Role of Biochemical Markers in Invasive Ventilation of Coronavirus Disease 2019 Patients: Multinomial Regression and Survival Analysis

Abstract

Background and objectives Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic. The disease mainly affects the respiratory system of the patient, in particular, the lungs, which leads to patients presenting with acute respiratory distress syndrome and acute respiratory failure, with 5-15% of patients requiring observation in the intensive care unit (ICU) with respiratory support in the form of ventilation. This study was aimed at identifying the role of biochemical markers in the risk stratification of invasive and non-invasive ventilation of hospitalized COVID-19 patients. Materials and methods The study was conducted as a prospective, observational study of all admitted COVID-19 patients. A comparative analysis was performed of the survivors who were on invasive versus (vs) non-invasive ventilation and the non-survivors similarly. After computing the descriptive statistics, a multinomial logistic regression model was applied to obtain an unadjusted odds ratio (OR) at 95% confidence interval (CI), with Hosmer-Lemeshow (HL) goodness-of-fit test used to predict the fitness of the data. Kaplan-Meier survival curves were obtained for each of the laboratory investigations predicting survival along with the intensive care stay and invasive ventilation. A log-rank test was carried out to compare the survival distributions. Results A total of 373 included patients in the study had a mean age of 52.78 ± 15.76 years with females younger than males, and indifference amongst invasive vs non-invasively ventilated (p=0.821). Females were slightly more prone to invasive ventilation (p=0.097). Overall, 39% of the subjects did not need respiratory support, while 13% were on a ventilator, 16% on bilevel positive airway pressure/continuous positive airway pressure (BiPAP/CPAP), and 31% on supplemental oxygen therapy. Among the laboratory markers, mean hemoglobin was evidently lower in the invasive group, leukocytosis and thrombocytopenia were present in both invasively ventilated and non-surviving patients, while neutrophilia and lymphocytopenia were statistically indifferent among the mode of ventilation. Elevated urea, creatinine, and sodium were also significantly deranged laboratory markers amongst the invasively ventilated group. C-reactive protein (CRP) and lactate dehydrogenase (LDH) were elevated significantly in the invasive group, while serum ferritin was more frequently raised in the non-invasively ventilated group. Procalcitonin (PCT) was significantly associated with invasive ventilation as opposed to the non-invasive group. D-dimer was equally raised in both the groups at admission but significantly elevated in the invasive group at discharge. A multinomial regression model signified D-dimer (

Comparison of first and second waves of COVID-19 through severity markers in ICU patients of a developing country

“…Another study conducted on hematological parameters of COVID-19 patients showed a mean PLR of 152 in non-severe and 257 in severely affected patients, respectively [24]. Another study conducted previously on a similar population revealed follow-ups of severe laboratory markers in recovered and non-surviving COVID-19 patients, with most of the trends were similar to our study [25]. An analysis conducted on 154 ICU admissions of COVID-19 showed APACHE-II score of 15 and SOFA score of 2.62 with significantly higher scores were predictive of mortality [26].…”

Correlation of refractory hypoxemia with biochemical markers and clinical outcomes of COVID-19 patients in a developing country: A retrospective observational study

“…Although, D-dimer was an effective predictor of mortality in COVID-19 specified by various studies [36,37]. Overall, mortality predictions have been mostly associated in the literature with LDH, followed by CRP, D-dimer, moderately associated with NLR and PCT, and least associated with serum ferritin [38,39]. There were a few limitations of our study, we did not utilize the measurement of oxygen saturation of arterial blood gases as a partial oxygen pressure (arterial PaO2) but instead as pulse oximetry.…”

Evaluating characteristics associated with the mortality among invasive ventilation COIVD -19 patients

“…Fang, Li [ 17 ] reported that male gender and COPD is associate with increased risk of invasive ventilation, however, this data is not evaluated in terms of mortality. The findings from the study by Asghar, Haider Kazmi [ 18 ] concluded that urea, creatinine, sodium, CRP and lactate dehydrogenase are significant markers of invasive ventilation. Among these markers, D-dimer, hypernatremia, procalcitonin, neutrophilia, leukocytosis, and serum urea can predict mortality in these patients.…”