Clusters of inflammation in COVID-19: descriptive analysis and prognosis on more than 15,000 patients from the Spanish SEMI-COVID-19 Registry

被引：5

作者：

Rubio-Rivas, Manuel ^{[1
]}

Maria Mora-Lujan, Jose ^{[1
]}

Formiga, Francesc ^{[1
]}

Corrales Gonzalez, Miguel Angel ^{[2
]}

Garcia Andreu, Maria del Mar ^{[3
]}

Moreno-Torres, Victor ^{[4
]}

Garcia Garcia, Gema Maria ^{[5
]}

Alcala Pedrajas, Jose N. ^{[6
]}

Boixeda, Ramon ^{[7
]}

Perez-Lluna, Leticia ^{[8
]}

Cortes-Rodriguez, Begona ^{[9
]}

Mella-Perez, Carmen ^{[10
]}

Navas Alcantara, Maria de la Sierra ^{[11
]}

Lopez Reboiro, Manuel Lorenzo ^{[12
]}

Alfaro-Lara, Veronica ^{[13
]}

Perez-Martin, Santiago ^{[14
]}

Angel Martin-Oterino, Jose ^{[15
]}

Gracia Gutierrez, Anyuli ^{[16
]}

Martin-Urda Diez-Canseco, Anabel ^{[17
]}

Comas Casanova, Pere ^{[18
]}

Perez Garcia, Cristina ^{[19
]}

Varona, Jose F. ^{[20
,21
]}

Gomez-Huelgas, Ricardo ^{[22
,23
]}

Anton-Santos, Juan-Miguel ^{[24
]}

Lumbreras-Bermejo, Carlos ^{[25
]}

机构：

[1] Univ Barcelona, Bellvitge Univ Hosp, Bellvitge Biomed Res Inst IDIBELL, Dept Internal Med, Barcelona 08907, Spain

[2] Costa del Sol Hosp, Dept Internal Med, Malaga, Spain

[3] Royo Villanova Hosp, Dept Internal Med, Zaragoza, Spain

[4] Puerta de Hierro Univ Hosp, Dept Internal Med, Madrid, Spain

[5] Badajoz Univ Hosp, Dept Internal Med, Badajoz, Spain

[6] Pozoblanco Hosp, Dept Internal Med, Cordoba, Spain

[7] Mataro Hosp, Dept Internal Med, Barcelona, Spain

[8] Sagunto Hosp, Dept Internal Med, Valencia, Spain

[9] Alto Guadalquivir Hosp, Dept Internal Med, Jaen, Spain

[10] Ferrol Clin Univ Hosp, Dept Internal Med, La Coruna, Spain

[11] Infanta Margarita Hosp, Dept Internal Med, Cordoba, Spain

[12] Monforte de Lemos Hosp, Dept Internal Med, Lugo, Spain

[13] Virgen del Rocio Univ Hosp, Dept Internal Med, Seville, Spain

[14] Marina Baixa Hosp, Dept Internal Med, Alicante, Spain

[15] Salamanca Univ Hosp, Dept Internal Med, Salamanca, Spain

[16] Def Gen Hosp, Dept Internal Med, Zaragoza, Spain

[17] Palamos Hosp, Dept Internal Med, Palamos, Girona, Spain

[18] Blanes Hosp, Dept Internal Med, Blanes, Spain

[19] Do Salnes Hosp, Dept Internal Med, Vilagarcia De Arousa, Pontevedra, Spain

[20] HM Monteprincipe Univ Hosp, Dept Internal Med, Madrid, Spain

[21] San Pablo Univ CEU, Sch Med, Madrid, Spain

[22] Univ Malaga UMA, Biomed Res Inst Malaga IBIMA, Malaga Reg Univ Hosp, Dept Internal Med, Malaga, Spain

[23] ISCIII, CIBER Obesidad & Nutr CIBERobn, Madrid, Spain

[24] Infanta Cristina Univ Hosp, Dept Internal Med, Madrid, Spain

[25] 12 Octubre Univ Hosp, Dept Internal Med, Madrid, Spain

来源：

INTERNAL AND EMERGENCY MEDICINE | 2022年 / 17卷 / 04期

关键词：

Coronavirus; COVID-19; Cluster analysis; Inflammation; Prognosis; Mortality; TOCILIZUMAB; MORTALITY; EFFICACY; SAFETY; IMPACT;

D O I：

10.1007/s11739-021-02924-4

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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.

引用

页码：1115 / 1127

页数：13

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