Inflammatory Biomarkers as Predictors of In-Hospital Mortality in Critically Ill COVID-19 Patients: A Retrospective Cohort Study

IF 2.9 Q2 MEDICINE, GENERAL & INTERNAL

Health Science Reports Pub Date : 2026-10-22 DOI:10.1002/hsr2.73411

Siamak Rimaz, Orchideh Amoie Foumani, Hamid Hoseinzadeh, Mohammad Shokri, Mohammad Haghighi, Mahboobeh Gholipour, Nastaran Najd, Amirhossein Azariyan, Mohammadreza Mobayen, Mahsa Sadeghi

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Abstract

Background and Aim

Inflammatory biomarkers have been proposed as prognostic indicators in COVID-19; however, their prognostic associations within critically ill ICU-admitted patients remain of interest. This study aimed to evaluate the associations of selected inflammatory biomarkers with in-hospital mortality and their discriminatory performance among critically ill COVID-19 patients.

Methods

In this retrospective cohort study, 244 adult patients with confirmed COVID-19 pneumonia admitted to the ICU between August 2020 and June 2021 were analyzed. Disease severity was assessed using the ISARIC 4 C Mortality Score. Associations between inflammatory biomarkers and mortality were evaluated using univariable and multivariable logistic regression, and discriminatory performance was assessed using ROC curve analysis.

Results

The in-hospital mortality rate was 90.6%. ESR and LDH levels were significantly higher in non-survivors. In a biomarker-restricted multivariable logistic regression model, ESR (OR 1.023 per 1 mm/h increase; 95% CI 1.004–1.042; p = 0.016) and LDH (OR 1.002 per 1 U/L increase; 95% CI 1.000–1.003; p = 0.009) remained significantly associated with in-hospital mortality after mutual adjustment for the other prespecified inflammatory biomarkers. LDH demonstrated good discriminatory performance (AUC 0.725; 95% CI 0.645–0.805). ESR showed modest discriminatory performance (AUC 0.646; 95% CI 0.559–0.732).

Conclusion

ESR and LDH remained significantly associated with in-hospital mortality after adjustment for the other prespecified inflammatory biomarkers. These findings suggest that ESR and LDH may provide adjunctive prognostic information in critically ill ICU patients; however, they should be interpreted in the context of the biomarker-restricted model and the limited adjustment set. Confirmation in larger prospective studies incorporating established clinical prognostic factors is warranted.

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