Coruña, Spain.
  • Navas Alcántara MS; Department of Internal Medicine, Infanta Margarita Hospital. Cabra, Córdoba, Spain.
  • López Reboiro ML; Department of Internal Medicine, Monforte de Lemos Hospital, Monforte de Lemos, Lugo, Spain.
  • Alfaro-Lara V; Department of Internal Medicine, Vírgen del Rocío University Hospital, Sevilla, Spain.
  • Pérez-Martín S; Department of Internal Medicine, Marina Baixa Hospital, Villajoyosa, Alicante, Spain.
  • Martín-Oterino JÁ; Department of Internal Medicine, Salamanca University Hospital, Salamanca, Spain.
  • Gracia Gutiérrez A; Department of Internal Medicine, Defense General Hospital, Zaragoza, Spain.
  • Martín-Urda Díez-Canseco A; Department of Internal Medicine, Palamós Hospital. Palamós, Girona, Spain.
  • Comas Casanova P; Department of Internal Medicine, Blanes Hospital, Blanes, Spain.
  • Pérez García C; Department of Internal Medicine, Do Salnes Hospital, Vilagarcía de Arousa, Pontevedra, Spain.
  • Varona JF; Department of Internal Medicine, HM Montepríncipe University Hospital, Madrid, Spain.
  • Gómez-Huelgas R; School of Medicine, San Pablo University-CEU, Madrid, Spain.
  • Antón-Santos JM; Department of Internal Medicine, Málaga Regional University Hospital, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Málaga, Spain.
  • Lumbreras-Bermejo C; CIBER Obesidad Y Nutricion (CIBERobn), ISCIII, Madrid, Spain.
Intern Emerg Med ; 17(4): 1115-1127, 2022 06.
Article in English | MEDLINE | ID: covidwho-1787874
ABSTRACT
Uncontrolled inflammation following COVID-19 infection is an important characteristic of the most seriously ill patients. The present study aims to describe the clusters of inflammation in COVID-19 and to analyze their prognostic role. This is a retrospective observational study including 15,691 patients with a high degree of inflammation. They were included in the Spanish SEMI-COVID-19 registry from March 1, 2020 to May 1, 2021. The primary outcome was in-hospital mortality. Hierarchical cluster analysis identified 7 clusters. C1 is characterized by lymphopenia, C2 by elevated ferritin, and C3 by elevated LDH. C4 is characterized by lymphopenia plus elevated CRP and LDH and frequently also ferritin. C5 is defined by elevated CRP, and C6 by elevated ferritin and D-dimer, and frequently also elevated CRP and LDH. Finally, C7 is characterized by an elevated D-dimer. The clusters with the highest in-hospital mortality were C4, C6, and C7 (17.4% vs. 18% vs. 15.6% vs. 36.8% vs. 17.5% vs. 39.3% vs. 26.4%). Inflammation clusters were found as independent factors for in-hospital mortality. In detail and, having cluster C1 as reference, the model revealed a worse prognosis for all other clusters C2 (OR = 1.30, p = 0.001), C3 (OR = 1.14, p = 0.178), C4 (OR = 2.28, p < 0.001), C5 (OR = 1.07, p = 0.479), C6 (OR = 2.29, p < 0.001), and C7 (OR = 1.28, p = 0.001). We identified 7 groups based on the presence of lymphopenia, elevated CRP, LDH, ferritin, and D-dimer at the time of hospital admission for COVID-19. Clusters C4 (lymphopenia + LDH + CRP), C6 (ferritin + D-dimer), and C7 (D-dimer) had the worst prognosis in terms of in-hospital mortality.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Lymphopenia Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans Language: English Journal: Intern Emerg Med Journal subject: Emergency Medicine / Internal Medicine Year: 2022 Document Type: Article Affiliation country: S11739-021-02924-4

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Lymphopenia Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans Language: English Journal: Intern Emerg Med Journal subject: Emergency Medicine / Internal Medicine Year: 2022 Document Type: Article Affiliation country: S11739-021-02924-4