Prognostic value of biochemical parameters among severe COVID-19 patients admitted to an intensive care unit of a tertiary hospital in South Africa

Zemlin, Annalise E; Allwood, Brian; Erasmus, Rajiv T; Masha, Tandi E.; Chapanduka, Zivanai C.; Jalavu, Thumeka P.; Ngah, Vera; Sigwadhi, Lovemore N.; Koegelenberg, Coenraad F. N.; Irusen, Elvis; Lalla, Usha; Yalew, Anteneh; Baines, Nicola; Tamuzi, Jacques L.; Barasa, Anne K.; Magutu, V.; Njeru, Caroline; Amayo, Angela; Mureithi, Marianne; Mungania, Mary; Sono-Setati, Musa E.; Zumla, Alimuddin; Nyasulu, Peter

doi:10.1016/j.ijregi.2022.01.012

Cited by 12 publications

(10 citation statements)

References 37 publications

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“…9 Limited studies have evaluated the prognostic biomarkers in developing countries where the burden of Covid-19 is the highest. 10 Only small studies are available from developing countries including India, [11][12][13][14][15][16][17] where the disease led to massive burden and deaths. Measurement of laboratory biomarkers is expensive and not routinely available in most developing countries.…”

Section: Introductionmentioning

confidence: 99%

Biomarkers and Outcomes in Hospitalized Covid-19 Patients: A Prospective Registry

Khedar

Gupta

Sharma

et al. 2022

Preprint

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Objectives: To determine association of biomarkers high sensitivity C-reactive protein (hsCRP), D-dimer, interleukin-6 (IL-6), lactic dehydrogenase (LDH), ferritin and neutrophil-lymphocyte ratio (NLR) at hospital admission with clinical features and outcomes in Covid-19. Methods: Successive virologically confirmed Covid-19 patients hospitalized from April 2020 to July 2021 were recruited in a prospective registry. Details of clinical presentation, investigations, management and outcomes were recorded. All the biomarkers were divided into tertiles to determine associations with clinical features and outcomes. Numerical data are presented in median and interquartile range (IQR 25-75). Univariate and multivariate (age, sex, risk factor, comorbidity adjusted) odds ratio (OR) and 95% confidence intervals (CI) were calculated to determine association of deaths with each biomarker. Results: We identified 3036 virologically confirmed Covid-19 patients during the study period, 1215 were hospitalized and included in the present study. Men were 70.0%, aged >60y 44.8%, hypertension 44.8% diabetes 39.6% and cardiovascular disease 18.9%. Median symptom duration was 5 days (IQR 4-7) and SpO2 95% (90-97). Total white cell count was 6.9x103/micro-litre, (5.0-9.8), neutrophils 79.2% (68.1-88.2) and lymphocytes 15.8% (8.7-25.5). Medians (IQR) for biomarkers were hsCRP 6.9 mg/dl (2.2-18.9), D-dimer 464 ng/dl (201-982), IL-6 20.1 ng/dl (6.5-60.4), LDH 284 mg/dl (220-396) and ferritin 351 mg/dl (159-676). Oxygen support at admission was in 38.6%, and non-invasive or invasive ventilatory support in 11.0% and 11.6% respectively. 173 (13.9%) patients died and 15 (1.2%) transferred to hospice care. For each biomarker, those in the second and third tertiles, compared to the first, had worse clinical and laboratory abnormalities, and greater oxygen and ventilatory support. Multivariate adjusted OR (95% CI) for deaths in second and third vs first tertiles, respectively, were for hsCRP 2.29(1.14-4.60) and 13.39(7.23-24.80); D-dimer 3.26(1.31-7.05) and 13.89(6.87-28.27); IL-6 2.61(1.31-5.18) and 10.96(5.88-20.43); ferritin 3.19(1.66-6.11) and 9.13(4.97-16.78); LDH 1.85(0.87-3.97) and 10.51(5.41-20.41); and NLR 3.34(1.62-6.89) and 17.52(9.03-34.00) (p<0.001). Conclusions: In Covid-19, high levels of biomarkers- hsCRP, D-dimer, IL-6, LDH, ferritin and NLR are associated with more severe illness and significantly greater in-hospital mortality. NLR, a simple, widely available and inexpensive investigation provides prognostic information similar to the more expensive biomarkers.

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Section: Introductionmentioning

confidence: 99%

Biomarkers and Outcomes in Hospitalized Covid-19 Patients: A Prospective Registry

Khedar

Gupta

Sharma

et al. 2022

Preprint

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“…Various biomarkers linked to multi-organ failure in severe COVID-19 infection include pro-inflammatory cytokines, albumin, Ferritin, bilirubin, alanine transaminase, LDH, urea, creatinine, and eGFR [14]. In the present study, the total leukocyte count, CRP, urea, creatinine, IL-6, and LDH were significantly more significant, and platelet count was significantly lower in the non-survivors group, showing the SARS-CoV-2 infection-associated multi-organ failure.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Inflammatory Profile of COVID-19 Infection at a Tertiary Care Centre in Northern Part of Tamil Nadu – A Retrospective Study

