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Early Biochemical Markers in Predicting the Clinical Outcome of COVID-19 Patients Admitted in Tertiary Care Hospital
Shrishtidhar Prasad1, Suprava Patel1, Ajoy Kumar Behera2
1Department of Biochemistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India.
Insights
This study identified key serum biomarkers, including uric acid, potassium, and albumin, that predict mortality in coronavirus disease 2019 patients. These findings aid in assessing patient risk and guiding clinical decisions for better outcomes.
Area of Science:
- Biochemistry
- Clinical Medicine
- Epidemiology
Background:
- Coronavirus disease 2019 (COVID-19) poses a significant global health threat.
- Identifying predictors of severity and mortality is crucial for effective patient management.
- Routine serum biomarkers offer a potentially accessible tool for risk stratification.
Purpose of the Study:
- To investigate the impact of commonly available serum biomarkers on COVID-19 severity and mortality.
- To identify specific biomarkers that can predict mortality risk in adult COVID-19 patients.
Main Methods:
- A retrospective analysis of 1,233 adult COVID-19 patients (127 nonsurvivors, 1,106 survivors).
- Collection and analysis of demographic, clinical, and laboratory data, focusing on serum biomarker levels.
- Statistical analysis to determine the influence of various predictors on mortality outcomes.
Main Results:
- Older age (>40 years) and male sex were associated with increased mortality risk.
- Serum urea, albumin, albumin-to-globulin ratio, and C-reactive protein-to-albumin ratio (CAR) showed significant predictive value.
- Elevated serum creatinine, uric acid, and hyperkalemia were linked to higher nonsurvival risk, while hypoalbuminemia showed a protective association.
- Key predictors of mortality included oxygen saturation, lactate dehydrogenase, ferritin, hyperuricemia, hyperkalemia, hypoalbuminemia, and high CAR values.
Conclusions:
- Serum uric acid, potassium, albumin, and CAR values at admission are significant predictors of mortality in COVID-19 patients.
- These biomarkers can aid in early risk assessment and clinical decision-making.
- Further research may validate these findings for routine clinical application.
Abstract:
Introduction An array of routinely accessible serum biomarkers was assessed to explore their overall impact on severity and mortality in coronavirus disease 2019. Materials and Methods A retrospective analysis of 1,233 adults was conducted. The study groups comprised 127 nonsurvivors and 1,106 survivors. Data for demographic details, clinical presentations, and laboratory reports were recorded from the medical record section. The predictors were analyzed for their influence on mortality. Results The mean (+ standard deviation) age of the patients in the nonsurvivor group was 58.8 (13.8) years. The mean age (56.4 years) was highest in severe grade patients. The odds ratio for death was 2.72 times for patients above the age of 40 years. About 46% of nonsurvivors died within 5 days of admission. Males were found to be more prone to death than females by a factor of 1.36. Serum urea depicted highest sensitivity (85%) for nonsurvival at 52.5 mg/dL. Serum albumin (3.23 g/dL), albumin-to-globulin ratio (0.97), and C-reactive protein-to albumin ratio (CAR) (2.08) showed a sensitivity of more than 70% for mortality outcomes. The high hazard ratio (HR) for deceased patients with hyperkalemia was 2.419 (95% confidence interval [CI] = 1.96-2.99; p < 0.001). The risk for nonsurvival was increased with elevated serum creatinine by 15.6% and uric acid by 21.7% ( p < 0.001). The HR for hypoalbuminemia was 0.254 (95% CI: 0.196-0.33; p < 0.001) and CAR was 1.319 (95% CI: 1.246-1.397; p < 0.001). Saturation of oxygen ( p < 0.001), lactate dehydrogenase ( p = 0.006), ferritin ( p = 0.004), hyperuricemia ( p = 0.027), hyperkalemia ( p < 0.001), hypoalbuminemia ( p = 0.002), and high CAR values (0.031) served as potential predictors for mortality. Conclusion Adjusting for all the predictor variables, serum uric acid, potassium, albumin, and CAR values at the time of admission were affirmed as the potential biomarkers for mortality.
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