• Manuel Rubio-Rivas, José María Mora-Luján, Francesc Formiga, Miguel Ángel Corrales González, María Del Mar García Andreu, Víctor Moreno-Torres, Gema María García García, José N Alcalá Pedrajas, Ramon Boixeda, Leticia Pérez-Lluna, Begoña Cortés-Rodríguez, Carmen Mella-Pérez, María de la Sierra Navas Alcántara, Manuel Lorenzo López Reboiro, Verónica Alfaro-Lara, Santiago Pérez-Martín, Martín-OterinoJosé ÁngelJÁDepartment of Internal Medicine, Salamanca University Hospital, Salamanca, Spain., Anyuli Gracia Gutiérrez, Anabel Martín-Urda Díez-Canseco, Pere Comas Casanova, Cristina Pérez García, José F Varona, Ricardo Gómez-Huelgas, Juan-Miguel Antón-Santos, Carlos Lumbreras-Bermejo, and SEMI-COVID-19 Network.
• Department of Internal Medicine, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, 08907, Barcelona, Spain. mrubio@bellvitgehospital.cat.
• Intern Emerg Med. 2022 Jun 1; 17 (4): 111511271115-1127.

AbstractUncontrolled inflammation following COVID-19 infection is an important characteristic of the most seriously ill patients. The present study aims to describe the clusters of inflammation in COVID-19 and to analyze their prognostic role. This is a retrospective observational study including 15,691 patients with a high degree of inflammation. 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 identified 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 defined 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%). Inflammation clusters were found as independent factors for in-hospital 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 identified 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.© 2022. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).

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