The Systemic Inflammation Index on Admission Predicts In-Hospital Mortality in COVID-19 Patients

Molecules. 2020 Dec 4;25(23):5725. doi: 10.3390/molecules25235725.


Background: The rapid onset of a systemic pro-inflammatory state followed by acute respiratory distress syndrome is the leading cause of mortality in patients with COVID-19. We performed a retrospective observational study to explore the capacity of different complete blood cell count (CBC)-derived inflammation indexes to predict in-hospital mortality in this group.

Methods: The neutrophil to lymphocyte ratio (NLR), derived NLR (dNLR), platelet to lymphocyte ratio (PLR), mean platelet volume to platelet ratio (MPR), neutrophil to lymphocyte × platelet ratio (NLPR), monocyte to lymphocyte ratio (MLR), systemic inflammation response index (SIRI), systemic inflammation index (SII), and the aggregate index of systemic inflammation (AISI) were calculated on hospital admission in 119 patients with laboratory confirmed COVID-19.

Results: Non-survivors had significantly higher AISI, dNLR, NLPR, NLR, SII, and SIRI values when compared to survivors. Similarly, Kaplan-Meier survival curves showed significantly lower survival in patients with higher AISI, dNLR, MLR, NLPR, NLR, SII, and SIRI. However, after adjusting for confounders, only the SII remained significantly associated with survival (HR = 1.0001; 95% CI, 1.0000-1.0001, p = 0.029) in multivariate Cox regression analysis.

Conclusions: The SII on admission independently predicts in-hospital mortality in COVID-19 patients and may assist with early risk stratification in this group.

Keywords: CBC; COVID-19; SII; coronavirus; inflammation.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Blood Cell Count
  • COVID-19 / epidemiology
  • COVID-19 / mortality*
  • COVID-19 / physiopathology
  • Comorbidity
  • Female
  • Hospital Mortality*
  • Humans
  • Inflammation / blood*
  • Lymphocyte Count
  • Male
  • Middle Aged
  • Neutrophils
  • ROC Curve
  • Retrospective Studies