ADVANCED LUNG CANCER INFLAMMATORY INDEX AS A PROGNOSTIC MARKER FOR OXYGEN REQUIREMENT IN PATIENTS ADMITTED WITH SARS-COV-2 INFECTION

Sridhar, Arthi; Yang, Wei; Advani, Shailesh; Jani, Pushan; Jafri, Syed

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Severe acute respiratory syndrome coronavirus (SARS-COV-2) infection continues to spread at exponential rates globally with more than 145 million confirmed cases worldwide and over 3 million deaths. SARS-COV-2 presents with different clinical manifestations ranging from asymptomatic to severe infection, requiring various levels of O2 support, facing high rates of mortality. Systemic inflammatory response to the viral infection contributes to a variety of clinical manifestations and to the degree of severity of illness. Limited evidence exists on potential biomarkers to quantify severity and outcomes of SARS-COV-2 infection. Our objective is to see if Advanced lung cancer inflammation index (ALI) calculated at the time of admission to the hospital can be used as a prognostic marker for oxygen requirements and adverse clinical outcomes. METHODS: We conducted a retrospective chart review of all patients ages 18 and above admitted to Memorial Hermann Hospitals between March 1, 2020 to June 30, 2020 who tested positive for SARS-COV-2 by RT-PCR. The ALI was calculated using patients Body mass index (BMI), serum albumin and neutrophil/lymphocyte ratio (NLR) from the admission labs using the formula ALI= BMI (kg/m2) × albumin (g/dL)/NLR. Patient related information was obtained by reviewing medical records after obtaining Institutional review board approval. RESULTS: A total of 700 patients were identified out of which 417 patients had complete medical records for analysis. Patients were stratified into group A (high inflammation (ALI < 18) n = 205) and group B (low inflammation (ALI ≥ 18) n = 218). 67% of the patients were aged 45 or older. 52.5% of the patients had a BMI < 30. 22.3% of patients in group A, 22.3% and 16.7% patients in group B, 16.7% were of white race. ALI < 18 was associated with higher oxygen requirements (73% vs 52%, p ≥ 0.0001), higher mechanical ventilation requirements (16.59% vs 9.91%, p = 0.04) and higher mortality rates (14.15% vs 7.08%, p = 0.02). In multi-variate analysis, ALI < 18 was significantly associated with oxygen requirements, (OR 2.62 (1.64 - 4.17), p ≤ 0.0001). CONCLUSIONS: In patients diagnosed with SARS-CoV-2 infection, an ALI < 18, representing high systemic inflammation, calculated at the time of admission is associated with significantly increased oxygen requirements, severe disease and mortality. CLINICAL IMPLICATIONS: Advanced lung cancer inflammation index can be easily calculated from basic clinical parameters available in most clinical settings. It can be used as a tool in early identification of patients who are likely to have more severe respiratory disease and poorer outcomes in patients with SARS-COV-2 infections. Early use of steroids can be considered in this population of patients with an ALI <18. DISCLOSURES: No relevant relationships by Shailesh Advani, source=Web Response No relevant relationships by Syed Jafri, source=Web Response No relevant relationships by Pushan Jani, source=Web Response No relevant relationships by Arthi Sridhar, source=Web Response No relevant relationships by Wei Yang, source=Web Response