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Association between biomarkers and COVID-19 severity and mortality: a nationwide Danish cohort study
Gethin Hodges1, Jannik Pallisgaard2, Anne-Marie Schjerning Olsen3,4
1Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark gethin.william.hodges@regionh.dk.
Insights
Elevated levels of C-reactive protein (CRP), leucocytes, procalcitonin, urea, troponins, and D-dimer, along with decreased estimated glomerular filtration rate (eGFR), are linked to increased death or intensive care unit (ICU) admission risk in COVID-19 patients.
Area of Science:
- Biochemistry
- Critical Care Medicine
- Infectious Diseases
Background:
- COVID-19 poses significant risks of mortality and intensive care unit (ICU) admission.
- Biomarkers are crucial for assessing disease severity and patient prognosis in COVID-19.
- Understanding the predictive value of common biomarkers can aid clinical decision-making.
Purpose of the Study:
- To investigate the association between baseline levels of common biomarkers and the risk of death or ICU admission in hospitalized COVID-19 patients.
- To quantify the standardized absolute risks for various biomarker levels concerning adverse outcomes.
Main Methods:
- Retrospective cohort study utilizing national registry data from all hospitals in Denmark.
- Included 1310 adult patients hospitalized with COVID-19 between February and May 2020 with available biochemistry data.
- Cox analysis and bootstrapping were employed to assess associations, adjusting for age and gender.
Main Results:
- Higher levels of C-reactive protein (CRP), leucocytes, procalcitonin, urea, troponins, and D-dimer were significantly associated with increased risk of death/ICU admission.
- Lower estimated glomerular filtration rate (eGFR) was also linked to a higher risk of the composite endpoint.
- Specific absolute risks were quantified for different biomarker levels, demonstrating a clear dose-response relationship for many markers.
Conclusions:
- Elevated CRP, leucocytes, procalcitonin, urea, troponins, and D-dimer, alongside low eGFR, are significant predictors of adverse outcomes in COVID-19 patients.
- These findings highlight the utility of routine biochemical markers in risk stratification for COVID-19.
- The study underscores the importance of monitoring these biomarkers for timely intervention and resource allocation.
Objective:
To evaluate the association between common biomarkers, death and intensive care unit (ICU) admission in patients with COVID-19.
Design:
Retrospective cohort study. From electronic national registry data, we used Cox analysis and bootstrapping to evaluate associations between baseline levels of biomarkers and standardised absolute risks of death/ICU admission, adjusted for age and gender.
Setting:
All hospitals in Denmark.
Participants:
1310 patients aged ≥18 years admitted to hospital with COVID-19 from 27th of February to 1st of May 2020, with available biochemistry data.
Main Outcome Measures:
A composite of death/ICU admission occurring within 30 days.
Results:
Of the 1310 patients admitted to hospital (54.6% men; median age 73.6 years), 352 (26.9%) experienced the composite endpoint and 263 (20.1%) died. For the composite endpoint, the absolute risks for moderately and severely elevated C reactive protein (CRP) were significantly higher, 21.5% and 39.2%, respectively, compared with 5.0% for those with normal CRP. Moderately and severely elevated leucocytes were significantly higher, 34.5% and 46.6% risk, respectively, compared with 23.2% for those with normal leucocytes. Moderately and severely decreased estimated glomerular filtration rates (eGFR) were significantly higher, 41.5% and 45.9% risk, respectively, compared with 30.4% for those with normal/mildly decreased eGFR. Normal and elevated ureas were significantly higher, 22.3% and 40.6% risk, respectively, compared with 7.3% for those with low urea. Elevated D-dimer was significantly higher, 31.8% risk, compared with 17.5% for those with normal D-dimer. Moderately and severely elevated troponins were significantly higher, 27.7% and 57.3% risk, respectively, compared with 9.4% for those with normal troponin. Elevated procalcitonin was significantly higher, 52.1% risk, compared with 28.0% for those with normal procalcitonin.
Conclusion:
In this nationwide study of patients admitted with COVID-19, elevated levels of CRP, leucocytes, procalcitonin, urea, troponins and D-dimer, and low levels of eGFR were associated with higher standardised absolute risk of death/ICU admission within 30 days.
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