The relationship of laboratory parameters and mortality of patients followed in intensive care units with COVID-19

Yıl 2022, Cilt: 5 Sayı: 4, 1015 - 1022, 20.07.2022

Meltem Karacan Gölen , Dilek Yılmaz Okuyan , Ömür İlban , Mahmut Sami Tutar , Şaziye Melike Işık

https://doi.org/10.32322/jhsm.1106106

Öz

Aim: We aimed to evaluate the parameters associated with mortality in COVID-19 patients followed up in the intensive care unit.
Material and Method: Three hundred twenty-one patients followed up with the diagnosis of COVID-19 were included in the study. Demographic characteristics, laboratory and clinical parameters were compared in patients with and without mortality.
Results: A higher intubation rate (98.6% vs. 10.9%) and longer hospitalization (10.0 vs. 8.0 days) were detected in the non-survivor group (p<0.001). The neutrophil count, ferritin, troponin I, INR, PT, LDH, urea, creatinine, procalcitonin, WBC, CRP, AST, neutrophil/lymphocyte ratio, and CRP/albumin ratio were significantly higher in the non-survivor group, whereas the lymphocyte count, albumin, monocyte, and platelet counts were significantly lower. A multivariate logistic regression model identified endotracheal intubation, high platelet count, low LDH, low albumin, and decreased CRP/albumin ratio as risk factors associated with intensive care unit mortality. Albumin had the highest prognostic accuracy with an AUC of 0.681 (95% CI: 0.621-0.742) and the highest sensitivity (84.5%), and the platelet count had the highest specificity (69.2%).
Conclusion: Advanced age, intubation status, and duration of intubation were associated with mortality, and it was thought that an increase in LDH levels and CRP/albumin ratio and a decrease in albumin levels and platelet counts had predictive value in predicting mortality

