Markers associated with an unfavourable outcome in SARS-CoV-2 infection: Insights from a Romanian military hospital

Abstract

Background and objectives. The use of affordable and simple tools to identify patients with severe forms of COVID-19 is imperative worldwide. The aim of the present study was to identify factors associated with the unfavourable progression of SARS-CoV-2 infection in the Military Emergency Clinical Hospital “Dr. Victor Popescu”, Romania. Materials and methods. Data from 166 patients admitted with a positive SARS-CoV-2 reverse transcription-quantitative PCR test were retrospectively collected. The presence of lung changes on chest X-ray scans was the criterion used to divide the subjects into two groups: patients with no radiological findings (group 1; n=45) and patients with radiological features of pneumonia (group 2; n=121). Results. The mean age (P<0.0001) and body mass index (P=0.0109) were significantly higher in group 2 compared with group 1. Ageusia and headache, as clinical manifestations of COVID-19, were significantly prevalent (P=0.005 and P=0.007, respectively) in group 2; in the same group, cardiovascular risk factors and established cardiovascular disease were highly prevalent. In SARS-CoV-2 patients with radiological lung changes, correlations were identified between neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (P<0.001; CI 95%, 0.137-0.471) and fibrinogen (P=0.009; CI 95%, 0.054-0.406), respectively. Only the platelet-to-lymphocyte ratio (PLR) was identified as a marker of X-ray changes (P=0.029). Within group 2, and for patients with unfavourable disease progression, the NLR were significantly correlated with intensive care unit admission (P<0.0001) and were highly correlated with mortality (P=0.001). Increased lactate dehydrogenase (LDH) values had the same tendency.