Role of inflammatory biomarkers in the prediction of ICU admission and mortality in patients with COVID-19 Biomarkers and COVID-19

Main Article Content

Qamar Ahmad, MD Sarah E DePerrior, MPH Sunita Dodani, MD, FCPS, MSc, PhD Joshua F Edwards, MPH Paul Ellis Marik, MD, FCCP, FCCM

Abstract

Background: Inflammatory cytokines have been implicated in the pathophysiology and prognosis of severe COVID-19. Inflammatory biomarkers may guide the clinician in making treatment decisions as well as in the allocation of resources.


 Objective: This study aimed to assess how levels of inflammatory biomarkers predict disease severity and mortality in patients with COVID-19 by testing a predictive scoring model developed by Zhou et al and further refining the model in a population of patients hospitalized with COVID-19.


 


Study Design and Methods: This retrospective study included patients with COVID-19 admitted to ten Virginia hospitals from January 1, 2020, to June 15, 2020. Inflammatory markers including CRP, D-Dimer, ferritin, N/L ratio, and procalcitonin were studied and logistic regression models were applied to ascertain the risk of ICU admission and mortality with elevated markers.


 Results: Data from a total of 701 patients were analyzed. In bivariate tests age, CRP, D-Dimer, and N/L ratio were associated with in-hospital mortality as well as admission to the ICU.  Procalcitonin was associated with admission to the ICU but not mortality. Males and African Americans were more likely to require ICU-level care. In final models, age and CRP were significantly associated with mortality (OR 1.06, 95% CI 1.04-1.08, and OR 1.06, 95% CI 1.03-1.10 respectively) as well as ICU admissions (OR 1.02, 95% CI 1.01-1.03 and OR 1.03, 95% CI 1.01-1.06 respectively). The previously established composite scores of CRP, D-Dimer, and N/L ratio were predictive of mortality (Area under the curve [AUC] 0.69 for multiplicative score) as well as ICU admissions (AUC 0.61 for multiplicative score). However, improved accuracy was obtained with age and CRP for predicting mortality (AUC 0.77) and ICU admission (AUC 0.62).


Conclusions: CRP and age appear to be the strongest predictors for ICU admission and mortality compared to D-Dimer, Ferritin, Procalcitonin, and N/L ratio in patients with COVID-19.

Article Details

How to Cite
AHMAD, Qamar et al. Role of inflammatory biomarkers in the prediction of ICU admission and mortality in patients with COVID-19. Medical Research Archives, [S.l.], v. 8, n. 12, dec. 2020. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/2307>. Date accessed: 24 jan. 2021. doi: https://doi.org/10.18103/mra.v8i12.2307.
Section
Research Articles

References

1. COVID-19 Map - Johns Hopkins Coronavirus Resource Center. https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 . Acessed 7-6-2020.

2. Wiersinga WJ, Rhodes A, Cheng AC et al. Pathophysiology, transmission, diagnosis, and treatment of Coronavirus Disease 2019 (COVID-19). A review. JAMA 2020; 324:782-93.
3. Huang I, Pranata R, Lim MA et al. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis 2020; 14:1-14.
4. Liu F, Li L, Xu MD et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol 2020; 127:104370.
5. Zheng Z, Peng F, Xu B et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. J Infect 2020; 81:e16-e25.
6. Wang L. C-reactive protein levels in the early stage of COVID-19. Medecine et Maladies Infectieuses 2020; 50:332-34.
7. Tan C, Huang Y, Shi F et al. C-reactive protein correlates with computed tomographic findings and predicts severe COVID-19 early. J Med Virol 2020; 92:856-62.
8. Liang W, Liang H, Ou L et al. Development and validation of a clinical risk score to predict the occurance of critical illness in hospitalized patients with COVID-19. JAMA Intern Med 2020; 180:1081-89.
9. Zhou Y, Yang Z, Guo Y et al. A new predictor of disease severity in patients with COVID-19 in Wuhan,China. medRxiv 2020; Preprint.
10. Yuki K, Fujiogi M, Koutsogiannaki S. COVID-19 pathophysiology: A review. Clin Immunol 2020; 215:108427.
11. Paces J, Strizova Z, Smrz D et al. COVID-19 and the immune system. Physiol Res 2020; 69:379-88.
12. Pan F, Yang L, Li Y et al. Factors assocaited with death outcomes in patients with severe coronavirus disease-19 (COVID-19): a case-control study. Int J Med Sci 2020; 17:1281-92.
13. Wang D. Clinical characteristics of 138 hospitalized patients with 2019 novel Cornonvirus-infected pneumonia in Wuhan, China. JAMA 2020; 323:1061-69.
14. Velavan TP, Meyer CG. Mild versus severe COVID-19: Laboratory markers. Int J Infect DIs 2020; 95:304-7.
15. Kang SJ, Jung SI. Age-related morbidity and mortality among patients with COVID-19. Infect Chemother 2020; 52:154-64.
16. Black S, Kushner I, Samols D. C-reactive protein. J Biol Chem 2004; 279:48487-90.
17. Han H, Ma Q, Li C et al. Profiling serum cytokines in COVID-19 patients reveals IL-6 and IL-10 are disease severity predictors. Emerging Microbes & Infection 2020; 9:1123-30.
18. Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chim Acta 2020; 505:190-191.

Most read articles by the same author(s)

Obs.: This plugin requires at least one statistics/report plugin to be enabled. If your statistics plugins provide more than one metric then please also select a main metric on the admin's site settings page and/or on the journal manager's settings pages.