What determinants make a person with Covid-19 need high-flow nasal assistance, mechanical ventilation, admission to the ICU and have a greater chance of dying.
An investigation based on data from the SEMI-COVID-19 Registry of the Spanish Society of Internal Medicine (SEMI) determines that three different levels of risk can be established (low, medium and high) in Covid-19 based on different inflammatory parameters at the time of hospital admission of the patient due to SARS-CoV-2 infection.
The risk categories, as detailed in the study published in the “Journal of Clinical Medicine”, have been determined taking into account the lymphocyte count and C-reactive protein, lactate dehydrogenase, ferritin, and D-dimer values taken at the time of hospital admission of the patients.
Thus, for example, the low-risk category was defined when all the parameters were in the first tertile, the high-risk category when some of the parameters were in the third tertile, and the intermediate risk category when the conditions were not met. low or high risk.
«We believe that its early identification and appropriate clinical management based on this strategy of risk stratification can be crucial to improve the prognosis of patients with Covid-19 who require hospitalization, “they write in their work, which has analyzed a total of 17,122 patients with confirmed Covid-19 infection.
For Manuel Rubio-Rivas, the first author of the article and who led the research from the Autoimmune Diseases Unit of Internal Medicine of the Bellvitge University Hospital, «the usefulness of this risk stratification strategy lies in that it is not only prognostic, but also it can serve as a generator of hypotheses about which drug regimen may be better based on the degree of inflammatory response. ‘
This same idea argues Xavier Corbella, from the Hospital de Bellvitge, who adds that “the early identification and appropriate clinical management of the inflammatory state based on this strategy of risk stratification is crucial to improve the prognosis of patients with Covid-19 who require hospitalization”.
As the researchers recall, since the beginning of the pandemic, “inflammation has been synonymous with clinical complications during admission and, ultimately, has increased the likelihood of death.”
This study “not only confirms this observation, but also defines three clearly differentiated prognostic groups, both in terms of resource use (need for a high-flow nasal cannula, non-invasive mechanical ventilation or invasive mechanical ventilation) and in terms of admission to the ICU or in-hospital death ”.
Rubio-Rivas emphasizes that since analytic inflammation findings precede respiratory deterioration, “basing the therapeutic strategy on the patient’s respiratory status is an error.” In his opinion, “we must take advantage of the analytical information that we have a few days before this deterioration, which translates into an increase in mortality.”
This expert recalls that there are many patients admitted with inflammatory analytical criteria that translate into a mortality of up to 20% and are not under any immunosuppressive / anti-inflammatory treatment because their respiratory status is still correct. “You have to go ahead of the disease and not behind.”
The high-risk category presents sociodemographic and comorbidity characteristics already recognized as poor prognostic factors.
To date, there is no definitive answer as to why elderly patients, especially men and those with certain comorbidities, become more inflamed, but what is clear, the researchers reiterate, is that “the inflammatory response of these patients is certainly older.
According to these results, the researchers consider that they carefully review the need to keep patients in the low-risk category. In his opinion, close outpatient follow-up would be more appropriate for these patients.
And he adds, “we believe that it is essential to detect patients who belong to the high-risk category from the beginning and to take more intensive therapeutic management measures.”
The results obtained show that “it is not only important whether or not the patients belong to the high-risk category”, but also how many high-risk parameters are met. In this regard, “it is not yet clear whether any of the parameters analyzed is more important than the others.”
Patients in the high-risk group were older and predominantly male. They had a higher degree of dependence on daily tasks before admission, high blood pressure, dyslipidemia, diabetes, heart problems, chronic kidney failure, cancer and EPOC.