Cargando…
COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study
BACKGROUND: A subset of patients with severe COVID-19 develop a hyperinflammatory syndrome, which might contribute to morbidity and mortality. This study explores a specific phenotype of COVID-19-associated hyperinflammation (COV-HI), and its associations with escalation of respiratory support and s...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier Ltd.
2020
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442426/ https://www.ncbi.nlm.nih.gov/pubmed/32864628 http://dx.doi.org/10.1016/S2665-9913(20)30275-7 |
_version_ | 1783573451160682496 |
---|---|
author | Manson, Jessica J Crooks, Colin Naja, Meena Ledlie, Amanda Goulden, Bethan Liddle, Trevor Khan, Emon Mehta, Puja Martin-Gutierrez, Lucia Waddington, Kirsty E Robinson, George A Ribeiro Santos, Liliana McLoughlin, Eve Snell, Antonia Adeney, Christopher Schim van der Loeff, Ina Baker, Kenneth F Duncan, Christopher J A Hanrath, Aidan T Lendrem, B Clare De Soyza, Anthony Peng, Junjie J'Bari, Hajar Greenwood, Mandy Hawkins, Ellie Peckham, Hannah Marks, Michael Rampling, Tommy Luintel, Akish Williams, Bryan Brown, Michael Singer, Mervyn West, Joe Jury, Elizabeth C Collin, Matthew Tattersall, Rachel S |
author_facet | Manson, Jessica J Crooks, Colin Naja, Meena Ledlie, Amanda Goulden, Bethan Liddle, Trevor Khan, Emon Mehta, Puja Martin-Gutierrez, Lucia Waddington, Kirsty E Robinson, George A Ribeiro Santos, Liliana McLoughlin, Eve Snell, Antonia Adeney, Christopher Schim van der Loeff, Ina Baker, Kenneth F Duncan, Christopher J A Hanrath, Aidan T Lendrem, B Clare De Soyza, Anthony Peng, Junjie J'Bari, Hajar Greenwood, Mandy Hawkins, Ellie Peckham, Hannah Marks, Michael Rampling, Tommy Luintel, Akish Williams, Bryan Brown, Michael Singer, Mervyn West, Joe Jury, Elizabeth C Collin, Matthew Tattersall, Rachel S |
author_sort | Manson, Jessica J |
collection | PubMed |
description | BACKGROUND: A subset of patients with severe COVID-19 develop a hyperinflammatory syndrome, which might contribute to morbidity and mortality. This study explores a specific phenotype of COVID-19-associated hyperinflammation (COV-HI), and its associations with escalation of respiratory support and survival. METHODS: In this retrospective cohort study, we enrolled consecutive inpatients (aged ≥18 years) admitted to University College London Hospitals and Newcastle upon Tyne Hospitals in the UK with PCR-confirmed COVID-19 during the first wave of community-acquired infection. Demographic data, laboratory tests, and clinical status were recorded from the day of admission until death or discharge, with a minimum follow-up time of 28 days. We defined COV-HI as a C-reactive protein concentration greater than 150 mg/L or doubling within 24 h from greater than 50 mg/L, or a ferritin concentration greater than 1500 μg/L. Respiratory support was categorised as oxygen only, non-invasive ventilation, and intubation. Initial and repeated measures of hyperinflammation were evaluated in relation to the next-day risk of death or need for escalation of respiratory support (as a combined endpoint), using a multi-level logistic regression model. FINDINGS: We included 269 patients admitted to one of the study hospitals between March 1 and March 31, 2020, among whom 178 (66%) were eligible for escalation of respiratory support and 91 (34%) patients were not eligible. Of the whole cohort, 90 (33%) patients met the COV-HI criteria at admission. Despite having a younger median age and lower median Charlson Comorbidity Index scores, a higher proportion of patients with COV-HI on admission died during follow-up (36 [40%] of 90 patients) compared with the patients without COV-HI on admission (46 [26%] of 179). Among the 178 patients who were eligible for full respiratory support, 65 (37%) met the definition for COV-HI at admission, and 67 (74%) of the 90 patients whose respiratory care was escalated met the criteria by the day of escalation. Meeting the COV-HI criteria was significantly associated with the risk of next-day escalation of respiratory support or death (hazard ratio 2·24 [95% CI 1·62–2·87]) after adjustment for age, sex, and comorbidity. INTERPRETATION: Associations between elevated inflammatory markers, escalation of respiratory support, and survival in people with COVID-19 indicate the existence of a high-risk inflammatory phenotype. COV-HI might be useful to stratify patient groups in trial design. FUNDING: None. |
format | Online Article Text |
id | pubmed-7442426 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Elsevier Ltd. |
record_format | MEDLINE/PubMed |
spelling | pubmed-74424262020-08-24 COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study Manson, Jessica J Crooks, Colin Naja, Meena Ledlie, Amanda Goulden, Bethan Liddle, Trevor Khan, Emon Mehta, Puja Martin-Gutierrez, Lucia Waddington, Kirsty E Robinson, George A Ribeiro Santos, Liliana McLoughlin, Eve Snell, Antonia Adeney, Christopher Schim van der Loeff, Ina Baker, Kenneth F Duncan, Christopher J A Hanrath, Aidan T Lendrem, B Clare De Soyza, Anthony Peng, Junjie J'Bari, Hajar Greenwood, Mandy Hawkins, Ellie Peckham, Hannah Marks, Michael Rampling, Tommy Luintel, Akish Williams, Bryan Brown, Michael Singer, Mervyn West, Joe Jury, Elizabeth C Collin, Matthew Tattersall, Rachel S Lancet Rheumatol Articles BACKGROUND: A subset of patients with severe COVID-19 develop a hyperinflammatory syndrome, which might contribute to morbidity and mortality. This study explores a specific phenotype of COVID-19-associated hyperinflammation (COV-HI), and its associations with escalation of respiratory support and survival. METHODS: In this retrospective cohort study, we enrolled consecutive inpatients (aged ≥18 years) admitted to University College London Hospitals and Newcastle upon Tyne Hospitals in the UK with PCR-confirmed COVID-19 during the first wave of community-acquired infection. Demographic data, laboratory tests, and clinical status were recorded from the day of admission until death