Age-stratified prognostic performance of hematologic inflammatory indices for 30-day mortality in emergency department patients with PCR-confirmed COVID-19: A cohort study from the pre-vaccination pandemic era
Article excerpt
by Derya Abuşka, Özlem Dikme, Özgür Dikme, Tahir Talat Yurttaş, Uğur Durmuş, Atakan Yüksekbaş Background During the pandemic era, rapid and accessible prognostic tools were essential to support clinical decision-making for emergency department (ED) patients presenting with acute infectious symptoms.…
by Derya Abuşka, Özlem Dikme, Özgür Dikme, Tahir Talat Yurttaş, Uğur Durmuş, Atakan Yüksekbaş
Background During the pandemic era, rapid and accessible prognostic tools were essential to support clinical decision-making for emergency department (ED) patients presenting with acute infectious symptoms. Hematologic inflammatory indices derived from complete blood count (CBC) parameters, such as the systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and pan-immune-inflammation value (PIV), have been increasingly investigated for risk stratification. This retrospective cohort study evaluated the age-stratified prognostic performance of these indices for 30-day mortality in ED patients during the pandemic period.
Methods This retrospective cohort study included adults presenting to a tertiary-care ED between March 1 and May 31, 2020. All included patients were retrospectively confirmed to have SARS-CoV-2 infection by RT-PCR. CBC-derived inflammatory markers (SII, SIRI, and PIV) were calculated at admission. The primary outcome was 30-day mortality; the secondary outcome was ICU admission. Age-stratified analyses (A total of 2,778 PCR-confirmed patients were included (mean age 47.8 ± 16.2; 58.7% male). Thirty-day mortality was 6.2%. In the overall cohort, SII, SIRI, and PIV demonstrated modest prognostic performance for mortality (AUCs: 0.663, 0.659, and 0.649, respectively). In patients Hematologic inflammatory indices obtained at ED presentation demonstrated age-dependent prognostic performance for 30-day mortality, with SII showing good discrimination and high negative predictive value (98.9%) in patients younger than 65 years and reduced discriminatory performance in elderly patients. These readily available and cost-effective parameters may support rule-out decisions for younger adults in emergency settings, while in elderly patients clinical assessment and comorbidity profiling should be prioritized over inflammatory marker interpretation.