Laboratory risk factors for mortality in severe and critical COVID-19 patients admitted to the ICU

Abstract

Background: Several studies have reported clinical characteristics and risk factors for predicting adverse outcomes in COVID-19.4–6 However, data exclusively from the ICU especially in the low- and middle-income countries (LMIC) remain lacking. This study aimed to explore risk factors associated with mortality based on laboratory parameters at hospital admission in severe and critical COVID-19 patients admitted to the ICU. Methods: This study is a retrospective cohort study. Data from the electronic medical records were collected retrospectively from all severe and critical COVID-19 patients requiring ICU admission in two designated COVID-19 hospitals in Jakarta, Indonesia. A multivariate logistic regression analysis was used to identify the predictors associated with ICU mortality. The model performance was evaluated by the area under curve (AUC) from the receiver operating characteristic (ROC) analysis. Results: There were 334 patients admitted to the ICU with COVID-19 included in the statistical analysis. The ICU mortality rate was 75.1%, with 251 patients died in the hospital. Independent risk factors associated mortality including white blood cell count >13.9 x109/L (OR=2.41; 95% CI, 1.15-5.06, p=0.02), neutrophil to lymphocyte ratio >10.7 (OR=2.20; 95% CI, 1.20 – 4.03, p=0.011), and creatinine >0.8 mg/dL (OR=3.55; 95% CI, 2.05 – 6.17, p<0.001). The model yielded an AUC of 0.72 (95% CI, 0.659-0.780, p<0.0001) for predicting ICU mortality in severe and critical COVID-19 patients. Conclusions: White blood cell, neutrophil to lymphocyte ratio, and serum creatinine on hospital admission are significant predictors of mortality in severe and critical COVID-19 patients admitted to the ICU. The ICU mortality rate during the second wave of the pandemic in this study was high.