Clinical and Laboratory Predictors of Mortality in Severe COVID-19 Pneumonia: A Retrospective Study from India

Overview

Journal Thorac Res Pract

Publisher Aves

Specialty Pulmonary Medicine

Date 2023 Jul 28

PMID 37503640

Authors

Swathi Karanth Marsur Prabhakar

Swapna Ramaswamy

Vanitha Basavarajachar

Anushree Chakraborty

Akshata Shivananjiah

Nagaraja Chikkavenkatappa

Affiliations

Soon will be listed here.

Abstract

Objective: Wide arrays of laboratory parameters have been proposed by many studies for prognosis in COVID-19 patients. In this study, we wanted to determine if the International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score in addition to certain clinical and laboratory parameters would help in predicting mortality. We wanted to determine if a greater severity score on chest x-ray at presentation translated to poor patient outcomes using the COVID-19 chest radiography score.

Material And Methods: This retrospective study was conducted at SDS TRC and Rajiv Gandhi Institute of chest diseases, Bangalore from March 2021 to June 2021. This study included 202 real-time-polymerase chain reaction-positive COVID-19 patients aged above 18 years admitted to the intensive care unit of our hospital. Demographic characteristics and baseline hematological and inflammatory markers (serum C-reactive protein, lactate dehydrogenase, troponin-I, ferritin, and d-dimer) were collected. Radiological severity on a chest x-ray was assessed using the validated COVID-19 chest radiography score. The International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score was assigned to each patient within 24 hours of intensive care unit admission. Outcome studied was in-hospital mortality.

Results: The overall mortality was 54.9% (111 cases). Age more than 50 years, >4 days of symptoms, peripheral oxygen saturation/ fraction of inspired oxygen ratio less than 200, elevated serum lactate dehydrogenase >398.5 IU/L, and hypoalbuminemia (<2.95 g/dL) were detected as independent predictors of mortality. A significant correlation of risk stratification with mortality (P = .057) was seen with International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score. There was no significant correlation between the COVID-19 chest radiography score and mortality.

Conclusion: Age >50 years, peripheral oxygen saturation/fraction of inspired oxygen ratio <200, mean symptom duration of >4 days, elevated serum lactate dehydrogenase, and hypoalbuminemia are independent predictors of mortality in severe COVID-19 pneumonia. International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score was different in the survivors and deceased.

Citing Articles

The predictive value of the LDH-albumin ratio on poor clinical course and mortality in COVID-19 patients: A single-center study.

Kaya H, Argun Baris S, Gultepe B, Basyigit I, Boyaci H Medicine (Baltimore). 2025; 104(9):e41660.

PMID: 40020123 PMC: 11875623. DOI: 10.1097/MD.0000000000041660.

References

Giraudo C, Cavaliere A, Fichera G, Weber M, Motta R, Pelloso M . Validation of a composed COVID-19 chest radiography score: the CARE project. ERJ Open Res. 2020; 6(4). PMC: 7682711. DOI: 10.1183/23120541.00359-2020. View

Doganay F, Ak R . Performance of the CURB-65, ISARIC-4C and COVID-GRAM scores in terms of severity for COVID-19 patients. Int J Clin Pract. 2021; 75(10):e14759. PMC: 8646358. DOI: 10.1111/ijcp.14759. View

Cheng P, Wu H, Yang J, Song X, Xu M, Li B . Pneumonia scoring systems for severe COVID-19: which one is better. Virol J. 2021; 18(1):33. PMC: 7874994. DOI: 10.1186/s12985-021-01502-6. View

Huang Y, Lyu X, Li D, Wang L, Wang Y, Zou W . A cohort study of 676 patients indicates D-dimer is a critical risk factor for the mortality of COVID-19. PLoS One. 2020; 15(11):e0242045. PMC: 7652321. DOI: 10.1371/journal.pone.0242045. View

Huang J, Cheng A, Kumar R, Fang Y, Chen G, Zhu Y . Hypoalbuminemia predicts the outcome of COVID-19 independent of age and co-morbidity. J Med Virol. 2020; 92(10):2152-2158. PMC: 7273060. DOI: 10.1002/jmv.26003. View

