Oppong, Alexandra E;
Coelewij, Leda;
Hutchinson, Matthew;
Carpenter, Ben;
Robinson, George A;
Liddle, Trevor;
Hawkins, Ellie;
... Manson, Jessica J; + view all
(2025)
Simple hyperinflammation scores predict mortality in hospitalized patients with COVID-19 and offer a personalized medicine approach to dexamethasone intervention.
International Journal of Infectious Diseases
, 161
, Article 108119. 10.1016/j.ijid.2025.108119.
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Abstract
BACKGROUND: Dexamethasone is recommended for use in all patients with COVID-19 requiring supplemental oxygen, however, only some patients develop hyperinflammation (COV-HI) potentially influencing their response to corticosteroids. This study tested the ability of criteria defining COV-HI to predict response to dexamethasone. METHODS: A retrospective, multicentre, observational cohort study of 1313-patients with PCR-confirmed COVID-19 during first and second waves of community-acquired infection including 212 patients who received dexamethasone monotherapy. Demographic data, laboratory tests and clinical status were recorded from admission until death or discharge, with minimum 28-days follow-up. Patients were stratified at admission as COV-HI-YES/COV-HI-NO based on three published COV-HI definitions. RESULTS: Patients with COV-HI shared a biological phenotype of hypoalbuminemia/anaemia, and elevated D-dimer/lactate dehydrogenase/alanine transaminase/respiratory rates. Combining these features predicted 28-day mortality and stratified COV-HI-YES from COV-HI-NO more effectively compared to individual markers/demographic features alone. In COV-HI-YES patients, dexamethasone treatment halved mortality-risk (relative risk=0.50) compared to untreated patients. However, in COV-HI-NO patients mortality-risk was 3.03x higher (CI=1.3-7.0) in treated versus untreated patients during a 28-day admission period. CONCLUSIONS: We present a framework for a new machine-learning based scoring system for COV-HI combining clinical assessment with laboratory markers for prediction of mortality and targeting glucocorticoids in hospitalised COVID-19 patients.
| Type: | Article |
|---|---|
| Title: | Simple hyperinflammation scores predict mortality in hospitalized patients with COVID-19 and offer a personalized medicine approach to dexamethasone intervention |
| Location: | Canada |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1016/j.ijid.2025.108119 |
| Publisher version: | https://doi.org/10.1016/j.ijid.2025.108119 |
| Language: | English |
| Additional information: | © 2025 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) |
| Keywords: | COVID-19 Hyperinflammation, Dexamethasone, Mortality risk |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Medicine |
| URI: | https://discovery.ucl.ac.uk/id/eprint/10216606 |
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