Early Routine Biomarkers of SARS-CoV-2 Morbidity and Mortality: Outcomes from an Emergency Section

Abstract

Background. COVID-19 is a severe acute respiratory disease caused by SARS-CoV-2, a virus belonging to the Coronaviridae family. This disease has spread rapidly around the world and soon became an international public health emergency leading to an unpredicted pressure on the hospital emergency units. Early routine blood biomarkers could be key predicting factors of COVID-19 morbidity and mortality as suggested for C-reactive protein (CRP), IL-6, prothrombin and D-dimer. This study aims to identify other early routine blood biomarkers for COVID-19 severity prediction disclosed directly into the emergency section. Methods. Our research was conducted on 156 COVID-19 patients hospitalized at the Sapienza University Hospital “Policlinico Umberto I” of Rome, Italy, between March 2020 and April 2020 during the paroxysm’s initial phase of the pandemic. In this retrospective study, patients were divided into three groups according to their outcome: (1) emergency group (patients who entered the emergency room and were discharged shortly after because they did not show severe symptoms); (2) intensive care unit (ICU) group (patients who attended the ICU after admission to the emergency unit); (3) the deceased group (patients with a fatal outcome who attended the emergency and, afterward, the ICU units). Routine laboratory tests from medical records were collected when patients were admitted to the emergency unit. We focused on Aspartate transaminase (AST), Alanine transaminase (ALT), Lactate dehydrogenase (LDH), Creatine kinase (CK), Myoglobin (MGB), Ferritin, CRP, and D-dimer. Results. As expected, ANOVA data show an age morbidity increase in both ICU and deceased groups compared with the emergency group. A main effect of morbidity was revealed by ANOVA for all the analyzed parameters with an elevation between the emergency group and the deceased group. Furthermore, a significant increase in LDH, Ferritin, CRP, and D-dimer was also observed between the ICU group and the emergency group and between the deceased group and ICU group. Receiver operating characteristic (ROC) analyses confirmed and extended these findings. Conclusions. This study suggests that the contemporaneous presence of high levels of LDH, Ferritin, and as expected, CRP, and D-dimer could be considered as potential predictors of COVID-19 severity and death.

Long-term T cell perturbations and waning antibody levels in individuals needing hospitalization for COVID-19

“…Our initial measurement of clinical parameters was consistent with others showing elevated CRP and LDH, common acute-inflammatory biomarkers [49, 68, 69]. These have been shown to have a positive correlation with the development of pulmonary lesions during early COVID-19, and consequently with severe COVID-19 and related respiratory complications [70, 71]. We recently found an association of soluble urokinase Plasminogen Activator Receptor with COVID-19 severity, and length of hospitalization [72].…”

“…to have a positive correlation with the development of pulmonary lesions during early COVID-19, and consequently with severe COVID-19 and related respiratory complications [70,71]. We recently found an association of soluble urokinase Plasminogen Activator Receptor with COVID-19 severity, and length of hospitalization [72].…”

Prognostic Value of Transaminases and Bilirubin Levels at Admission to Hospital on Disease Progression and Mortality in Patients with COVID-19—An Observational Retrospective Study

“…Our data are in line with other similar studies in the literature [12][13][14][15][16][17][18][19][20][21][22]. Those studies, mainly performed in the USA, showed a significant association between the increase in liver function and disease progression or death in patients with COVID-19 [20][21][22].…”

“…Liver damage is likely multifactorial: it may be due not only to direct viral damage, but also due to a systemic cytokine storm, pro-thrombotic state, drug use and abuse during COVID-19, and hypoxic injury [8]. Finally, several studies have investigated the role of liver enzymes on disease progression and mortality [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], showing a relation between the elevation of liver enzymes, considered as a manifestation of liver damage, and the severity of COVID-19 disease. In addition, the impact that the SARS-CoV-2 pandemic has determined on patients with liver disease has been considerable for both outpatient and inpatient management [23][24][25].…”

Predicting mortality in hospitalized COVID-19 patients

“…An early risk stratification might help in differentiating patients at higher risk of severe disease to provide an adequate care. Several anamnestic, clinical, and blood sample findings were previously reported to associate with a negative outcome, including obesity and metabolic syndrome [1], hypertension [2], inflammatory biomarkers [3], procalcitonin and D-dimer [4], impaired coagulation [5], and even the amount of time spent in the intensive care unit [6]. However, to date none of these emerged above the others.…”