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Background <p>The Alpha (B.1.1.7) and Omicron (B.1.1.529) waves of COVID-19 represented contrasting epidemiological phases in Slovakia, differing in severity, immunity, and outcomes. We aimed to compare clinical and immunological characteristics of hospitalized patients and identify predictors of mortality.</p> Methods <p>A retrospective observational study was conducted including 609 adults hospitalized with RT-PCR-confirmed COVID-19 and ultrasound-verified viral pneumonia at the Department of Infectology and Travel Medicine in Košice. The Alpha cohort comprised 299 patients (January–March 2021) and the Omicron cohort 310 patients (January–March 2022). Demographic, clinical, and laboratory parameters were analyzed, focusing on lymphocyte subsets (CD4⁺, CD8⁺, CD19⁺), IL-6, lactate, and the neutrophil-to-lymphocyte ratio (Ne/Ly). Mortality associations were assessed using relative risk (RR) and 95% confidence intervals (CI). Additionally, we developed a composite risk score integrating six binary laboratory parameters.</p> Results <p>Mortality decreased from 20.7% during Alpha to 6.8% during Omicron (p &lt; 0.001). Low CD4⁺ and CD8⁺ T-cell counts, elevated IL-6, and high Ne/Ly were strong mortality predictors in both waves. IL-6 &gt; 50&#xa0;ng/L increased mortality risk nearly eightfold during Alpha and ninefold during Omicron (p &lt; 0.001). CD19⁺ lymphopenia and elevated lactate were significant predictors only during Alpha. Vaccination during Omicron reduced mortality almost tenfold (p = 0.005). The composite score demonstrated a stepwise increase in mortality with higher values, indicating its potential utility as an exploratory prognostic tool.</p> Conclusions <p>Mortality risk factors varied between waves, reflecting differences in variant virulence and population immunity. Incorporating immunological and inflammatory markers into prognostic models can improve risk stratification. The proposed composite score may aid in early identification of high-risk COVID-19 patients.</p>

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Association of Immune and Inflammatory Markers with Mortality Profiles in Hospitalized COVID-19 Patients during Alpha and Omicron Waves in Slovakia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月13日

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  • Ondrej Zahornacký,
  • Štefan Porubčin,
  • Alena Rovňáková,
  • Pavol Jarčuška,
  • Katarína Tokarčíková

摘要

Background

The Alpha (B.1.1.7) and Omicron (B.1.1.529) waves of COVID-19 represented contrasting epidemiological phases in Slovakia, differing in severity, immunity, and outcomes. We aimed to compare clinical and immunological characteristics of hospitalized patients and identify predictors of mortality.

Methods

A retrospective observational study was conducted including 609 adults hospitalized with RT-PCR-confirmed COVID-19 and ultrasound-verified viral pneumonia at the Department of Infectology and Travel Medicine in Košice. The Alpha cohort comprised 299 patients (January–March 2021) and the Omicron cohort 310 patients (January–March 2022). Demographic, clinical, and laboratory parameters were analyzed, focusing on lymphocyte subsets (CD4⁺, CD8⁺, CD19⁺), IL-6, lactate, and the neutrophil-to-lymphocyte ratio (Ne/Ly). Mortality associations were assessed using relative risk (RR) and 95% confidence intervals (CI). Additionally, we developed a composite risk score integrating six binary laboratory parameters.

Results

Mortality decreased from 20.7% during Alpha to 6.8% during Omicron (p < 0.001). Low CD4⁺ and CD8⁺ T-cell counts, elevated IL-6, and high Ne/Ly were strong mortality predictors in both waves. IL-6 > 50 ng/L increased mortality risk nearly eightfold during Alpha and ninefold during Omicron (p < 0.001). CD19⁺ lymphopenia and elevated lactate were significant predictors only during Alpha. Vaccination during Omicron reduced mortality almost tenfold (p = 0.005). The composite score demonstrated a stepwise increase in mortality with higher values, indicating its potential utility as an exploratory prognostic tool.

Conclusions

Mortality risk factors varied between waves, reflecting differences in variant virulence and population immunity. Incorporating immunological and inflammatory markers into prognostic models can improve risk stratification. The proposed composite score may aid in early identification of high-risk COVID-19 patients.