Evolution of Modeled Cortisol Is Prognostic of Death in Hospitalized Patients With COVID-19 Syndrome

Kamyar M Hedayat, David Chalvet, Maël Yang, Shahrokh Golshan, Caroline Allix-Beguec, Serge Beneteaud, Thomas Schmit, Kamyar M Hedayat, David Chalvet, Maël Yang, Shahrokh Golshan, Caroline Allix-Beguec, Serge Beneteaud, Thomas Schmit

Abstract

Introduction: Patients hospitalized with SARS-CoV-2 have an elevated risk of mortality related to a severe inflammatory response. We hypothesized that biological modeling with a complete blood count (CBC) would be predictive of mortality.

Method: In 2020, 81 patients were randomly selected from La Rochelle Hospital, France for a simple blinded retrospective study. Demographic, vital signs, CBC and CRP were obtained on admission, at days 2-3 and 3-5. From a CBC, two biological modeling indexes were resulted: the neutrophil-to-lymphocyte ratio (NLR) and cortisol index adjusted (CA).

Results: By ANOVA, in survivors vs. non-survivors there was statistical different at p < 0.01 for age (66.2 vs. 80), CRP (92 vs. 179 mg/dL, normal < 10), cortisol index adjusted (323 vs. 698, normal 3-7) and genito-thyroid indexes (7.5 vs. 18.2, normal 1.5-2.5), and at p = 0.02 creatinine (1.03 vs. 1.48, normal 0.73-1.8 mg/dL). By mixed model analysis, CA and NLR improved in those who survived across all three time points, but worsened again after 3-5 days in non-survivors. CRP continued to improve over time in survivors and non-survivors. Positive vs. Negative predictive value were: CRP (91.1%, 30.4%), NLR (94.5%, 22.7%), CA (100%, 0%).

Discussion: Cortisol modeling and the neutrophil-to-lymphocyte ratio were more accurate in describing the course of non-survivors than CRP.

Conclusion: In patients admitted for SARS CoV-2 infection, biological modeling with a CBC predicted risk of death better than CRP. This approach is inexpensive and easily repeated.

Keywords: C-reactive protein; COVID-19; biological; cortisol index; critical care outcomes; models; neutrophil/lymphocyte ratio (NLR).

Conflict of interest statement

KMH is a shareholder in SBRG and Numa Health. DC, TS, and MY are shareholders in Numa Health. KMH serves as a paid advisor to Numa Health. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Hedayat, Chalvet, Yang, Golshan, Allix-Beguec, Beneteaud and Schmit.

Figures

FIGURE 1
FIGURE 1
Patient selection and longitudinal monitoring process.
FIGURE 2
FIGURE 2
Mixed model analysis of C-reactive protein (mg/dL), time of blood draw, and survival.
FIGURE 3
FIGURE 3
Mixed model analysis of genito-thyroid index (Neutrophil-to-Lymphocyte ratio, no units), time of blood draw, and survival.
FIGURE 4
FIGURE 4
Mixed model analysis of Cortisol index adjusted (no units), time of blood draw, and survival.

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Source: PubMed

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