Anahtar Kelimeler

COVID-19, intensive care, mortality, laboratory parameters

Kaynakça

• Phelan AL, Katz R, Gostin LO. The Novel Coronavirus Originating in Wuhan, China: Challenges for Global Health Governance. JAMA 2020; 323: 709-10.
• Song E, Zhang C, Israelow B, et al. Neuroinvasion of SARS-CoV-2 in human and mouse brain. J Exp Med 2021.doi: 10.1084/jem.20202135.
• Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China JAMA Neurol 2020; 77: 683-90.
• Zhou F, Yu T, Du R, 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.
• Du RH, Liu LM, Yin W, et al. Hospitalization and critical care of 109 decedents with COVID-19 pneumonia in Wuhan, China. Ann Am Thorac Soc 2020; 17: 839-46.
• Myers LC, Parodi SM, Escobar GJ, Liu VX. Characteristics of hospitalized adults with COVID-19 in an integrated health care system in California. JAMA 2020; 323: 2195-98.
• Wang Y, Lu X, Li Y et al. Clinical Course and Outcomes of 344 Intensive Care Patients with COVID-19. Am J Respir Crit Care Med 2020; 201: 1430-34.
• Grasselli G, Zangrillo A, Zanella A, et al. COVID-19 Lombardy ICU Network. Baseline characteristics and outcomes of 1591 patients ınfected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA 2020; 323: 1574-81.
• Case definition for coronavirus disease 2019 (COVID-19), as of 29 May 2020. Available at: https://www.ecdc.europa.eu/en/covid-19/surveillance/case-definition. Updated 2020. Accessed January 21, 2021
• WHO Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance, 25 January 2020.
• Ho FK, Petermann-Rocha F, Gray SR, et al. Is older age associated with COVID-19 mortality in the absence of other risk factors? General population cohort study of 470,034 participants. PLoS One 2020; 15: e0241824.
• 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.
• Bienvenu LA, Noonan J, Wang X, Peter K. Higher mortality of COVID-19 in males: sex differences in immune response and cardiovascular comorbidities. Cardiovasc Res 2020; 116: 2197-206.
• Griffith DM, Sharma G, Holliday CS, et al. Men and COVID-19: a biopsychosocial approach to understanding sex differences in mortality and recommendations for practice and policy ınterventions. Prev Chronic Dis 2020; 17: E63.
• Grasselli G, Greco M, Zanella A, et al; COVID-19 Lombardy ICU Network. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med 2020; 180: 1345-55.
• Izcovich A, Ragusa MA, Tortosa F, et al. Prognostic factors for severity and mortality in patients infected with COVID-19: a systematic review. PLoS One 2020; 15: e0241955.
• Han Y, Zhang H, Mu S, et al. Lactate dehydrogenase, an independent risk factor of severe COVID-19 patients: a retrospective and observational study. Aging (Albany NY) 2020; 12: 11245-58.
• The Republic of Turkey Ministry of Health Directorate General of Public Health COVID-19 (SARS-CoV-2 Infection) (Study of Scientific Board) 30 May 2020.
• Ingraham NE, Lotfi-Emran S, Thielen BK, et al. Immunomodulation in COVID-19. Lancet Respir Med 2020; S2213-2600: 30226-5.
• Shen C, Wang Z, Zhao F, et al. Treatment of 5 critically ill patients with COVID-19 with convalescent plasma. JAMA 2020; 323: 1582-9.
• Korley FK, Durkalski-Mauldin V, Yeatts SD et l. Early Convalescent Plasma for High-Risk Outpatients with Covid-19. N Engl J Med. 2021 Aug 18. doi: 10.1056/NEJMoa2103784.
• Xu X, Han M, Li T, et al. Effective treatment of severe COVID-19 patients with tocilizumab. Proc Natl Acad Sci USA 2020; 117: 10970-5.
• Çolak S, Tekgöz E, Çınar M, et al. Efficacy of tocilizumab in severe COVID-19: a retrospective study. J Health Sci Med 2022; 5: 592-9.
• Cummings MJ, Baldwin MR, Abrams D, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet 2020; 395: 1763-70.
• Bhatraju PK, Ghassemieh BJ, Nichols M, et al. COVID-19 in critically ill patients in the Seattle Region—case series. N Engl J Med 2020; 382: 2012-22.
• Arentz M, Yim E, Klaff L, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA 2020; 323: 1612-4.
• Fan BE, Chong VCL, Chan SSW, et al. Hematologic parameters in patients with COVID-19 infection. Am J Hematol 2020; 95: E215.
• Guan WJ, Ni ZY, Hu Y, et al. China Medical Treatment Expert Group for COVID-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020; 382: 1708-20.
• Yang M, Chen X, Xu Y. A retrospective study of the C-reactive protein to lymphocyte ratio and disease severity in 108 patients with early COVID-19 pneumonia from January to March 2020 in Wuhan, China. Med Sci Monit 2020; 26: e926393.
• Bellan M, Patti G, Hayden E, et al. Fatality rate and predictors of mortality in an Italian cohort of hospitalized COVID-19 patients. Sci Rep 2020; 10: 20731.
• Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based of an analysis of data of 150 patients from Wuhan, China. Intens Care Med 2020: 846–8.
• Kermali M, Khalsa RK, Pillai K, Ismail Z, Harky A. The role of biomarkers in diagnosis of COVID-19 - a systematic review. Life Sci 2020; 254: 117788.
• Liu Y, Sun W, Guo Y, et al. Association between platelet parameters and mortality in coronavirus disease 2019: Retrospective cohort study. Platelets 2020; 31: 490-6.
• Bertsimas D, Lukin G, Mingardi L, et al. Hellenic COVID-19 Study Group. COVID-19 mortality risk assessment: an international multi-center study. PLoS One 2020; 15: e0243262
• Han Y, Zhang H, Mu S, et al. Lactate dehydrogenase, an independent risk factor of severe COVID-19 patients: a retrospective and observational study. Aging (Albany NY) 2020; 12: 11245-58.
• Poggiali E, Zaino D, Immovilli P, et al. Lactate dehydrogenase and C-reactive protein as predictors of respiratory failure in CoVID-19 patients. Clin Chim Acta 2020; 509: 135-8.
• Kara U, Şimşek F, Özhan MÖ, et al. The factor analysis approach to mortality prediction in COVID-19 severe disease using laboratory values: a retrospective study. J Health Sci Med 2022; 5: 528-33.
• Aloisio E, Chibireva M, Serafini L et al. A comprehensive appraisal of laboratory biochemistry tests as major predictors of COVID-19 severity. Arch Pathol Lab Med 2020; 144: 1457-64.
• Liu W, Tao ZW, Wang L, et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin Med J (Engl) 2020; 133: 1032-8.
• Park JE, Chung KS, Song JH, et al. The C-reactive protein/albumin ratio as a predictor of mortality in critically ill patients. J Clin Med 2018; 7: 333.