D-dimer, Troponin, and Urea Level at Presentation With COVID-19 can Predict ICU Admission: A Single Centered Study

Abstract

Background: Identifying clinical-features or a scoring-system to predict a benefit from hospital admission for patients with COVID-19 can be of great value for the decision-makers in the health sector. We aimed to identify differences in patients' demographic, clinical, laboratory, and radiological findings of COVID-19 positive cases to develop and validate a diagnostic-model predicting who will develop severe-form and who will need critical-care in the future.Methods: In this observational retrospective study, COVID-19 positive cases (total 417) diagnosed in Al Kuwait Hospital, Dubai, UAE were recruited, and their prognosis in terms of admission to the hospital and the need for intensive care was reviewed until their tests turned negative. Patients were classified according to their clinical state into mild, moderate, severe, and critical. We retrieved all the baseline clinical data, laboratory, and radiological results and used them to identify parameters that can predict admission to the intensive care unit (ICU).Results: Patients with ICU admission showed a distinct clinical, demographic as well as laboratory features when compared to patients who did not need ICU admission. This includes the elder age group, male gender, and presence of comorbidities like diabetes and history of hypertension. ROC and Precision-Recall curves showed that among all variables, D dimers (>1.5 mg/dl), Urea (>6.5 mmol/L), and Troponin (>13.5 ng/ml) could positively predict the admission to ICU in patients with COVID-19. On the other hand, decreased Lymphocyte count and albumin can predict admission to ICU in patients with COVID-19 with acceptable sensitivity (59.32, 95% CI [49.89–68.27]) and specificity (79.31, 95% CI [72.53–85.07]).Conclusion: Using these three predictors with their cut of values can identify patients who are at risk of developing critical COVID-19 and might need aggressive intervention earlier in the course of the disease.

The Prognostic Value of ADAMTS-13 and von Willebrand Factor in COVID-19 Patients: Prospective Evaluation by Care Setting

“…This may reflect a more pronounced prothrombotic state in ICU patients. The D-dimer concentration shows a significant association with COVID-19 severity, reaching the highest values in the patients admitted to the ICU and in those requiring mechanical ventilation [22,23]. The present results are…”

“…This may reflect a more pronounced pro-thrombotic state in ICU patients. The D-dimer concentration shows a significant association with COVID-19 severity, reaching the highest values in the patients admitted to the ICU and in those requiring mechanical ventilation [ 22 , 23 ]. The present results are consistent with the previous findings, as the D-dimer levels observed in the ICU patients were more than 10-fold higher than those observed in the MW patients.…”

Temporal Associations of the SARS-CoV-2 NP Antigen and Anti-Spike Total Ig Levels with Laboratory Parameters in a Greek Cohort of Hospitalized COVID-19 Patients

“…Such a model recently identified CRP, LDH, and urea as significant prognostic factors for severe COVID-19 illness [ 28 ]. CRP, LDH, and D-dimer have also been associated with increased mortality risk in patients with comorbidities [ 29 ], while D-dimer and urea, in combination with troponin, have been identified as predictors of admission to the intensive care unit [ 30 ].…”

Red Cell Distribution Width Upon Hospital Admission Predicts Short-Term Mortality in Hospitalized Patients With COVID-19: A Single-Center Experience

“…While most patients experience mild illness without significant respiratory manifestations, approximately 19% of patients have a severe disease course with reported case fatality rates of up to 49% among critically ill cases in China (2). Several laboratory markers have been identified to be of prognostic value in COVID-19, including lactate dehydrogenase (LDH), blood urea nitrogen (BUN) and neutrophil to lymphocyte ratio (NLR) among others (3)(4)(5). As of January 9, 2021 a total of 376.993 COVID-19 cases with 6.687 fatal outcomes were reported in Austria (6).…”