Potential biomarkers predictors of mortality in COVID-19 patients in the Emergency Department

Abstract

Objective. Identify which biomarkers performed in the first emergency analysis help to stratify COVID-19 patients according to mortality risk. Method. Observational, descriptive and cross-sectional study performed with data collected from patients with suspected COVID-19 in the Emergency Department from February 24 to March 16, 2020. The univariate and multivariate study was performed to find independent mortality markers and calculate risk by building a severity score. Results. A total of 163 patients were included, of whom 33 died and 29 of them were positive for the COVID-19 PCR test. We obtained as possible factors to conform the Mortality Risk Score age> 75 years ((adjusted OR = 12,347, 95% CI: 4,138-36,845 p = 0.001), total leukocytes> 11,000 cells / mm3 (adjusted OR = 2,649, 95% CI: 0.879-7.981 p = 0.083), glucose> 126 mg / dL (adjusted OR = 3.716, 95% CI: 1.247-11.074 p = 0.018) and creatinine> 1.1 mg / dL (adjusted OR = 2.566, 95% CI: 0.889- 7.403, p = 0.081) This score was called COVEB (COVID, Age, Basic analytical profile) with an AUC 0.874 (95% CI: 0.816-0.933, p <0.001; Cut-off point = 1 (sensitivity = 89.66 % (95% CI: 72.6% -97.8%), specificity = 75.59% (95% CI: 67.2% -82.8%). A score <1 has a negative predictive value = 100% (95% CI: 93.51% -100%) and a positive predictive value = 18.59% (95% CI: 12.82% -25.59%). Conclusions. Clinical severity scales, kidney function biomarkers, white blood cell count parameters, the total neutrophils / total lymphocytes ratio and procalcitonin are early risk factors for mortality. The variables age, glucose, creatinine and total leukocytes stand out as the best predictors of mortality. A COVEB score <1 indicates with a 100% probability that the patient with suspected COVID-19 will not die in the next 30 days.

Prognostic Factors at Admission for In-Hospital Mortality from COVID-19 Infection in an Older Rural Population in Central Spain

“…Patients who died had significantly increased inflammatory response with significantly elevated C-reactive protein (CRP) levels (mean [SD] 164 [99] vs. 126 [102] mg/L; p < 0.0001), but no significant D-dimer or ferritin serum levels. Respiratory failure in the emergency room was worse among patients who died (partial pressure of oxygen—pO2 (mean SD) 55.7 [19.5] vs. 65.6 [ 26 ] mmHg, p < 0.001). In addition, these patients also had significantly more acute renal injury (serum creatinine levels (mean [SD] 1.66 [1.05] vs. 1.11 [0.5] mg/L; p < 0.0001), urea (76.5 [48.5] vs. 48.8 [32.4] mg/dL; p < 0.001), and heart injury (ultra-sensitive troponin (mean [SD] 134.6 [283.2] vs. 28.23 [45.3] ng/mL, p = 0.046) on admission compared to patients who survived, which may help explain the higher mortality rates.…”

“…In contrast, patients’ sex was not associated significantly to mortality. While male sex has been revealed as a risk factor for mortality in several studies carried out both in Spain [ 22 ] and other countries [ 11 , 14 , 15 , 18 , 23 , 24 ], it was not in many others [ 17 , 20 , 21 , 25 , 26 , 27 ]. Male sex could act, therefore, as a confounding variable for other risk factors more commonly described among males, such as cardiovascular diseases or tobacco use.…”

“…As for the analytical findings, bivariate analyses identified thrombocytopenia, lymphopenia and elevated serum LDH, CRP, ultrasensitive Troponin I, urea, and creatinine as significantly more common in deceased patients. All of these afflictions have been shown to be related to severity [ 13 , 14 ] or independently associated with risk of death due to COVID-19 [ 17 , 18 , 23 ], and also specifically among Spanish patients [ 22 , 26 , 36 ]. Conversely, we did not find any relationship between D-dimer, WBC, or ferritin levels and mortality, as other studies did [ 13 , 14 , 23 , 24 ], nor among Spanish patients [ 22 , 26 ].…”

Lack of Association of Initial Viral Load in SARS-CoV-2 Patients with In-Hospital Mortality

“… 14 – 16 Likewise, other biochemical parameters play a critical role in severity stratification and prognosis. 17 , 18 …”

High admission blood glucose is an independent risk factor of poor prognosis in COVID-19: A systematic review and dose-response meta-analysis

“…To the best of our knowledge, this is the first meta-analysis conducted to show the potential use of admission BG as a predictor of poor prognosis in COVID-19 patients. Although our eligibility criteria may introduce language bias, our study included a relatively large number of cohorts and only four non-English articles were excluded [52][53][54][55] , suggesting that any potential bias was negligible. We hope that our findings may enhance the current knowledge on the management of COVID-19, thus contributing to the alleviation of the devastating disease burden.…”