Abstract

Laboratory Based Mortality Prediction in Covid-19 patients

Background: Several markers were linked to adverse clinical outcomes in critically ill patients with COVID-19. Previous reports showed that elevated Neutrophil-to-Lymphocyte Ratio (NLR), C-Reactive Protein (CRP), D-dimer, vitamin D levels, and serum ferritin are associated with worse outcomes and increased mortality of critically ill patients with COVID-19; however, evidence is still insufficient to implement the predictive values of these markers in the management algorithm for the patients. Objectives: To evaluate the predictive value of five blood markers on the outcomes of critically ill COVID-19 patients. Methods: We performed a prospective study that included 40 critically ill patients with COVID-19 (COVID severity index ≥ 8) who were admitted to the Intensive Care Unit (ICU) of a tertiary hospital in Egypt. Blood samples for the studied markers were collected within two days of admission. Results: Forty patients were included, with a mean age of 55.6 ± 9.9 years and equal gender distribution. Nearly 62.5% of the patients needed mechanical ventilation, with mean days of ventilation of 15 days. The SOFA score after 48 hours was 9 ± 2.8. Fifty-five percent of participants needed high doses of vasopressors. The mean length of stay in the ICU was 17.7 days ± 5.5 days, and the mortality occurred in 55% of participants. There was a trend towards an association between mortality and male sex, presence of diabetes mellites, bilateral infiltration of lungs, and heart failure. After admission, the serum CRP, ferritin, D-dimer, NLR, and SOFA score after 48 hours had a significant role in the prediction of mortality. Both NLR and D-dimer had the highest area under the curve and sensitivity (95.5% for NLR vs. 90.9% for D-dimer), specificity (100% for both), PPV, and NPV at a cut-off value of 5.5 and 0.85 for both, respectively. Besides, the vitamin D level after 48 hours had a significant role in predicting mortality at a cut-off ≤ 18. Conclusions: CRP, NLR, and D-dimer were found to be reliable predictors of COVID-19 outcomes, including critical illness and mortality. Elevated serum ferritin and vitamin D an be used as supplementary predictors but cannot be relied on as independent predictors. The interpretation of these biomarkers should be correlated with many demographic and clinical factors

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