[Lymphocyte-to-C-reactive protein ratio in COVID-19: an unexplored tool]. / índice linfocito proteína C reactiva en COVID-19: una herramienta poco explorada.

BACKGROUND: COVID-19 develops severe inflammatory responses that can lead to death. It is essential 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.

Introducción: El COVID-19 genera respuestas inflamatorias graves que pueden terminar en la muerte. En pandemia resulta fundamental tener instrumentos de f ácil acceso que estimen su evolución. 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. Resultados: 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.

Índice linfocito proteína c reactiva en COVID-19: una herramienta poco explorada / Lymphocyte-to-C-reactive protein ratio in COVID-19: an unexplored tool

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.

Analysis of Oxygen Blood Saturation/Respiratory Rate Index, NEWS2, CURB65, and quick Sequential Organ Failure Assessment Scores to Assess Prognosis in Patients with Mild Coronavirus Disease 2019.

BACKGROUND: Hospital bed saturation has been one of the problems to solve during the SARS-CoV-2 pandemic. However, not every patient who is admitted requires close monitoring or specific therapeutics. Mild cases could be managed in the outpatient setting. OBJECTIVE: Our study aimed to analyze the accuracy of the oxygen saturation/respiratory rate (sat/RR) index, NEWS2, CURB65, and quick Sequential Organ Failure Assessment (qSOFA) scores to predict supplemental oxygen requirement and prolonged hospital stay in patients with mild coronavirus disease 2019 (COVID-19). METHODS: A prospective cohort study in an academic medical center. We compared the values of these scores according to the occurrence or not of each outcome. When differences between groups were statistically significant, the discriminatory capacity of the score for that outcome was analyzed. RESULTS: We included 271 patients. Of them, 11.07% required supplemental oxygen, showing significantly higher values of NEWS2 score and qSOFA score, and lower values of Sat/RR index. About 38% presented prolonged hospital stay, with significantly higher values of NEWS2 score and lower values of sat/RR index. The ROC curve area under the curve (AUC) of sat/RR index to discriminate the requirement of supplemental oxygen was 0.72 (CI 95% 0.61-0.84). The ROC curve of NEWS2 and qSOFA for the same outcome was 0.75 (95% [95% CI 0.65-0.85]) and 0.66 (95% CI 0.57-0.76), respectively. The ability of the Sat/RR index to discriminate the requirement of prolonged hospitalization showed an AUC of 0.67 (95% [95% CI 0.60- 0.73]). The NEWS2 score showed an AUC of 0.63 (CI 95% 0.56-0.70) for the same outcome. CONCLUSIONS: sat/RR index and NEWS2 score have a good capacity to discriminate patients at risk of clinical worsening, being the Sat/RR index simpler and easier to calculate.