AUTHOR=Torres-Ruiz Jiram , Pérez-Fragoso Alfredo , Maravillas-Montero José Luis , Llorente Luis , Mejía-Domínguez Nancy R. , Páez-Franco José Carlos , Romero-Ramírez Sandra , Sosa-Hernández Victor Andrés , Cervantes-Díaz Rodrigo , Absalón-Aguilar Abdiel , Nuñez-Aguirre Miroslava , Juárez-Vega Guillermo , Meza-Sánchez David , Kleinberg-Bid Ari , Hernández-Gilsoul Thierry , Ponce-de-León Alfredo , Gómez-Martín Diana TITLE=Redefining COVID-19 Severity and Prognosis: The Role of Clinical and Immunobiotypes JOURNAL=Frontiers in Immunology VOLUME=12 YEAR=2021 URL=https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2021.689966 DOI=10.3389/fimmu.2021.689966 ISSN=1664-3224 ABSTRACT=Background

Most of the explanatory and prognostic models of COVID-19 lack of a comprehensive assessment of the wide COVID-19 spectrum of abnormalities. The aim of this study was to unveil novel biological features to explain COVID-19 severity and prognosis (death and disease progression).

Methods

A predictive model for COVID-19 severity in 121 patients was constructed by ordinal logistic regression calculating odds ratio (OR) with 95% confidence intervals (95% CI) for a set of clinical, immunological, metabolomic, and other biological traits. The accuracy and calibration of the model was tested with the area under the curve (AUC), Somer’s D, and calibration plot. Hazard ratios with 95% CI for adverse outcomes were calculated with a Cox proportional-hazards model.

Results

The explanatory variables for COVID-19 severity were the body mass index (BMI), hemoglobin, albumin, 3-Hydroxyisovaleric acid, CD8+ effector memory T cells, Th1 cells, low-density granulocytes, monocyte chemoattractant protein-1, plasma TRIM63, and circulating neutrophil extracellular traps. The model showed an outstanding performance with an optimism-adjusted AUC of 0.999, and Somer’s D of 0.999. The predictive variables for adverse outcomes in COVID-19 were severe and critical disease diagnosis, BMI, lactate dehydrogenase, Troponin I, neutrophil/lymphocyte ratio, serum levels of IP-10, malic acid, 3, 4 di-hydroxybutanoic acid, citric acid, myoinositol, and cystine.

Conclusions

Herein, we unveil novel immunological and metabolomic features associated with COVID-19 severity and prognosis. Our models encompass the interplay among innate and adaptive immunity, inflammation-induced muscle atrophy and hypoxia as the main drivers of COVID-19 severity.