Inflammatory proteins as strong predictors of death in COVID-19 patients with coexisting neurological diseases

Abstract

AbstractBackgroundAlthough many studies published so far on COVID-19 have examined its clinical prognosis, there is still no universal laboratory test that can assess the risk of a fatal outcome in patients with coexisting neurological diseases.MethodsThe plasma concentrations of C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), ferritin, interleukin 6 (IL-6), D-dimers, and highly sensitive troponin I (hsTnI) were determined in a group of 400 consecutive in-patients with COVID-19 and concomitant neurological comorbidities.ResultsThe median concentration levels of most of the inflammatory mediators/indicators, calculated for the whole group of patients, remained above the normal reference ranges, whereas the median concentrations of these substances were much higher in the sub-group of patients who died. Backward stepwise logistic regression confirmed the statistically significant predictors of death in a descending order of odds ratios as follows: LDH (3.8), ferritin (2.8), hsTnI (2.0), IL-6 (1.7), and age (1.01). A concentration of hsTnI > 64 ng/L appeared to constitute a strong predictor of an unfavorable prognosis. Patients who were treated with lopinavir and ritonavir, who required mechanical ventilation, and treatment with dexamethasone presented with significant increase in the concentrations of all the studied inflammatory proteins and increased odds ratio for death.ConclusionHigh plasma concentrations of pro-inflammatory proteins in patients suffering from COVID-19 and concomitant neurological diseases were associated with a more serious clinical course and an increased risk of death. The presence of these substances is worth monitoring as a valuable indicator of the current clinical condition of COVID-19 patients.