Synthetic metrics of early predictive value in patients with COVID-19 pneumonia

Abstract

Clinical observations have shown that COVID-19-associated pneumonia is often accompanied by coagulopathy, an increase in C-reactive protein and D-dimer. Early laboratory assessment may represent a promising approach for predicting the development of thrombotic complications and the severity of COVID-19. Thrombotic complications often cause a rapid deterioration in the patient’s condition, the development of ARDS and a negative outcome of the disease. In this study, the authors sought to identify synthetic indicators that may be associated with the development of acute respiratory distress syndrome (ARDS) requiring treatment in an intensive care unit in patients with viral pneumonia caused by COVID-19. Differences in D-dimer levels and the ratios of D-dimer and C-reactive protein (CRP) levels to the number of days (Days) elapsed from disease onset to hospitalization were investigated between COVID-19 patients who were transferred to the intensive care unit, within two weeks after admission to the hospital (n = 78), and patients with COVID-19 with a stable course of the disease (n = 70). Multiple comparisons showed statistically significantly higher values of CRP / Days at admission in patients with COVID-19 transferred to the ICU (median 22,57) compared with stable patients (median 7,19), p < 0,0001. D-dimer levels on admission did not have statistically significant differences in these groups, while comparison of D-dimer / days ratios in patients transferred to the ICU and in stable patients revealed statistically significant differences: median 44,57 and 41,27, respectively (p = 0,0048). The authors suggest that these synthetic indicators, which are easily determined in patients with COVID-19 upon admission to the hospital, can be used as early predictive markers of severe pneumonia and a high risk of ARDS, requiring transfer to the intensive care unit.