Effect of Direct Bilirubin Level on Clinical Outcome and Prognoses in Severely/Critically Ill Patients With COVID-19

Abstract

ObjectivesWe aimed to investigate how changes in direct bilirubin (DBiL) levels in severely/critically ill the coronavirus disease (COVID-19) patients during their first week of hospital admission affect their subsequent prognoses and mortality.MethodsWe retrospectively enrolled 337 severely/critically ill COVID-19 patients with two consecutive blood tests at hospital admission and about 7 days after. Based on the trend of the two consecutive tests, we categorized patients into the normal direct bilirubin (DBiL) group (224), declined DBiL group (44) and elevated DBiL group (79).ResultsThe elevated DBiL group had a significantly larger proportion of critically ill patients (χ2-test, p < 0.001), a higher risk of ICU admission, respiratory failure, and shock at hospital admission (χ2-test, all p < 0.001). During hospitalization, the elevated DBiL group had significantly higher risks of shock, acute respiratory distress syndrome (ARDS), and respiratory failure (χ2-test, all p < 0.001). The same findings were observed for heart damage (χ2-test, p = 0.002) and acute renal injury (χ2-test, p = 0.009). Cox regression analysis showed the risk of mortality in the elevated DBiL group was 2.27 (95% CI: 1.50–3.43, p < 0.001) times higher than that in the normal DBiL group after adjusted age, initial symptom, and laboratory markers. The Receiver Operating Characteristic curve (ROC) analysis demonstrated that the second test of DBiL was consistently a better indicator of the occurrence of complications (except shock) and mortality than the first test in severely/critically ill COVID-19 patients. The area under the ROC curve (AUC) combined with two consecutive DBiL levels for respiratory failure and death was the largest.ConclusionElevated DBiL levels are an independent indicator for complication and mortality in COVID-19 patients. Compared with the DBiL levels at admission, DBiL levels on days 7 days of hospitalization are more advantageous in predicting the prognoses of COVID-19 in severely/critically ill patients.

Guild-Level Microbiome Signature Associated with COVID-19 Severity and Prognosis

“…Moreover, COVID-19 patients with an elevated TBIL at admission had a higher mortality rate ( 28 ). In addition to TBIL, increased direct bilirubin (DBIL) has been reported as an independent indicator of complications and mortality in COVID-19 patients ( 29 ). In particular, DBIL levels on day 7 of hospitalization are advantageous for predicting the prognosis of COVID-19 in severe/critical patients ( 29 ).…”

“…In addition to TBIL, increased direct bilirubin (DBIL) has been reported as an independent indicator of complications and mortality in COVID-19 patients ( 29 ). In particular, DBIL levels on day 7 of hospitalization are advantageous for predicting the prognosis of COVID-19 in severe/critical patients ( 29 ). Lactate dehydrogenase (LDH) has been associated with worse outcomes in viral infection.…”

Guild-level microbiome signature associated with COVID-19 severity and prognosis

“…Moreover, COVID-19 patients with an elevated TBIL at admission had a higher mortality 37 . In addition to TBIL, increased direct bilirubin (DBIL) has been reported as an independent indicator for complication and mortality in COVID-19 patients 38 . Particularly, DBIL levels at Day 7 of hospitalization are advantageous in predicting the prognosis of COVID-19 in severe/critical patients 38 .…”

“…In addition to TBIL, increased direct bilirubin (DBIL) has been reported as an independent indicator for complication and mortality in COVID-19 patients 38 . Particularly, DBIL levels at Day 7 of hospitalization are advantageous in predicting the prognosis of COVID-19 in severe/critical patients 38 . Lactate dehydrogenase (LDH) have been associated with worse outcomes in viral infection.…”

“…The two competing guilds microbiome signature at admission was associated with several immune, coagulation, hemogram and biochemical indicators of hospitalized patients after 1 week. These indicators included D-Dimer, Fg, FDP, LYMPH%, LYMPH#, Neu%, TC, CA, ALB, TBIL, DBIL, LDH and glucose, which have been reported to play the essential role in the host immune response to COVID-19 infection and disease progression [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] . The microbiome signature may server as an early predictor of COVID-19 prognosis as it was positively associated with bio-clinical parameters that have inverse relationship with poor prognosis, and negatively associated with those that have direct relationship with poor prognosis.…”