Predictors of Mortality in Patients of COVID-19 Pneumonia in Intensive Care Unit: An Observational Study in a Tertiary Care Hospital, Lucknow, India

Abstract

Introduction: Coronavirus Disease-2019 (COVID-19) is caused by the Severe Acute Respiratory Coronavirus-2 (SARS-CoV-2) which is an enveloped positive-sense single-stranded RNA virus. Initial steps of the infection involve binding of the spike protein (S) of the virus to Angiotensin Converting Enzyme-2 (ACE-2) receptor on the mucosal surfaces of various organs like lungs, kidney, heart, intestine. Pathogenesis of complications are still poorly understood. Aim: This study was designed to find out the baseline biochemical parameters at the time of admission which may predict outcome in COVID-19 patients. Materials and Methods: This observational study was conducted in a dedicated COVID-19 hospital, Dr. Ram Manohar Lohia Institute of Medical Sciences (Dr. RMLIMS), Lucknow, Uttar Pradesh, India, from 1st July, 2020 to 30th November, 2020. A total of 109 moderate to severe COVID-19 pneumonia patients who required Intensive Care Unit (ICU) admission, were enrolled. Based on their outcome, patients were divided into two groups: “Survived” and “Expired”. Biochemical characteristics of patients were compared among the two groups using univariate and multivariate analysis. Results: On Univariate analysis Coagulation profile, Prothrombin Time (PT), International Normalised Ratio (INR), Activated Partial Thromboplastin Time (APTT) and D-Dimer values were raised significantly in the expired group. Among other acute phase reactants Lactate Dehydrogenase (LDH), C-Reactive Protein (CRP), Interleukin-6 (IL-6), and Creatinine Phosphokinase-MB (CPKMB) were raised in expired group and this difference was significant statistically too. On Multivariate analysis among all acute phase reactant only IL-6 was increased significantly. All other variables were found to be non significantly associated with mortality, statistically (p-value <0.05). Conclusion: Baseline biochemical parameters have prognostic values in COVID-19 patients. Raised IL-6 levels can be viewed as an independent predictor of mortality among COVID-19 patients at the time of admission in ICU.

Lactate dehydrogenase and aspartate aminotransferase levels associated with the severity of COVID‑19: A systematic review and meta‑analysis

“…Essential information included in the study is shown in Table I. The clinical endpoints for each study were split between severe vs. non-severe (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25), survival or discharge vs. non-survival, or ICU (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). At the time of analysis, the non-survival and ICU patients were classified as the severe group.…”

“…All studies were retrospective observation studies, except one was the case-control study (15). The disease severity in nine studies was diagnosed according to the 'Diagnosis and Treatment of Novel Coronavirus Pneumonia' developed by the National Health Care Commission of China (15,22,25,29,30,32,33,36,37); two studies were determined according to World Health Organization (WHO) criteria (27,31); five studies were determined based on clinical and radiological findings (21,23,24,26,35); seven studies were not clarified (16)(17)(18)(19)(20)28,34).…”

“…Fifteen studies were conducted in Asia. Eleven of the studies were in China ( 15 , 22 , 23 , 25 , 29 , 30 , 32 , 33 , 35-37 ), one in Japan ( 31 ), one in India ( 19 ), one in Iran ( 28 ), and one in Pakistan ( 24 ); four studies were conducted in Europe, one in Georgia ( 21 ), one in Belgium ( 17 ), one in the Italian ( 18 ), one in Spain ( 34 ); two studies were performed in the Eurasian country of Turkey ( 16 , 26 ); one study was performed in African Morocco ( 27 ); one study was performed in North America Mexico ( 20 ). All studies were retrospective observation studies, except one was the case-control study ( 15 ).…”