Shanmukham¹,

Srivijayan²,

Venugopal³

et al. 2022

Cureus

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The coronavirus disease (COVID-19) pandemic has incurred high costs for the entire planet. The complex interactions between the host, virus, and environment have resulted in various clinical outcomes. It is crucial to comprehend sickness severity and outcome predictors to provide early preventative measures for a better outcome. The current study aimed to determine the association of clinical and inflammatory profiles with the outcome of COVID-19 infection in patients admitted to the intensive care unit. MethodsThis retrospective study was done in patients admitted to intensive care units for COVID-19 with a positive reverse transcriptase polymerase chain reaction (RTPCR) assay. A total of 125 patients above 18 years were included in the study. The patient's age, gender, and co-morbidities like type 2 diabetes mellitus, hypertension, respiratory illness, and coronary artery disease were noted. The patient's symptomatology, vital signs, oxygen saturation (Spo2), need for inotropes, and non-invasive positive pressure ventilator support (NIPPV) were observed. Computed tomography severity score (CTSS) and hematological and inflammatory parameters at the time of admission were noticed. Patient's management and treatment outcomes as survivors and non-survivors were noted. ResultsThe mean age was significantly greater in non-survivors. The common symptoms were fever, respiratory distress, cough, muscle pain, and sore throat. The leucocyte count, C-reactive protein (CRP), urea, creatinine, interleukin-6 (IL-6), and lactate dehydrogenase (LDH) were greater, and platelet counts were lower significantly in the non-survivors group. On multivariable logistic regression, CT severity score, NIPPV, and IL-6 had an odds ratio of 1.17, 0.052, and 1.03, respectively. IL-6 had a sensitivity of 81.5% and a specificity of 81.8% with a cut-off value of 37.5. ConclusionVigilant monitoring of leucocyte count, CRP, urea, creatinine, IL-6, LDH, platelet count, and CT severity score is essential for managing COVID-19 infection. IL-6 was found to be a significant marker as a predictor of outcome in our study.

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“…Data quality assurance was done by the research assistants and veri ed by the supervisor of the research team before analysis. Detailed information about the clinical parameters is de ned in the previously published articles [17,18].…”

Section: Data Collectionmentioning

confidence: 99%

Estimating the causal effect of dexamethasone versus hydrocortisone on the neutrophil-lymphocyte ratio in critically ill COVID-19 patients from Tygerberg Hospital ICU using targeted maximum likelihood estimation method

Nkuhairwe,

Esterhuizen,

Sigwadhi

et al. 2023

Preprint

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Background Causal inference from observational studies is a study topic that has advanced fast over the years, as have methods for causal effect estimation. Among them, Targeted Maximum Likelihood estimation (TMLE) possesses the most outstanding statistical properties, and with no outright treatment for COVID-19, there was an opportunity to estimate the causal effect of dexamethasone versus hydrocortisone upon the neutrophil-lymphocyte ratio (NLR), a vital indicator for disease progression among critically ill COVID-19 patients. This study is designed to show the application of TMLE variations to estimate the causal effect of dexamethasone versus hydrocortisone on the neutrophil-lymphocyte ratio in critically ill COVID-19 patients. Methods We retrospectively analysed data from the first and second COVID-19 waves, including critically ill COVID-19 patients. TMLE variations were used in the analysis and Super Learner (SL), Bayesian Additive Regression Trees (BART) and parametric regression (PAR) were implemented to estimate the average treatment effect (ATE) and its 95%CI Statistical analysis was carried out with ltmle package in R-software. Result presented in graph and tables. Results The study had 168 participants, 128 on dexamethasone and 40 on hydrocortisone. The mean causal difference in NLR on day 5; ATE [95% CI]: from SL-TMLE was − 2.28[-6.811, 2.246], BART-TMLE − 2.10[-6.464, 2.262] and PAR-TMLE − 2.16[-5.710, 1.397]. The ATE of dexamethasone versus hydrocortisone on NLR was not statistically significant since the confidence interval included zero. Conclusion In critically ill COVID-19 patients admitted to ICU, the effect of dexamethasone on NLR was not significantly different from that of hydrocortisone. This means that the variation in NLR impact between the two medicines may be attributable to random chance. However, TMLE remains an excellent tool for causal analysis of observational research, with the ability to be supplemented by numerous prediction approaches.

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Prognostic value of biochemical parameters among severe COVID-19 patients admitted to an intensive care unit of a tertiary hospital in South Africa

Cited by 12 publications

References 37 publications

Biomarkers and Outcomes in Hospitalized Covid-19 Patients: A Prospective Registry

Biomarkers and Outcomes in Hospitalized Covid-19 Patients: A Prospective Registry

Clinical and Inflammatory Profile of COVID-19 Infection at a Tertiary Care Centre in Northern Part of Tamil Nadu – A Retrospective Study

Estimating the causal effect of dexamethasone versus hydrocortisone on the neutrophil-lymphocyte ratio in critically ill COVID-19 patients from Tygerberg Hospital ICU using targeted maximum likelihood estimation method

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