D-dimer, CRP, PCT, and IL-6 Levels at Admission to ICU Can Predict In-Hospital Mortality in Patients with COVID-19 Pneumonia

Milenkovic, Marija; Hadžibegović, Adi; Kovač, Mirjana; Jovanović, B; Stanisavljević, Jovana; Djikic, Marina; Sijan, D; Ladjević, Nebojša; Palibrk, Ivan; Djukanović, Marija; Veličković, Jelena; Ratković, Sanja; Brajković, Milica; Popadić, Višeslav; Klašnja, Slobodan; Tošković, Borislav; Zdravkovic, Darko; Crnokrak, Bogdan; Marković, Olivera; Bjekić-Macut, Jelica; Aleksic, Aleksandra; Petricevic, Simona; Memon, Lidija; Milojević, Ana; Zdravković, Marija

doi:10.1155/2022/8997709

Cited by 61 publications

(47 citation statements)

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“…A prospective cohort study identified cut-off values of 86 pg/mL for IL-6 and of 87.5 mg/L for CRP [ 33 ]. Another retrospective study of inflammatory biomarker levels at admission found cut-off values of 74.98 pg/mL and of 81 mg/L for IL-6 and CRP, respectively [ 34 ]. Similar IL-6 cut-off values to the ones in our analysis used for predicting fatal outcome were reported by Zhou et al [ 35 ] in a retrospective study of 66 patients, out of which only 17 were critical cases.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory Biomarkers Associated with In-Hospital Mortality in Critical COVID-19 Patients

Pál

Molnar

Huţanu

et al. 2022

IJMS

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The COVID-19 pandemic poses global healthcare challenges due to its unpredictable clinical course. The aim of this study is to identify inflammatory biomarkers and other routine laboratory parameters associated with in-hospital mortality in critical COVID-19 patients. We performed a retrospective observational study on 117 critical COVID-19 patients. Following descriptive statistical analysis of the survivor and non-survivor groups, optimal cut-off levels for the statistically significant parameters were determined using the ROC method, and the corresponding Kaplan-Meier survival curves were calculated. The inflammatory parameters that present statistically significant differences between survivors and non-survivors are IL-6 (p = 0.0004, cut-off = 27.68 pg/mL), CRP (p = 0.027, cut-off = 68.15 mg/L) and IL-6/Ly ratio (p = 0.0003, cut-off = 50.39). Additionally, other statistically significant markers are creatinine (p = 0.031, cut-off = 0.83 mg/dL), urea (p = 0.0002, cut-off = 55.85 mg/dL), AST (p = 0.0209, cut-off = 44.15 U/L), INR (p = 0.0055, cut-off = 1.075), WBC (p = 0.0223, cut-off = 11.68 × 109/L) and pH (p = 0.0055, cut-off = 7.455). A survival analysis demonstrated significantly higher in-hospital mortality rates of patients with values of IL-6, IL-6/Ly, AST, INR, and pH exceeding previously mentioned thresholds. In our study, IL-6 and IL-6/Ly have a predictive value for the mortality of critically-ill patients diagnosed with COVID-19. The integration of these parameters with AST, INR and pH could contribute to a prognostic score for the risk stratification of critical patients, reducing healthcare costs and facilitating clinical decision-making.

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Section: Discussionmentioning

confidence: 99%

Inflammatory Biomarkers Associated with In-Hospital Mortality in Critical COVID-19 Patients

Pál

Molnar

Huţanu

et al. 2022

IJMS

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“…This is in contrast to several studies that showed that elevated CRP levels at ICU admission is predictive of mortality in COVID-19 patients. 23 , 24 We hypothesize that the up- and down-regulating factors influencing the daily trend of CRP levels are too diverse, in severely ill COVID-19 patients in the ICU, resulting in a trend that is not significantly predictive of mortality.…”

Section: Discussionmentioning

confidence: 99%

Joint Modeling of Repeated Measurements of Different Biomarkers Predicts Mortality in COVID-19 Patients in the Intensive Care Unit

