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

Donogh Maguire, Conor Richards, Marylynne Woods, Ross Dolan, Jesse Wilson Veitch, Wei M J Sim, Olivia E H Kemmett, David C Milton, Sophie L W Randall, Ly D Bui, Nicola Goldmann, Amy Brown, Eilidh Gillen, Allan Cameron, Barry Laird, Dinesh Talwar, Ian M Godber, John Wadsworth, Anthony Catchpole, Alan Davidson, Donald C McMillan, Donogh Maguire, Conor Richards, Marylynne Woods, Ross Dolan, Jesse Wilson Veitch, Wei M J Sim, Olivia E H Kemmett, David C Milton, Sophie L W Randall, Ly D Bui, Nicola Goldmann, Amy Brown, Eilidh Gillen, Allan Cameron, Barry Laird, Dinesh Talwar, Ian M Godber, John Wadsworth, Anthony Catchpole, Alan Davidson, Donald C McMillan

Abstract

Background: 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.

Conflict of interest statement

The authors have declared that no competing interests exist.

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