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CC BY-NC-ND 4.0 · J Lab Physicians 2022; 14(03): 295-305
DOI: 10.1055/s-0042-1742631
Original Article

Early Biochemical Markers in Predicting the Clinical Outcome of COVID-19 Patients Admitted in Tertiary Care Hospital

Shrishtidhar Prasad‡   *
1   Department of Biochemistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
,
Suprava Patel  ‡   *
1   Department of Biochemistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
,
Ajoy Kumar Behera
2   Department of Pulmonary Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
,
Naik Gitismita
3   Department of Community and Family Medicine, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
,
Seema Shah
1   Department of Biochemistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
,
Rachita Nanda 
1   Department of Biochemistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
,
Eli Mohapatra 
1   Department of Biochemistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
› Author Affiliations Funding None.
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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.

Keywords

total clinical severity score - serum markers - mortality predictor - sensitivity and specificity - primary biomarkers.

Authors' Contribution

S. Patel, A.K. Behera designed the study and performed the statistical analysis. S. Patel and S. Shah wrote the protocol and the first draft of the manuscript. S. Prasad and G. Naik managed the data analyses of the study. R. Nanda and E. Mohapatra managed the literature searches and intellectual content. All authors read and approved the final manuscript.


* These authors contributed equally and hold the first authorship.




Publication History

Article published online:
10 February 2022

© 2022. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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