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Risk Categories in COVID-19 Based on Degrees of Inflammation: Data on More Than 17,000 Patients from the Spanish SEMI-COVID-19 Registry

Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, 08907 Barcelona, Spain
Hestia Chair in Integrated Health and Social Care, School of Medicine, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
Department of Internal Medicine, San Pedro Hospital, 26006 Logroño, Spain
Department of Internal Medicine, Hospital Costa del Sol, 29603 Marbella, Spain
Department of Internal Medicine, Hospital Puerta de Hierro Hospital, 28220 Majadahonda, Spain
Head of the Department of Internal Medicine, La Paz Hospital, 28046 Madrid, Spain
Department of Internal Medicine, Royo Villanova Hospital, 50007 Zaragoza, Spain
Department of Internal Medicine, 12 de Octubre University Hospital, 28041 Madrid, Spain
Department of Internal Medicine, Gregorio Marañón Hospital, 28009 Madrid, Spain
Department of Internal Medicine, La Princesa University Hospital, 28006 Madrid, Spain
Department of Internal Medicine, Moisès Broggi Hospital, 08970 Sant Joan Despí, Spain
Department of Internal Medicine, Cabueñes Hospital, 33203 Gijón, Spain
Department of Internal Medicine, Río Hortega University Hospital, 47014 Valladolid, Spain
Department of Internal Medicine, Nuestra Señora del Prado Hospital, 45600 Talavera de la Reina, Spain
Department of Internal Medicine, Virgen de la Salud Hospital-Toledo University Hospital, 45004 Toledo, Spain
Department of Internal Medicine, Son Llatzer Hospital, 07005 Mallorca, Spain
Department of Internal Medicine, Santa Marina Hospital, 48004 Bilbao, Spain
Department of Internal Medicine, Torrevieja University Hospital, 03186 Torrevieja, Spain
Department of Internal Medicine, Ourense University Hospital, 32005 Ourense, Spain
Department of Internal Medicine, Tajo University Hospital, 41007 Toledo, Spain
Department of Internal Medicine, Juan Ramón Jiménez University Hospital, 21005 Huelva, Spain
Department of Internal Medicine, La Fe Hospital, 46009 Valencia, Spain
Department of Internal Medicine, Infanta Cristina University Hospital, 28981 Parla, Spain
Author to whom correspondence should be addressed.
M. Rubio-Rivas and X. Corbella contributed equally as co-first authors of the study.
A complete list of the SEMI-COVID-19 Network members is provided in the Acknowledgments.
Academic Editors: Giovanni Frisullo and Marco Luigetti
J. Clin. Med. 2021, 10(10), 2214;
Received: 12 March 2021 / Revised: 17 May 2021 / Accepted: 18 May 2021 / Published: 20 May 2021
(1) Background: The inflammation or cytokine storm that accompanies COVID-19 marks the prognosis. This study aimed to identify three risk categories based on inflammatory parameters on admission. (2) Methods: Retrospective cohort study of patients diagnosed with COVID-19, collected and followed-up from 1 March to 31 July 2020, from the nationwide Spanish SEMI-COVID-19 Registry. The three categories of low, intermediate, and high risk were determined by taking into consideration the terciles of the total lymphocyte count and the values of C-reactive protein, lactate dehydrogenase, ferritin, and D-dimer taken at the time of admission. (3) Results: A total of 17,122 patients were included in the study. The high-risk group was older (57.9 vs. 64.2 vs. 70.4 years; p < 0.001) and predominantly male (37.5% vs. 46.9% vs. 60.1%; p < 0.001). They had a higher degree of dependence in daily tasks prior to admission (moderate-severe dependency in 10.8% vs. 14.1% vs. 17%; p < 0.001), arterial hypertension (36.9% vs. 45.2% vs. 52.8%; p < 0.001), dyslipidemia (28.4% vs. 37% vs. 40.6%; p < 0.001), diabetes mellitus (11.9% vs. 17.1% vs. 20.5%; p < 0.001), ischemic heart disease (3.7% vs. 6.5% vs. 8.4%; p < 0.001), heart failure (3.4% vs. 5.2% vs. 7.6%; p < 0.001), liver disease (1.1% vs. 3% vs. 3.9%; p = 0.002), chronic renal failure (2.3% vs. 3.6% vs. 6.7%; p < 0.001), cancer (6.5% vs. 7.2% vs. 11.1%; p < 0.001), and chronic obstructive pulmonary disease (5.7% vs. 5.4% vs. 7.1%; p < 0.001). They presented more frequently with fever, dyspnea, and vomiting. These patients more frequently required high flow nasal cannula (3.1% vs. 4.4% vs. 9.7%; p < 0.001), non-invasive mechanical ventilation (0.9% vs. 3% vs. 6.3%; p < 0.001), invasive mechanical ventilation (0.6% vs. 2.7% vs. 8.7%; p < 0.001), and ICU admission (0.9% vs. 3.6% vs. 10.6%; p < 0.001), and had a higher percentage of in-hospital mortality (2.3% vs. 6.2% vs. 23.9%; p < 0.001). The three risk categories proved to be an independent risk factor in multivariate analyses. (4) Conclusion: The present study identifies three risk categories for the requirement of high flow nasal cannula, mechanical ventilation, ICU admission, and in-hospital mortality based on lymphopenia and inflammatory parameters. View Full-Text
Keywords: COVID-19; cytokine storm; prognosis; risk factors; mortality COVID-19; cytokine storm; prognosis; risk factors; mortality
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MDPI and ACS Style