et al. 2022

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Introduction: Predicting disease severity is important for treatment decisions in patients with COVID-19 in the intensive care unit (ICU). Different biomarkers have been investigated in COVID-19 as predictor of mortality, including C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and soluble urokinase-type plasminogen activator receptor (suPAR). Using repeated measurements in a prediction model may result in a more accurate risk prediction than the use of single point measurements. The goal of this study is to investigate the predictive value of trends in repeated measurements of CRP, PCT, IL-6, and suPAR on mortality in patients admitted to the ICU with COVID-19. Methods: This was a retrospective single center cohort study. Patients were included if they tested positive for SARS-CoV-2 by PCR test and if IL-6, PCT, suPAR was measured during any of the ICU admission days. There were no exclusion criteria for this study. We used joint models to predict ICU-mortality. This analysis was done using the framework of joint models for longitudinal and survival data. The reported hazard ratios express the relative change in the risk of death resulting from a doubling or 20% increase of the biomarker’s value in a day compared to no change in the same period. Results: A total of 107 patients were included, of which 26 died during ICU admission. Adjusted for sex and age, a doubling in the next day in either levels of PCT, IL-6, and suPAR were significantly predictive of in-hospital mortality with HRs of 1.523 (1.012-6.540), 75.25 (1.116-6247), and 24.45 (1.696-1057) respectively. With a 20% increase in biomarker value in a subsequent day, the HR of PCT, IL-6, and suPAR were 1.117 (1.03-1.639), 3.116 (1.029-9.963), and 2.319 (1.149-6.243) respectively. Conclusion: Joint models for the analysis of repeated measurements of PCT, suPAR, and IL-6 are a useful method for predicting mortality in COVID-19 patients in the ICU. Patients with an increasing trend of biomarker levels in consecutive days are at increased risk for mortality.

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“…Zimmerman et al described the prognostic value of the first CRP measurement of patients hospitalized due to H1N1 influenza [ 32 ]. Inflammatory biomarkers in general, and specifically CRP, are known to have a prognostic value in COVID-19 patients [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. The availability of the CRP and CBC, in comparison to other biomarkers, is even more pronounced when considering that both are available as a point-of-care test that can be completed at the clinic or at the nursing home where the patients reside, at their bedside [ 33 , 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies demonstrated the usefulness of CRP and blood count as prognostic biomarkers in patients who were admitted to the hospital with COVID-19 infection [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. However, all of these studies referred to the adult population as one group and did not examine the association between these biomarkers and adverse outcomes in sub-populations.…”

Section: Introductionmentioning

confidence: 99%

Age-Dependent Biomarkers for Prediction of In-Hospital Mortality in COVID-19 Patients

Feigin

Levinson

Wasserman

et al. 2022

JCM

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Background: Several biomarkers and models have been proposed to predict in-hospital mortality among COVID-19 patients. However, these studies have not examined the association in sub-populations. The present study aimed to identify the association between the two most common inflammatory biomarkers in the emergency department and in-hospital mortality in subgroups of patients. Methods: A historical cohort study of adult patients who were admitted to acute-care hospital between March and December 2020 and had a diagnosis of COVID-19 infection. Data on age, sex, Charlson comorbidity index, white blood cell (WBC) count, C-reactive protein (CRP), and in-hospital mortality were collected. Discrimination ability of each biomarker was observed and the CHAID method was used to identify the association in subgroups of patients. Results: Overall, 762 patients (median age 70.9 years, 59.7% males) were included in the study. Of them, 25.1% died during hospitalization. In-hospital mortality was associated with higher CRP (median 138 mg/L vs. 85 mg/L, p < 0.001), higher WBC count (median 8.5 vs. 6.6 K/µL, p < 0.001), and higher neutrophil-to-lymphocyte ratio (NLR) (median 9.2 vs. 5.4, p < 0.001). The area under the ROC curve was similar among all biomarkers (WBC 0.643, NLR 0.677, CRP 0.646, p > 0.1 for all comparisons). The CHAID method revealed that WBC count was associated with in-hospital mortality in patients aged 43.1–66.0 years (<11 K/µL: 10.1% vs. 11+ K/µL: 27.9%), NLR in patients aged 66.1–80 years (≤8: 15.7%, >8: 43.3%), and CRP in patients aged 80.1+ years (≤47 mg/L: 18.8%, 47.1–149 mg/L: 43.1%, and 149.1+: 71.7% mortality). Conclusions: WBC, NLR, and CRP present similar discrimination abilities. However, each biomarker should be considered as a predictor for in-hospital mortality in different age groups.

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D-dimer, CRP, PCT, and IL-6 Levels at Admission to ICU Can Predict In-Hospital Mortality in Patients with COVID-19 Pneumonia

Cited by 61 publications

References 50 publications

Inflammatory Biomarkers Associated with In-Hospital Mortality in Critical COVID-19 Patients

Inflammatory Biomarkers Associated with In-Hospital Mortality in Critical COVID-19 Patients

Joint Modeling of Repeated Measurements of Different Biomarkers Predicts Mortality in COVID-19 Patients in the Intensive Care Unit

Age-Dependent Biomarkers for Prediction of In-Hospital Mortality in COVID-19 Patients

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