×
Home Current Archive Editorial board
News Contact
Review paper

Early predictors of severity and mortality in COVID-19 hospitalized patients

By
Sehveta Mustafić Orcid logo ,
Sehveta Mustafić
Contact Sehveta Mustafić

Department of Laboratory Diagnostics, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Faculty of Medicine, University in Tuzla, Tuzla, Bosnia and Herzegovina

Edin Jusufović ,
Edin Jusufović

Faculty of Medicine, University in Tuzla, Tuzla, Bosnia and Herzegovina

Department of Pulmonology, Public Educational and Health Centre, Tuzla, Bosnia and Herzegovina

Fatima Hukić ,
Fatima Hukić

Department of Laboratory Diagnostics, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Faculty of Medicine, University in Tuzla, Tuzla, Bosnia and Herzegovina

Emir Trnačević ,
Emir Trnačević

Department of Laboratory Diagnostics, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Pharmaceutical Faculty, University in Tuzla, Tuzla, Bosnia and Herzegovina

Anja Divković ,
Anja Divković

Department of Laboratory Diagnostics, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Pharmaceutical Faculty, University in Tuzla, Tuzla, Bosnia and Herzegovina

Alma Trnačević
Alma Trnačević

Faculty of Medicine, University in Tuzla, Tuzla, Bosnia and Herzegovina

Department of Infectious Diseases, University Clinical Centre Tuzla, Tuzla, Bosnia and Herzegovina

Abstract

Aim
To identify laboratory tests for early detection and the development of more severe illness and death in COVID-19 hospitalized patients.
Methods
A prospective study was done on 66 hospitalized COVID-19 patients (males: 54.5%; mean age 70.1 ± 9.6 years)
who were stratified into: moderate (n=36; 54.5%), severe (n=12; 18.2%), and critically ill (n=18; 27.3%). Besides clinical findings, a wide spectrum of laboratory parameters was monitored at admission and control during the first seven days of hospitalization and used to predict progression from non-severe to severe illness and to predict the final outcome.
Results
Critically ill patients showed a higher control value of white blood cell count, C-reactive protein, lactate dehydrogenase,
ferritin, but lower lymphocyte count and O2 saturation. Patients with fatal outcome (23; 34.85%) showed a higher control value of neutrophil, lactate dehydrogenase, ferritin, and lower lymphocyte and O2 saturation. Progression from moderate to severe or critical illness was predicted by increasing lactate dehydrogenase (95% CI 0.5803 to 0.8397;p=0.003729), increase in ferritin (95% CI 0.5288 to 0.8221;p=0.03248), and by drop in O2 saturation (95% CI 0.5498 to 0.8179;p=0.01168). A fatal outcome was predicted by increase in ferritin (95% CI 0.5059 to 0.8195;p=0.04985),
as well as by drop in O2 saturation (95% CI 0.5916 to 0.8803; p=0.001861).
Conclusion
Increase in ferritin, and drop in O2 saturation could be the most important prognostic parameters for the development of
more severe clinical illness and death in COVID-19 hospitalized patients.