Albalawi O, Alharbi Y, Bakouri M, Alqahtani A, Alanazi T, Almutairi A . Clinical characteristics and predictors of mortality among COVID-19 patients in Saudi Arabia. J Infect Public Health. 2021; 14(8):994-1000. PMC: 8192299. DOI: 10.1016/j.jiph.2021.06.005. View

Xu Y, Yang H, Wang J, Li X, Xue C, Niu C . Serum Albumin Levels are a Predictor of COVID-19 Patient Prognosis: Evidence from a Single Cohort in Chongqing, China. Int J Gen Med. 2021; 14:2785-2797. PMC: 8238547. DOI: 10.2147/IJGM.S312521. View

Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S . Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020; 180(7):934-943. PMC: 7070509. DOI: 10.1001/jamainternmed.2020.0994. View

Jain A, Kansal S, Sardana R, Bali R, Kar S, Chawla R . A Retrospective Observational Study to Determine the Early Predictors of In-hospital Mortality at Admission with COVID-19. Indian J Crit Care Med. 2021; 24(12):1174-1179. PMC: 7775949. DOI: 10.5005/jp-journals-10071-23683. View

10.

Mahendra M, Nuchin A, Kumar R, Shreedhar S, Mahesh P . Predictors of mortality in patients with severe COVID-19 pneumonia - a retrospective study. Adv Respir Med. 2021; 89(2):135-144. DOI: 10.5603/ARM.a2021.0036. View

11.

Liu K, Fang Y, Deng Y, Liu W, Wang M, Ma J . Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J (Engl). 2020; 133(9):1025-1031. PMC: 7147277. DOI: 10.1097/CM9.0000000000000744. View

12.

van Dam P, Zelis N, van Kuijk S, Linkens A, Bruggemann R, Spaetgens B . Performance of prediction models for short-term outcome in COVID-19 patients in the emergency department: a retrospective study. Ann Med. 2021; 53(1):402-409. PMC: 7919920. DOI: 10.1080/07853890.2021.1891453. View

13.

Rice T, Wheeler A, Bernard G, Hayden D, Schoenfeld D, Ware L . Comparison of the SpO2/FIO2 ratio and the PaO2/FIO2 ratio in patients with acute lung injury or ARDS. Chest. 2007; 132(2):410-7. DOI: 10.1378/chest.07-0617. View

14.

Kokturk N, Babayigit C, Kul S, Duru Cetinkaya P, Nayci S, Argun Baris S . The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients. Respir Med. 2021; 183:106433. PMC: 8079263. DOI: 10.1016/j.rmed.2021.106433. View

15.

Shi C, Wang L, Ye J, Gu Z, Wang S, Xia J . Predictors of mortality in patients with coronavirus disease 2019: a systematic review and meta-analysis. BMC Infect Dis. 2021; 21(1):663. PMC: 8264491. DOI: 10.1186/s12879-021-06369-0. View

16.

Henry B, Aggarwal G, Wong J, Benoit S, Vikse J, Plebani M . Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis. Am J Emerg Med. 2020; 38(9):1722-1726. PMC: 7251362. DOI: 10.1016/j.ajem.2020.05.073. View

17.

Verma A, Hora T, Jung H, Fralick M, Malecki S, Lapointe-Shaw L . Characteristics and outcomes of hospital admissions for COVID-19 and influenza in the Toronto area. CMAJ. 2021; 193(12):E410-E418. PMC: 8096386. DOI: 10.1503/cmaj.202795. View

18.

Pandita A, Gillani F, Shi Y, Hardesty A, McCarthy M, Aridi J . Predictors of severity and mortality among patients hospitalized with COVID-19 in Rhode Island. PLoS One. 2021; 16(6):e0252411. PMC: 8213072. DOI: 10.1371/journal.pone.0252411. View

19.

Richardson S, Hirsch J, Narasimhan M, Crawford J, McGinn T, Davidson K . Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020; 323(20):2052-2059. PMC: 7177629. DOI: 10.1001/jama.2020.6775. View

20.

Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y . Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020; 146(1):110-118. PMC: 7152876. DOI: 10.1016/j.jaci.2020.04.006. View