The Risk Factors Affecting Length of Stay and Mortality in Covid 19 Patients: Laboratory Parameters, Comorbidities, and Demographic Characteristics

Year 2021, , 474 - 478, 30.08.2021

Leman Acun Delen , Esra Erdoğan , Şeyma Yaşar

https://doi.org/10.18521/ktd.899368

Cited By: 2

Abstract

Objective: Covid 19 can cause fatal pneumonia and serious complications. In the course of the
disease the levels of different biochemical parameters increased and these parameters provide
important information about the prognosis of the disease. The aim of this study was to
investigate the relationship between biochemical parameters and length of stay and mortality in
Covid 19 patients.
Methods: In this retrospective study, a total of 767 Covid 19 patients hospitalized in our
hospital were included. The demographic characteristics, length of stay, comorbid diseases and
biochemical parameters of the patients were scanned from the hospital's database and patient
files and recorded. Patients were grouped according to the length of stay; 1st Group: 7 days and
less, 2ndGroup: 8-10 days, 3rdGroup: 11-13 days, and 4thGroup: 14 days and more.
Results: The mean CRP level was significantly higher in group 4 compared to group 1 (p =
0.002). The mean levels of LDH, PRO_BNP, and procalcitonin were significantly higher in
group 4 compared to group 1 and group 2 (p <0.001, p = 0.026, p = 0.007, respectively). The
mean level of fibrinogen was significantly higher in group 4 compared to group 2 (p = 0.011).
Presence of DM and HT as comorbidities (p = 0.022, p = 0.006) and high levels of LDH and
ferritin (p <0.001, p = 0.041) significantly increased the risk of death.
Conclusions: The results of our study show that positive correlation between the levels of CRP,
LDH, PCT, PROBNP, and fibrinogen the prolongation of hospitalization in Covid 19 patients
and these parameters can be associated with the severity disease. These results show that
increased levels of LDH and ferritin, age, prolongation of hospitalization, and the presence of
HT and DM increase mortality rate and can be specific parameters in terms of prognosis.

Keywords

CRP, COVID-19, Laboratory tests, Mortality, Comorbidity diseases

Covid 19 Hastalarında Kalış Süresini ve Mortaliteyi Etkileyen Risk Faktörleri: Laboratuvar Parametreleri, Komorbiditeler ve Demografik Özellikler

Abstract

Amaç: Covid 19, ölümcül pnömoniye ve ciddi komplikasyonlara neden olabilen güncel pandemik hastalıktır. Hastalığın farklı evrelerinde farklı biyokimyasal parametrelerin düzeyinde artış görülmekte ve bu parametreler hastalığın seyri konusunda önemli bilgiler vermektedir. Bu çalışmada, Covid 19 hastalarındaki yatış süresi ve mortalite oranı ile biyokimyasal parametreler arasındaki ilişkinin araştırılması amaçlanmıştır.
Materyal ve Metot: Bu retrospektif çalışmaya, hastanemizde yatan toplam767 Covid 19 hastası dahil edildi. Hastanenin veri tabanı ve hasta dosyaları incelenerek hastaların demografik özellikleri, yatış süreleri, ek hastalıları ve biyokimyasal parametreler taranarak kaydedildi. Hastalar yatış gününe göre, 1. Grup: 7 gün ve altı, 2. Grup: 8-10 gün arası 3. Grup: 11-13 gün arası, 4. Grup: 14 gün ve üzeri olmak üzere toplam 4 gruba ayrıldı. Hastaların demografik özellikleri, laboratuvar bulguları, ek hastalıkları ve mortalite oranları bu gruplara göre düzenlenerek istatiksel analiz yapıldı.
Bulgular: Hastaların 459 (60%)’u erkek 308 (40%)’i kadındı. Grup 4 hastalarındaki CRP düzeyi, grup 1’deki hastalara göre istatiksel anlamlı olarak yüksekti (p=0.002). Grup 4 hastalarındaki LDH, PRO_BNP ve prokalsitonin düzeyi hem grup 1 hemde grup 2’ye göre istatiksel anlamlı olarak yüksekti (sırasıyla p<0.001, p=0.026, p=0.007). Fibrinojen düzeyi, grup 4 deki hastalarda grup 2’deki hastalara göre anlamlı olarak yüksekti (p=0.011). DM, HT, LDH ve ferritin düzeyi yüksekliği ölüm riskinin anlamlı olarak artırmıştı (sırasıyla p=0.022, p=0,006 p<0.001, p=0,041). Benzer olarak yaş ve yatış gününün uzaması ölüm riskini anlamlı olarak artırmıştı (p<0.001).
Sonuç: Çalışmamızın sonuçları, Covid 19 hastalarının yatış süresinin uzamasıyla CRP, LDH, PCT, PROBNP ve fibrinojen düzeyinin doğru orantılı olarak arttığını ve hastalığın şiddetliye ilişkili olabileceğini göstermektedir. Yine bu sonuçlar, LDH ve ferritin düzeyinin, yaş, yatış gününün uzaması, HT, DM gibi ek hastalıkların varlığının mortalite oranını artırdığını ve prognoz açısından daha spesifik parametreler olduğunu göstermektedir.