References

1.
Nandy K, Salunke A, Pathak S, Pandey A, Doctor C, Puj K, et al. Coronavirus disease (COVID-19): a systematic review and meta-analysis to evaluate the impact of various comorbidities on serious events. DiabetesMetabSyndr. 2020;1017–25.
2.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan. Lancet. 2020;497–506.
3.
Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Zhong NS; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;1708–20.
4.
Zhu N, Zhang D, Wang, Yang L, Song B, Zhao J, et al. China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from patients with pneumonia in China. N Engl J Med. 2019;727–33.
5.
Kappert K, Jahić A, Tauber R. Assessment of serum ferritin as a biomarker in COVID-19: bystander or participant? Insights by comparison with other infectious and non-infectious diseases. Biomarkers. 2020;616–25.
6.
Tahaghoghi-Hajghorbani S, Zafari P, Masoumi E, Rajabinejad M, Jafari-Shakib R, Hasani B, et al. The role of dysregulated immune responses in CO-VID-19 pathogenesis. Virus Res. 2020;
7.
Rodríguez-Morales A, Macgregor K, Kanagarajah S, Patel D, Schlagenhauf P. Going global -travel and the 2019 novel coronavirus. Travel Med Infect Dis. 2020;101578.
8.
Zhou P, Yang X, Wang X, Hu B, Zhang L, Zhang W, et al. Addendum: a pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;6.
9.
Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. China medical treatment expert group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;1708–20.
10.
Mehta P, Mcauley D, Brown M, Sanchez E, Tattersall R, Manson J. HLH Across Speciality Collaboration, UK. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;1033–4.
11.
Hirano T, Murakami M. COVID-19: a new virus, but a familiar receptor and cytokine release syndrome. Immunity. 2020;731–3.
12.
Feld J, Tremblay D, Thibaud S, Kessler A. Naymagon L. Ferritin levels in patients with COVID-19: poor predictor of mortality and hemophagocytic lymphohistiocytosis. Int J Lab Hematol. 2020;773–9.
13.
Abbaspour N, Hurrell R, Kelishadi R. Review on iron and its importance for human health. J Res Med Sci. 2014;164–74.
14.
Chen T, Wu D, Chen H, Yang Y, Chen D, Ma G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;1091.
15.
Pranata R, Huang I, Lukito A, Raharjo S. Elevated N-terminal pro-brain natriuretic peptide is associated with increased mortality in patients with COVID-19: systematic review and meta-analysis. Postgrad Med J. 2020;387–91.
16.
Huang I, Pranata R. Lymphopenia in severe coronavirus disease-2019 (COVID-19): systematic review and meta-analysis. J Intensive Care. 2020;36.
17.
Huang I, Pranata R, Lim M, Oehadian A. Alisjahbana B. C-reactive protein, procalcitonin, d-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. 2020;1753466620937175.
18.
Chinese management guideline for COVID-19 (version 7.0). National Health Commission of the People’s Republic of China. 2020;
19.
Rukmini S. Who are India’s COVID-19 patients? 2020;
20.
Mehra M, Desai S, Kuy S, Henry T, Patel A. Cardiovascular disease, drug therapy, and mortality in Covid-19. N Engl J Med. 2020;102.
21.
Lipsitch M, Donnelly C, Fraser C, Blake I, Dorigatti C, Ferguson I, et al. Potential biases in estimating absolute and relative case-fatality risks during outbreaks. PLoSNegl Trop Dis. 2015;3846.
22.
Cummings M, Baldwin M, Abrams D, Jacobson S, Meyer B, Balough E, et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020;1763–70.
23.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;1054–62.
24.
Velavan T, Meyer C. Mild versus severe CO-VID-19: laboratory markers. Int J Infect Dis. 2020;304–7.
25.
Li T, Lu H, Zhang W. Clinical observation and management of COVID-19 patients. Emerg Microbes Infect. 2020;687–90.
26.
Dymond T. The Effects of viral infection on lymphocyte metabolism: a new perspective on disease characterization. Viral Immunol. 2018;278–81.
27.
Liu Z, Long W, Tu M, Chen S, Huang Y, Wang S, et al. Lymphocyte subset (CD4+, CD8+) counts reflect the severity of infection and predict the clinical outcomes in patients with COVID-19. J Infect. 2020;318–56.
28.
Shang Y, Liu T, Wei Y, Li J, Shao L, Liu M, et al. Scoring systems for predicting mortality for severe patients with COVID-19. EClinicalMedicine. 2020;100426.
29.
Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease. JAMA Intern Med. 2019;934–43.
30.
Deng Y, Liu W, Liu K, Fang Y, Shang J, Zhou L, et al. Clinical characteristics of fatal and recovered cases of coronavirus disease. Chin Med J (Engl). 2019;1261–7.
31.
Lippi G, Plebani M, Henry B. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis. ClinChi-mActa. 2020;145–8.
32.
Han Y, Zhang H, Mu S, Wei W, Tong J, Song C, et al. Lactate dehydrogenase, an independent risk factor of severe COVID-19 patients: a retrospective and observational study. Aging (Albany NY). 2020;11245–58.
33.
Erez A, Shental O, Tchebiner J, Laufer-Perl M, Wasserman A, Sella T, et al. Diagnostic and prognostic value of very high serum lactate dehydrogenase in admitted medical patients. Isr Med Assoc J. 2014;439–43.
34.
Henry B, Aggarwal G, Wong J, Benoit S, Vikse J, Plebani M, et al. Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: apooled analysis. Am J Emerg Med. 2020;1722–6.
35.
Henry B, De Oliveira M, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. ClinChem Lab Med. 2020;1021–8.
36.
Shi J, Li Y, Zhou X, Zhang Q, Ye X, Wu Z, et al. Lactate dehydrogenase and susceptibility to deterioration of mild COVID-19 patients: a multicenter nested case-control study. BMC Med. 2020;168.
37.
Poggiali E, Zaino D, Immovilli P, Rovero L, Losi G, Dacrema A, et al. Terracciano C. Lactate dehydrogenase and c-reactive protein as predictors of respiratory failure in COVID-19 patients. ClinChimActa. 2020;135–8.
38.
Netea GBE, Rovina M, Akinosoglou N, Antoniadou K, Antonakos A, Damoraki N, et al. Complex immune dysregulation in COVID-19 patients with severe respiratory failure. Cell Host Microbe. 2020;992–1000.
39.
Li Y, Hu Y, Yu J, Ma T. Retrospective analysis of laboratory testing in 54 patients with severe-or critical-type 2019 novel coronavirus pneumonia. Lab Invest. 2020;794–800.
40.
Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan. Intensive Care Med. 2020;846–8.
41.
Rosário C, Zandman-Goddard G, Holtz M, E, Cruz D, Shoenfeld D, et al. The hyperferritinemic syndrome: macrophage activation syndrome, Still’s disease, septic shock and catastrophic antiphospholipid syndrome. BMC Med. 2013;185.
42.
Thomas L, Thomas C. Detection of iron restriction in anaemic and non-anaemic patients: New diagnostic approaches. Eur J Haematol. 2017;262–8.
43.
Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;420–2.
44.
Xie J, Wu W, Li S, Hu Y, Hu M, Li J, et al. Clinical characteristics and outcomes of critically ill patients with novel coronavirus infectious disease (COVID-19) in China: a retrospective multicenter study. Intensive Care Med. 2020;1863–72.
45.
Jin Y, Wang M, Zuo Z, Fan C, Ye F, Cai Z, et al. Diagnostic value and dynamic variance of serum antibody in coronavirus disease. Int J Infect Dis. 2019;49–52.

Citation

Authors retain copyright. This work is licensed under a Creative Commons Attribution 4.0 International License. Creative Commons License

 

Article metrics

Google scholar: See link

The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.