The predictive role of biochemical markers on outcomes of severe Covid-19 patients admitted to intensive care unit

Abstract

Background: The pandemic of severe acute respiratory syndrome by coronavirus 2 (SARS-CoV-2) is a multi-system disease caused by a diffuse systemic process involving a complex interaction of the inflammatory, immunological and coagulative cascades. This study aims to identify the most effective biomarkers to predict poor outcome in intensive care unit (ICU) patients with severe COVID-19 disease. Methods: A single-centre retrospective observational study enrolled 69 deceased and 20 recovered patients treated in the ICU of the General Hospital Gradiska in the period from March 1, 2021. until April 1, 2022. We evaluated the leukocytes (WBC), lymphocytes (LYM), neutrophils (NEU), platelets (PLT), haemoglobin, neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). In addition, we evaluated the IL-6, ferritin, CRP, D-dimer, magnesium, bilirubin and lactate dehydrogenase. Results: Between deceased and recovered patients on admission to the ICU, there was a significant differencebetween the following parameters: WBC x10 9/L 11.50 (8.86–14.75) vs. 9.40 (5.90–11.90), p =0.026 ; NEU x10 9 /L 10.15 (7.81–12.74) vs. 8.60 (4.80–10.30) p=0.022 ; NLR 15.01 (10.60–24.33) vs. 9.45 (5.10– 14.90) p=0.02 ; SII 3712 (2240–6543) vs. 1949 (993–3720) p=0.003 . The magnesium level increased significantly over time in the patients who died, while the haemoglobin level and platelet count decreased. ROC analysis showed the following AUC values: WBC 0.774; NEU 0.781; NLR 0.786; SII 0.776; D-dimer 0.741, and bilirubin 0.713. Conclusion: In this retrospective study WBC, NEU, NLR, SII, D-dimer, and bilirubin determined at hospital admission had a high value in predicting death among patients with severe COVID-19.

Uvod: Pandemija teškog akutnog respiratornog sindroma koronavirusa 2 (SARS-CoV-2) je multisistemska bolest izazvana difuznim sistemskim procesom koji uključuje kompleksne interakcije inflamatornih, imunoloških i koagulacionih kaskadnih procesa. Cilj ove studije je da utvrdi najefikasnije biomarkere u proceni lošeg ishoda pacijenata u jedinici intenzivne nege (ICU) obolelih od teškog oblika bolesti COVID-19. Metode: Retrospektivna opservaciona studija je uključivala 69 preminulih i 20 preživelih pacijenata lečenih u ICU u Opštoj bolnici Gradiška u periodu od 01.03.2021. do 01.04.2022. godine. Procenjivane su vrednosti leukocita (WBC), limfocita (LYM), neutrofila (NEU), trombocita (PLT), hemoglobina, odnosa neutrofila i limfocita (NLR), odnosa trom bocita i limfocita (PLR), sistemskog inflama tornog indeksa (SII). Takođe, procenjivane su vrednosti inter leukina6, feritina, CRP, D-dimera, magnezijuma, bilirubina i aktivnost laktat dehidrogenaze. Rezultati: Prilikom prijema pacijenata u ICU postojala je značajna razlika u vrednostima sledećih parametara između preminulih i preživelih pacijenata: WBC x 109/L 11,50 (8,86-14,75) prema (vs.) 9,40 (5,90-11,90), p=0,026; NEU x109/L 10,15 (7,81-12,74) vs. 8,60 (4,80-10,30) p=0,022; NLR 15,01 (10,60-24,33) vs. 9,45 (5,10-14,90) p=0,02; SII 3712 (2240-6543) vs. 1949 (993-3720) p=0,003. Takođe, tokom vremena koncentracija magnezijuma je značajno rasla u grupi preminulih pacijenata, dok je koncentracija hemoglobina i broj trombocita opadao. ROC analiza je pokazala sledeće AUC vrednosti: WBC 0,774; NEU 0,781; NLR 0,786; SII 0,776; D-dimer 0,741 i bilirubin 0,713. Zaključak: U ovoj retrospektivnoj studiji WBC, NEU, NLR, SII, D-dimer i bilirubin, određeni pri prijemu u ICU, su imali visoku vrednost u predviđanju smrti između pacijenata s teškim COVID-19.