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

Abstract

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.

COVID-19 and Laboratory Markers from Romanian Patients—A Narrative Review

“…Significantly lower survival rates were observed for patients with increased international normalized ratios (INR), with a HR of 1.54, as found by Pal et al [59].…”

“…Many authors have reported high levels in data from Romania and suggested a link with the severity of the infection, as well as a possible marker for severity [26,[32][33][34]40,62]. Some authors have reported other common renal markers such as creatinine and urea [30,40,59]. In the study by Totan et al, urea levels were similar across severity groups [56], while other authors have reported normal values in their patients as well [21,43].…”

Predictors of mortality in hospitalised patients with COVID-19: a 1-year case–control study

“…These events are common in the pathogenesis of uncontrolled inflammation and massive cytokine release, supporting the hypothesis that hyperinflammation is a possible pathogenic mechanism in COVID-19 and, therefore, the rise of serum ferritin level findings 21. Multiple studies have also suggested that higher levels of C reactive protein (CRP) or other inflammatory markers on admission are linked to disease progression, severity and death 22–24. However, given the high missingness rates, we could not impute some of those markers and further studies are required to evaluate their role and interactions for the prediction of mortality.…”

Ferritin and procalcitonin in COVID-19 associated acute kidney injury – gender disparities, but similar outcomes

“…In addition to the fact that serum ferritin is a well recognized inflammatory marker and has pro-inflammatory effects, some data suggest that ferritin also has a cytoprotective effect by sequestering free iron ions, thus diminishing endothelial apoptosis and oxidative stress [31,32]. There are reports in the literature revealing no influence of increased ferritin on mortality in critical COVID-19 patients [33] or in COVID-19-associated AKI patients [34]. Thus, a possible explanation of similar outcome of AKI in both genders, despite higher ferritin in men in our study, may be the cytoprotective effect of ferritin.…”