• Tyler Pitre, Aaron Jones, Johnny Su, Wryan Helmeczi, Grace Xu, Catherine Lee, Adib Shamsuddin, Adhora Mir, Sarah MacGregor, MyLinh Duong, Terence Ho, Marla K Beauchamp, Andrew P Costa, Rebecca Kruisselbrink, and COREG Investigators.
• Department of Medicine, McMaster University, Hamilton, Canada. tyler.pitre@medportal.ca.
• Intern Emerg Med. 2021 Sep 1; 16 (6): 1573-1582.

AbstractInflammatory biomarkers may be associated with disease severity and increased mortality in COVID-19 patients but have not been studied in North American populations. We sought to determine whether a set of commonly ordered inflammatory biomarkers can predict 28-day mortality. We analyzed a multi-centered (four) COVID-19 registry cohort from March 4th to December 7th, 2020. This cohort included COVID-19-positive patients admitted to medical wards or intensive care units. Patients presenting to the emergency department for COVID-19 symptoms and then subsequently discharged were also included. We performed Cox-regression analysis to measure whether commonly used biomarkers were associated with an increased 28-day mortality. Of 336 COVID-19-positive patients, 267 required hospital admission, and 69 were seen in the emergency room and discharged. The median age was 63 years (IQR 80-50) and the female-to-male ratio was 49:51. Derivation of internally validated cut-offs suggested that C-reactive protein ≥ 78.4 mg/L, neutrophil-to-lymphocyte ratio ≥ 6.1, lymphocyte-to-white blood cell ratio < 0.127, and a modified Glasgow prognostic score equal to 2 vs. 1 or 0 were associated with the highest increased risk of 28-day mortality. We provide early estimates of cut-off values for inflammatory biomarkers and indices measured at the time of admission that may be useful to clinicians for predicting 28-day mortality in North American COVID-19 patients.© 2021. Società Italiana di Medicina Interna (SIMI).

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