Rubio-Rivas, M.; Corbella, X.; Formiga, F.; Menéndez Fernández, E.; Martín Escalante, M.D.; Baños Fernández, I.; Arnalich Fernández, F.; Del Corral-Beamonte, E.; Lalueza, A.; Parra Virto, A.; Roy Vallejo, E.; Loureiro-Amigo, J.; Álvarez Suárez, A.M.; Abadía-Otero, J.; Navarro De La Chica, M.; Estévez González, R.; Hernández Milián, A.; Areses Manrique, M.; Blázquez Encinar, J.C.; González Noya, A.; González Ferrer, R.; Pérez Aguilera, M.; Gil Sánchez, R.; Millán Núñez-Cortés, J.; Casas-Rojo, J.M.; on behalf of the SEMI-COVID-19 Network. Risk Categories in COVID-19 Based on Degrees of Inflammation: Data on More Than 17,000 Patients from the Spanish SEMI-COVID-19 Registry. J. Clin. Med. 2021, 10, 2214.

AMA Style

Rubio-Rivas M, Corbella X, Formiga F, Menéndez Fernández E, Martín Escalante MD, Baños Fernández I, Arnalich Fernández F, Del Corral-Beamonte E, Lalueza A, Parra Virto A, Roy Vallejo E, Loureiro-Amigo J, Álvarez Suárez AM, Abadía-Otero J, Navarro De La Chica M, Estévez González R, Hernández Milián A, Areses Manrique M, Blázquez Encinar JC, González Noya A, González Ferrer R, Pérez Aguilera M, Gil Sánchez R, Millán Núñez-Cortés J, Casas-Rojo JM, on behalf of the SEMI-COVID-19 Network. Risk Categories in COVID-19 Based on Degrees of Inflammation: Data on More Than 17,000 Patients from the Spanish SEMI-COVID-19 Registry. Journal of Clinical Medicine. 2021; 10(10):2214.

Chicago/Turabian Style

Rubio-Rivas, Manuel, Xavier Corbella, Francesc Formiga, Estela Menéndez Fernández, María D. Martín Escalante, Isolina Baños Fernández, Francisco Arnalich Fernández, Esther Del Corral-Beamonte, Antonio Lalueza, Alejandro Parra Virto, Emilia Roy Vallejo, José Loureiro-Amigo, Ana M. Álvarez Suárez, Jesica Abadía-Otero, María Navarro De La Chica, Raquel Estévez González, Almudena Hernández Milián, María Areses Manrique, Julio C. Blázquez Encinar, Amara González Noya, Ruth González Ferrer, María Pérez Aguilera, Ricardo Gil Sánchez, Jesús Millán Núñez-Cortés, José M. Casas-Rojo, and on behalf of the SEMI-COVID-19 Network. 2021. "Risk Categories in COVID-19 Based on Degrees of Inflammation: Data on More Than 17,000 Patients from the Spanish SEMI-COVID-19 Registry" Journal of Clinical Medicine 10, no. 10: 2214.

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