Clusters of inflammation in COVID-19: descriptive analysis and prognosis on more than 15,000 patients from the Spanish SEMI-COVID-19 Registry.

Abstract

Uncontrolled infammation following COVID-19 infection is an important characteristic of the most seriously ill patients. The present study aims to describe the clusters of infammation in COVID-19 and to analyze their prognostic role. This is a retrospective observational study including 15,691 patients with a high degree of infammation. They were included in the Spanish SEMI-COVID-19 registry from March 1, 2020 to May 1, 2021. The primary outcome was in-hospital mortality. Hierarchical cluster analysis identifed 7 clusters. C1 is characterized by lymphopenia, C2 by elevated ferritin, and C3 by elevated LDH. C4 is characterized by lymphopenia plus elevated CRP and LDH and frequently also ferritin. C5 is defned by elevated CRP, and C6 by elevated ferritin and D-dimer, and frequently also elevated CRP and LDH. Finally, C7 is characterized by an elevated D-dimer. The clusters with the highest in-hospital mortality were C4, C6, and C7 (17.4% vs. 18% vs. 15.6% vs. 36.8% vs. 17.5% vs. 39.3% vs. 26.4%). Infammation clusters were found as independent factors for inhospital mortality. In detail and, having cluster C1 as reference, the model revealed a worse prognosis for all other clusters: C2 (OR=1.30, p=0.001), C3 (OR=1.14, p=0.178), C4 (OR=2.28, p<0.001), C5 (OR=1.07, p=0.479), C6 (OR=2.29, p<0.001), and C7 (OR=1.28, p=0.001). We identifed 7 groups based on the presence of lymphopenia, elevated CRP, LDH, ferritin, and D-dimer at the time of hospital admission for COVID-19. Clusters C4 (lymphopenia+LDH+CRP), C6 (ferritin+D-dimer), and C7 (D-dimer) had the worst prognosis in terms of in-hospital mortality.