Oskarsdottir T, Sigurdsson MI, Palsson R, Eythorsson E. Longitudinal changes in inflammatory biomarkers among patients with COVID-19: a nationwide study in Iceland.
Acta Anaesthesiol Scand 2022;
66:969-977. [PMID:
35748857 PMCID:
PMC9350372 DOI:
10.1111/aas.14109]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 05/08/2022] [Accepted: 05/19/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES
All SARS-CoV-2-positive persons in Iceland were prospectively monitored and those who required outpatient evaluation or were admitted to hospital underwent protocolized evaluation that included a standardized panel of biomarkers. The aim was to describe longitudinal changes in inflammatory biomarkers throughout the infection period of patients with COVID-19 requiring different levels of care.
DESIGN
Registry-based study SETTING: Nationwide study in Iceland PATIENTS: All individuals who tested positive for SARS-CoV-2 by real-time polymerase chain reaction (RT-PCR) from 28 February to 31 December 2020 in Iceland and had undergone blood tests between five days prior to and 21 days following onset of symptoms.
MEASUREMENTS AND MAIN RESULTS
Data were collected from the electronic medical record system of Landspitali-The National University Hospital of Iceland. Data analyses were descriptive and the evolution of biomarkers was visualized using Locally Weighted Scatterplot Smoothing (LOWESS) curves stratified by the worst clinical outcome experienced by the patient: outpatient evaluation only, hospitalization, and either intensive care unit (ICU) admission or death. Of 571 included patients, 310 (54.3%) only required outpatient evaluation or treatment, 202 (35.4%) were hospitalized and 59 (10.3%) were either admitted to the ICU or died. An early and persistent separation of the mean lymphocyte count, plasma C-reactive protein (CRP) and ferritin levels was observed between the three outcome groups, which occurred prior to hospitalization for those who later were admitted to ICU or died. Lower lymphocyte count, and higher CRP and ferritin levels correlated with worse clinical outcomes. Patients who were either admitted to the ICU or died had sustained higher white blood cell (WBC) and neutrophil counts, and elevated plasma levels of PCT and D-dimer compared with the other groups.
CONCLUSIONS
Lymphocyte count and plasma CRP and ferritin levels might be suitable parameters to assess disease severity early during COVID-19 and may serve as predictors of worse outcome.
Collapse