Keywords

COVID-19, Laboratuar testleri, Mortalite, Ek hastalıklar, CRP, LDH

References

• Benjamin GM, Ghazal A, Katya L, Lanbo Y, Emily JS, Silvia SC, et al. Predictors of COVID-19 severity: A literature review. Rev Med Virol. 2021; 31: 1–10.
• Bianca C, Emmanuel JF, Giuseppe L, Elizabeth MVC. Hematology Laboratory Abnormalities in Patients with Coronavirus Disease 2019 (COVID 19). Semin Thromb Hemost. 2020;46:845-849.
• Brandon MH, Maria HSOL, Stefanie B, Mario P and GL. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020; 58: 1021–1028.
• Celestin D, Francky TE, Jan René N, Dominic L, Angong W, Annie R et al. A meta-analysis of potential biomarkers associated with severity of coronavirus disease 2019 (COVID-19). Biomark Res. 2020; 31:8:37.
• Dan W, Ruifang L, Juan W, Qunqun J, Chang G, Juan Y, et al. Correlation analysis between disease severity and clinical and biochemical characteristics of 143 cases of COVID-19 in Wuhan, China: a descriptive study. BMC Infectious Diseases. 2020; 20:519-28.
• Fang L, Lin L, Meng DX, Juan W, Ding L, Yu SZ, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. Journal of Clinical Virology. 2020;127: 104370.
• Francesco DS, Alessio F, Lorenzo L, Roberto C, Danilo M , Tommasa V, et al. Features of severe COVID-19: A systematic review and meta-analysis. Eur J Clin Invest. 2020;50:e13378.
• Hernández GE. Obesity is the comorbidity more strongly associated for Covid-19 in Mexico. A case-control study. Obes Res Clin Pract. Obes Res Clin Pract 2020;14:375-379.
• Jing Y, Rougrong Z, Lijiao Z, Shanglong K, Jianfeng L, Xiaohe L, et al. The correlation between viral clearance and biochemical outcomes of 94 COVID‑19 infected discharged patients. Inflamm Res. 2020; 29: 1–8.
• Kai K, Amir J & Rudolf T. Assessment of serum ferritin as a biomarker in COVID-19: bystander or participant? Insights by comparison with other infectious and noninfectious diseases. Biomarkers. 2020;25:616-625.
• Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chim Acta 2020;505:190–1.
• Marcello C and Luisa A. Biochemical biomarkers alterations in Coronavirus Disease 2019 (COVID-19). Diagnosis. 2020; 7: 365–372.
• Palaiodimos L, Kokkinidis DG, Li W, Dimitrios K, Jennifer O, Shitij A, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism. 2020;108:154262.
• Palaiodimos X, Xu S, Yu M, Ke Wa, Yu T, Ying Z, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020;146: 110-118.
• Paula MO’S, Graham RL, Tomás PG, Vincent T, Amjad H, Seán JC, et al. COVID-19 in adults: test menu for hospital blood science laboratories. Ir J Med Sci. 2020;18: 1–6.
• Tan C, Huang Y, Shi F, Tan K, Qionghui M, Chen Y, et al. C-reactive protein correlates with CT findings and predicts severe COVID-19 early. J Med Virol. 2020;92:856-862.
• Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. J Am Med Assoc 2020;323: 1061–69.
• Xiaohong Y, Wanling H, Bing Y, Cunrong C, Rongfeng H, Feng W, et al. Changes of hematological and immunological parameters in COVID‑19 Patients. International Journal of Hematology. 2020; 12: 1–7.
• Xiaoling D, Beibei L, Jiahuan L, Junli Z, Yajuan Z and Keshu X. Blood biochemical characteristics of patients with coronavirus disease 2019 (COVID-19): a systemic review and meta-analysis. Clin Chem Lab Med. 2020; 58: 1172–1181.
• Xiaoyu F, Shen L, Hao Y, Penghao W, Yao Z, Zheng C, et al. Epidemiological, comorbidity factors with severity and prognosis of COVID-19: a systematic review and meta-analysis. Aging. 2020;12:12493-12503.
• Yang W, Cao Q, Qin L, Wang X, Cheng Z, Pan A, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): a multi-center study in Wenzhou city, Zhejiang, China. J Infect 2020;80:388–93.
• Yingchu Z, Bo L, Jiyang L, and Dong C. The Predictive Effectiveness of Blood Biochemical Indexes for the Severity of COVID-19. Canadian Journal of Infectious Diseases and Medical Microbiology 2020;4:1-6.
• Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395:1054–62.