Predictors of lethal COVID-19 in patients of intensive care unit

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Abstract

Aim – to identify potential independent routine laboratory predictors of lethal COVID-19 in critically ill patients admitted to the ICU.

Material and methods. This single-centered study included 120 critically ill adult patients with COVID-19 admitted to ICU of the Samara Regional Clinical Hospital named after V.D. Seredavin from August 1 to October 31, 2021. Data on demographics, chest computed tomography, echocardiography, lower extremity venous ultrasound, laboratory tests upon admission to ICU, and clinical outcomes were collected. Data of laboratory tests between survived and deceased patients were compared to identify risk factors of lethality. Univariable and multivariable logistic regression analyses were performed to examine the association of different laboratory parameters with mortality.

Results. As a result of our study, we obtained a multiple logistic regression model that can predict lethal outcomes (AUC=0.820) with relatively high sensitivity (85%) and specificity (85%).

According to our model, elevations in LDH (OR, 0.99; 95% CI, 0.99-1.2), Urea (OR, 0.82; 95% CI, 0.68-0.96), Glucose (OR, 0.99; 95% CI, 0.84-1.15), ASAT (OR, 0.97; 95% CI, 0.94-0.99), and also lymphopenia (lymphocytes count <3.00 × 109/L, OR, 2.53; 95% CI, 0.99-6.93) were predictive for lethal outcome of critically ill COVID-19 patients. Besides, by previously reported data, older age, a high percentage of lung damage on CT, and low heart output also were associated with high mortality risk.

Conclusion. Thus, LDH, Urea, ASAT, Glucose, and lymphocyte levels in COVID-19 patients upon ICU admission should be considered by physicians as independent predictors of the negative outcome.

About the authors

Olesya V. Gubaidullina

Samara State Medical University

Email: manovaolesya@yandex.ru
ORCID iD: 0000-0002-4871-3013

anesthesiologist-intensive care physician

Russian Federation, Samara

Artem V. Aleksankin

Samara State Medical University

Author for correspondence.
Email: aleksankin10@mail.ru
ORCID iD: 0000-0003-4518-9233

Head of the Department of Anesthesiology and Intensive Care No. 2

Russian Federation, Samara

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Supplementary files

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2. Figure 1. Single-variant logistic regression and ROC analysis of lymphocyte levels and neutrophil-lymphocyte index.

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3. Figure 2. Single-variant logistic regression (AG) and ROC analysis (H) for various biochemical parameters.

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4. Figure 3. Multivariate logistic regression and ROC analysis (A) based on LDH, urea, glucose, lymphocytes and ASAT levels.

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Copyright (c) 2024 Gubaidullina O.V., Aleksankin A.V.

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