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Biochemistry tests in hospitalized COVID-19 patients: Experience from a Canadian tertiary care centre
Angela C Rutledge1, Yun-Hee Choi2, Igor Karp2
1Department of Pathology and Laboratory Medicine, London Health Sciences Centre and St. Joseph's Health Care London, London, ON, Canada; Department of Pathology and Laboratory Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Insights
Biochemical markers like C-reactive protein (CRP), lactate, and troponin T (TnT) can help predict outcomes for COVID-19 patients. Elevated levels, particularly CRP and TnT, indicate a higher risk of death and longer hospital stays.
Area of Science:
- Biochemistry
- Critical Care Medicine
- Infectious Diseases
Background:
- Coronavirus Disease 2019 (COVID-19) presents with a wide spectrum of illness, from asymptomatic cases to fatal outcomes.
- Biochemical markers are being investigated for their potential role in managing and predicting the prognosis of COVID-19 patients.
Purpose of the Study:
- To evaluate the utility of specific biochemical markers in assessing outcomes for hospitalized COVID-19 patients.
- To determine the association between initial and serial measurements of alanine aminotransferase, CRP, ferritin, lactate, and TnT with in-hospital mortality and length of stay.
Main Methods:
- A retrospective study involving 67 COVID-19 patients admitted to a Canadian tertiary care center.
- Analysis included logistic regression, Cox proportional-hazards models, and accelerated failure time modelling to assess marker concentrations against clinical outcomes.
- Joint modelling was used to evaluate the dynamic relationship between marker levels over time and in-hospital death.
Main Results:
- Initial high-sensitivity troponin T (TnT) and C-reactive protein (CRP) concentrations correlated with longer hospital stays.
- Patients who died had significantly higher median initial TnT levels (55 ng/L vs. 16 ng/L). No survivors had initial TnT > 64 ng/L.
- CRP demonstrated prognostic value throughout the hospital stay, with increases associated with higher odds and hazard of death. Subsequent lactate measurements also predicted mortality.
Conclusions:
- C-reactive protein (CRP), lactate, and troponin T (TnT) are associated with adverse outcomes in COVID-19 patients.
- These markers show potential as valuable tools for monitoring the clinical course and prognosis of individuals hospitalized with COVID-19.
Background:
Coronavirus Disease 2019 (COVID-19) has variable clinical presentation, from asymptomatic to severe disease leading to death. Biochemical markers may help with management and prognostication of COVID-19 patients; however, their utility is still under investigation.
Methods:
A retrospective study was conducted to evaluate alanine aminotransferase, C-reactive protein (CRP), ferritin, lactate, and high sensitivity troponin T (TnT) levels in 67 patients who were admitted to a Canadian tertiary care centre for management of COVID-19. Logistic, cause-specific Cox proportional-hazards, and accelerated failure time regression modelling were performed to assess the associations of initial analyte concentrations with in-hospital death and length of stay in hospital; joint modelling was performed to assess the associations of the concentrations over the course of the hospital stay with in-hospital death.
Results:
Initial TnT and CRP concentrations were associated with length of stay in hospital. Eighteen patients died (27%), and the median initial TnT concentration was higher in patients who died (55 ng/L) than those who lived (16 ng/L; P < 0.0001). There were no survivors with an initial TnT concentration > 64 ng/L. While the initial TnT concentration was predictive of death, later measurements were not. Only CRP had prognostic value with both the initial and subsequent measurements: a 20% increase in the initial CRP concentration was associated with a 14% (95% confidence interval (CI): 1-29%) increase in the odds of death, and the hazard of death increased 14% (95% CI: 5-25%) for each 20% increase in the current CRP value. While the initial lactate concentration was not predictive of death, subsequent measurements were.
Conclusion:
CRP, lactate and TnT were associated with poorer outcomes and appear to be useful biochemical markers for monitoring COVID-19 patients.
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