On-admission and dynamic trend of laboratory profiles as prognostic biomarkers in COVID-19 inpatients

Abstract

This large-scale study aimed to investigate the trend of laboratory tests of patients with COVID-19. Hospitalized confirmed and probable COVID-19 patients in three general hospitals were examined from March 20, 2020, to June 18, 2021. The confirmed and probable COVID-19 patients with known outcomes and valid laboratory results were included. The least absolute shrinkage and selection operator (LASSO) and Cox regression were used to select admittance prognostic features. Parallel Pairwise Comparison of mortality versus survival was used to examine the trend of markers. In the final cohort, 11,944 patients were enrolled, with an in-hospital mortality rate of 21.8%, mean age of 59.4 ± 18.0, and a male-to-female ratio of 1.3. Abnormal admittance level of white blood cells, neutrophils, lymphocytes, mean cellular volume, urea, creatinine, bilirubin, creatine kinase-myoglobin binding, lactate dehydrogenase (LDH), Troponin, c-reactive protein (CRP), potassium, and creatinine phosphokinase reduced the survival of COVID-19 inpatients. Moreover, the trend analysis showed lymphocytes, platelet, urea, CRP, alanine transaminase (ALT), and LDH have a dissimilar trend in non-survivors compared to survived patients. This study proposed a novel approach to find serial laboratory markers. Serial examination of platelet count, creatinine, CRP, LDH, and ALT can guide healthcare professionals in finding patients at risk of deterioration.

Evolution of serious and life-threatening COVID-19 pneumonia as the SARS-CoV-2 pandemic progressed: an observational study of mortality to 60 days after admission to a 15-hospital US health system

“…We restricted our analyses to the earliest available clinical information before and at hospital admission, in part to enable generating a useful model to predict mortality and direct allocation of resources—an ‘early-warning’ model. Thus, we did not consider additional hospital events, such as mechanical ventilation or extracorporeal membrane oxygenation, escalation of care to an ICU, 81 subsequent laboratory test results during hospitalisation 74 or therapeutics. Such longitudinal models are most useful when implemented to support real-time decision-making.…”

“…Such longitudinal models are most useful when implemented to support real-time decision-making. 74 82 …”

Unravelling Insights into the Evolution and Management of SARS-CoV-2

“…Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels have increased in COVID-19, whereas platelet count and procalcitonin levels are normally within the range. Aspartate aminotransferase (AST), alanine transaminase (ALT), lactate dehydrogenase (LDH), creatine phosphokinase (CPK), creatinine, and prothrombin time, which can be employed as diagnostic markers, are associated with higher levels in severe instances (see Figure 2) [65][66][67].…”

“…The numbers of T cells, B cells, and natural killer (NK) cells are also lowered in severe instances, as are the numbers of helpers, regulatory, and memory T cells. Severe instances are marked by higher levels of proinflammatory cytokines and chemokines such as IFN-, IL-1, IP-10, MCP-1, TNF-, G-CSF, IL-8, IL-10, and MIP-1A [67,68].…”