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A Comprehensive Appraisal of Laboratory Biochemistry Tests as Major Predictors of COVID-19 Severity
Elena Aloisio1, Mariia Chibireva1, Ludovica Serafini1
1From the Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy (Aloisio, Chibireva, Serafini, Pasqualetti, Falvella, Dolci, Panteghini).
Insights
Biochemical markers like lactate dehydrogenase and albumin can predict COVID-19 severity. Specific cutoffs for these markers help clinicians stratify risk for hospitalized patients, aiding in better patient outcomes.
Area of Science:
- Biochemistry
- Clinical Medicine
- Infectious Diseases
Background:
- A significant number of patients with coronavirus disease 2019 (COVID-19) experience severe illness and adverse outcomes.
- Predicting COVID-19 severity is crucial for effective patient management, but established criteria for risk stratification are lacking.
Purpose of the Study:
- To evaluate six serum biomarkers (C-reactive protein, lactate dehydrogenase, D-dimer, albumin, ferritin, and cardiac troponin T) for their ability to predict COVID-19 severity.
- To establish specific cutoff values for these biomarkers to assist clinicians in stratifying the risk of hospitalized COVID-19 patients.
Main Methods:
- A retrospective analysis of 427 COVID-19 patients was conducted.
- Patients were categorized based on clinical outcomes: survivors vs. nonsurvivors and intensive care unit (ICU) admission vs. non-ICU admission.
- Receiver operating characteristic curves and likelihood ratios were used to determine predictive cutoff points for the biomarkers.
Main Results:
- Peak marker concentrations differed significantly between outcome groups.
- Univariate analysis showed all markers were associated with increased odds of death and ICU admission.
- Multivariate analysis identified high lactate dehydrogenase and low albumin as predictors of death, while low lactate dehydrogenase predicted lower ICU admission odds. Optimal cutoffs were determined for lactate dehydrogenase and albumin in predicting mortality and for lactate dehydrogenase in predicting ICU admission.
Conclusions:
- This study identifies key biochemical tests that are major predictors of COVID-19 severity.
- Definitive cutoff values for these biomarkers are established to aid in clinical risk stratification of hospitalized patients.
Context.—:
A relevant portion of coronavirus disease 2019 (COVID-19) patients develop severe disease with negative outcomes. Several biomarkers have been proposed to predict COVID-19 severity, but no definite interpretative criteria have been established to date for stratifying risk.
Objective.—:
To evaluate 6 serum biomarkers (C-reactive protein, lactate dehydrogenase, D-dimer, albumin, ferritin, and cardiac troponin T) for predicting COVID-19 severity and to define related cutoffs able to aid clinicians in risk stratification of hospitalized patients.
Design.—:
A retrospective study of 427 COVID-19 patients was performed. Patients were divided into groups based on their clinical outcome: nonsurvivors versus survivors and patients admitted to an intensive care unit versus others. Receiver operating characteristic curves and likelihood ratios were employed to define predictive cutoffs for evaluated markers.
Results.—:
Marker concentrations at peak were significantly different between groups for both selected outcomes. At univariate logistic regression analysis, all parameters were significantly associated with higher odds of death and intensive care. At the multivariate analysis, high concentrations of lactate dehydrogenase and low concentrations of albumin in serum remained significantly associated with higher odds of death, whereas only low lactate dehydrogenase activities remained associated with lower odds of intensive care admission. The best cutoffs for death prediction were greater than 731 U/L for lactate dehydrogenase and 18 g/L or lower for albumin, whereas a lactate dehydrogenase activity lower than 425 U/L was associated with a negative likelihood ratio of 0.10 for intensive treatment.
Conclusions.—:
Our study identifies which biochemistry tests represent major predictors of COVID-19 severity and defines the best cutoffs for their use.
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