or discharge, with a minimum follow-up time of 28 days. We defined COV-HI as a C-reactive protein concentration greater than 150 mg/L or doubling within 24 h from greater than 50 mg/L, or a ferritin concentration greater than 1500 μg/L. Respiratory support was categorised as oxygen only, non-invasive ventilation, and intubation. Initial and repeated measures of hyperinflammation were evaluated in relation to the next-day risk of death or need for escalation of respiratory support (as a combined endpoint), using a multi-level logistic regression model. FINDINGS: We included 269 patients admitted to one of the study hospitals between March 1 and March 31, 2020, among whom 178 (66%) were eligible for escalation of respiratory support and 91 (34%) patients were not eligible. Of the whole cohort, 90 (33%) patients met the COV-HI criteria at admission. Despite having a younger median age and lower median Charlson Comorbidity Index scores, a higher proportion of patients with COV-HI on admission died during follow-up (36 [40%] of 90 patients) compared with the patients without COV-HI on admission (46 [26%] of 179). Among the 178 patients who were eligible for full respiratory support, 65 (37%) met the definition for COV-HI at admission, and 67 (74%) of the 90 patients whose respiratory care was escalated met the criteria by the day of escalation. Meeting the COV-HI criteria was significantly associated with the risk of next-day escalation of respiratory support or death (hazard ratio 2·24 [95% CI 1·62–2·87]) after adjustment for age, sex, and comorbidity. INTERPRETATION: Associations between elevated inflammatory markers, escalation of respiratory support, and survival in people with COVID-19 indicate the existence of a high-risk inflammatory phenotype. COV-HI might be useful to stratify patient groups in trial design. FUNDING: None. Elsevier Ltd. 2020-10 2020-08-21 /pmc/articles/PMC7442426/ /pubmed/32864628 http://dx.doi.org/10.1016/S2665-9913(20)30275-7 Text en © 2020 Elsevier Ltd. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. |
spellingShingle | Articles Manson, Jessica J Crooks, Colin Naja, Meena Ledlie, Amanda Goulden, Bethan Liddle, Trevor Khan, Emon Mehta, Puja Martin-Gutierrez, Lucia Waddington, Kirsty E Robinson, George A Ribeiro Santos, Liliana McLoughlin, Eve Snell, Antonia Adeney, Christopher Schim van der Loeff, Ina Baker, Kenneth F Duncan, Christopher J A Hanrath, Aidan T Lendrem, B Clare De Soyza, Anthony Peng, Junjie J'Bari, Hajar Greenwood, Mandy Hawkins, Ellie Peckham, Hannah Marks, Michael Rampling, Tommy Luintel, Akish Williams, Bryan Brown, Michael Singer, Mervyn West, Joe Jury, Elizabeth C Collin, Matthew Tattersall, Rachel S COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study |
title | COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study |
title_full | COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study |
title_fullStr | COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study |
title_full_unstemmed | COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study |
title_short | COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study |
title_sort | covid-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study |
topic | Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442426/ https://www.ncbi.nlm.nih.gov/pubmed/32864628 http://dx.doi.org/10.1016/S2665-9913(20)30275-7 |
work_keys_str_mv | AT mansonjessicaj covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT crookscolin covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT najameena covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT ledlieamanda covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT gouldenbethan covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT liddletrevor covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT khanemon covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT mehtapuja covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT martingutierrezlucia covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT waddingtonkirstye covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT robinsongeorgea covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT ribeirosantosliliana covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT mcloughlineve covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT snellantonia covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT adeneychristopher covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT schimvanderloeffina covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT bakerkennethf covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT duncanchristopherja covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT hanrathaidant covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT lendrembclare covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT desoyzaanthony covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT pengjunjie covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT jbarihajar covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT greenwoodmandy covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT hawkinsellie covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT peckhamhannah covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT marksmichael covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT ramplingtommy covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT luintelakish covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT williamsbryan covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT brownmichael covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT singermervyn covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT westjoe covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT juryelizabethc covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT collinmatthew covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy AT tattersallrachels covid19associatedhyperinflammationandescalationofpatientcarearetrospectivelongitudinalcohortstudy |