Could we predict the prognosis of the COVID‐19 disease?

• Published in: Journal of medical virology Vol. 93; no. 4; pp. 2420 - 2430
• Main Authors: Tahtasakal, Ceren A., Oncul, Ahsen, Sevgi, Dilek Yıldız, Celik, Emine, Ocal, Murat, Turkkan, Hakkı M., Bayraktar, Banu, Oba, Sibel, Dokmetas, Ilyas
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-04-2021
• Subjects: Adult; Age; Aged; Aged, 80 and over; Calcium-binding protein; Comorbidity; Coronaviruses; COVID-19; COVID-19 - blood; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 - virology; Creatinine; Dimers; Female; Ferritin; Humans; Intensive Care Units; L-Lactate dehydrogenase; Laboratory tests; Lactate dehydrogenase; Lactic acid; Leukocytes (neutrophilic); Lymphocytes; Male; Mathematical analysis; Middle Aged; Mortality; Neutrophils; novel coronavirus; Oxygen content; pandemic; Pandemics; Patients; Procalcitonin; Prognosis; Retrospective Studies; Risk analysis; Risk Factors; SARS-CoV-2 - isolation & purification; SARS‐CoV 2; Sulfur dioxide; Troponin; Troponin I; Turkey - epidemiology; Urea; Viral diseases; Virology; Young Adult; Turkey; COVID-19; novel coronavirus; pandemic; SARS-CoV 2; prognosis
• ISSN: 0146-6615; 1096-9071
• DOI: 10.1002/jmv.26751

Objectives
Coronavirus 2019 disease (COVID‐19) lead to one of the pandemics of the last century. We aimed to predict poor prognosis among severe patients to lead early intervention.
Methods
The data of 534 hospitalized patients were assessed retrospectively. Risk factors and laboratory tests that might enable the prediction of prognosis defined as being transferred to the intensive care unit and/or exitus have been investigated.
Results
At the admission, 398 of 534 patients (74.5%) were mild‐moderate ill. It was determined that the male gender, advanced age, and comorbidity were risk factors for severity. To estimate the severity of the disease, receiver operating characteristic analysis revealed that the areas under the curve which were determined based on the optimal cut off values that were calculated for the variables of values of neutrophil to lymphocyte ratio (NLR > 3.69), C‐reactive protein (CRP > 46 mg/L), troponin I ( > 5.3 ng/L), lactate dehydrogenase (LDH > 325 U/L), ferritin ( > 303 ug/L), d‐dimer ( > 574 μg/L), neutrophil NE ( > 4.99 × 109/L), lymphocyte (LE < 1.04 × 109/L), SO2 ( < %92) were 0.762, 0.757,0.742, 0.705, 0.698, 0.694,0.688, 0.678, and 0.66, respectively. To predict mortality, AUC of values for optimal cutoff troponin I ( > 7.4 ng/L), age ( > 62), SO2 ( < %89), urea ( > 40 mg/dL), procalcitonin ( > 0.21 ug/L), CKMB ( > 2.6 ng/L) were 0.715, 0.685, 0.644, 0.632, 0.627, and 0.617, respectively.
Conclusions
The clinical progress could be severe if the baseline values of NLR, CRP, troponin I, LDH, are above, and LE is below the specified cut‐off point. We found that the troponin I, elder age, and SO2 values could predict mortality.
Highlights
Since the increased baseline levels of WBC, NE, CRP, ALT, AST, urea, creatinine, LDH, ferritin, d‐dimer, cardiac enzymes, high lactate, and the decreased baseline level of lymphocyte occur in the presence of a severe clinical manifestation; thus it is considered that they can be used as markers of poor prognosis
The clinical progress could be predicted to be severe, if the baseline values of NLR, CRP, troponin I, LDH, d‐dimer, ferritin, and NE are above the specified cut‐off point and if the value of the lymphocyte is below the cut‐off point.
It was determined that the values of troponin I, CRP, AST, d‐dimer, and oxygen saturation could be used to predict mortality.
Predicting poor prognosis will allow for early treatment and close follow‐up