Association and predictive value of biomarkers with severe outcomes in hospitalized patients with SARS-CoV-2 infection

• Published in: Cytokine (Philadelphia, Pa.) Vol. 149; p. 155755
• Main Authors: Fernandez-Botran, Rafael, Furmanek, Stephen, Ambadapoodi, Raghava Sekhar, Expósito González, Evelyn, Cahill, Meredith, Carrico, Ruth, Akca, Ozan, Ramírez, Julio A.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-01-2022
• Subjects: Aged; Biomarkers - metabolism; COVID-19; COVID-19 - metabolism; COVID-19 - pathology; Critical care; Cytokines and inflammatory mediators; Female; Growth factors; Hospital Mortality; Hospitalization; Humans; Inflammation; Inflammation - metabolism; Inflammation - pathology; Intensive care; Intensive Care Units; Male; Mechanical ventilation; Middle Aged; Retrospective Studies; SARS-CoV-2 - pathogenicity; Severity of Illness Index; CRP; PCT; Intensive care; BNP; ESR; Critical care; Inflammation; IHM; COVID-19; IMV; BUN; ICU; Growth factors; Mechanical ventilation; Cytokines and inflammatory mediators; VU
• ISSN: 1043-4666; 1096-0023
• DOI: 10.1016/j.cyto.2021.155755

•Risk factors for ICU admission were hyper-inflammation and decreased respiratory function (RF).•Risk factors for IMV were low platelets, abnormal neutrophil-lymphocyte ratio, and reduced RF.•Risk factors for vasopressor use (VU) were hyperinflammation, low platelets and reduced RF.•Risk factors for hospital mortality were hypercoagulability and decreased RF and kidney function.
This study analyzed the levels at admission of biomarkers for their association with and ability to predict risk of severe outcomes, including admission to the ICU, need for invasive mechanical ventilation (IMV), need for vasopressor use (VU), and in-hospital mortality (IHM) in 700 patients hospitalized with COVID-19. Biomarker data split by outcomes was compared using Mann-Whitney U tests; frequencies of biomarker values were compared using Chi-square tests and multivariable logistic regression analysis was performed to look at the impact of biomarkers by outcome. Patients that suffered IHM were more likely to have reduced platelet numbers and high blood urea nitrogen (BUN) levels among patients admitted to the ICU. Risk factors for mortality were related to hyper-coagulability (low platelet count and increased D-dimer) and decreased respiratory (PaO2/FiO2 ratio) and kidney function (BUN). Association with risks of other severe outcomes were as follows: ICU with hyper-inflammation (IL-6) and decreased respiratory function; IMV with low platelet count, abnormal neutrophil–lymphocyte ratio with reduced respiratory function, VU with inflammatory markers (IL-6), and low platelet count with respiratory function. Our studies confirmed the association of biomarkers of hematological, inflammatory, coagulation, pulmonary and kidney functions with disease severity. Whether these biomarkers have any mechanistic or causal role in the disease progress requires further investigation.