The predictive role of biochemical markers on outcomes of severe COVID-19 patients admitted to intensive care unit

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Abstract
Background: The pandemic of severe acute respiratory syndrome by coronavirus 2 (SARS-CoV-2) is a multi-system disease caused by a diffuse systemic process involving a complex interaction of the inflammatory, immunological and coagulative cascades. This study aims to identify the most effective biomarkers to predict poor outcome in intensive care unit (ICU) patients with severe COVID-19 disease. Methods: A single-centre retrospective observational study enrolled 69 deceased and 20 recovered patients treated in the ICU of the General Hospital Gradiska in the period from March 1, 2021. until April 1, 2022. We evaluated the leukocytes (WBC), lymphocytes (LYM), neutrophils (NEU), platelets (PLT), haemoglobin, neutrophil-lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and systemic immune-inflammation index (SII). In addition, we evaluated the IL-6, ferritin, CRP, D-dimer, magnesium, bilirubin and lactate dehydrogenase. Results: Between deceased and recovered patients on admission to the ICU, there was a significant difference between the following parameters: WBC x109/L 11.50 (8.86-14.75) vs. 9.40 (5.90-11.90), p =0.026; NEU x109/L 10.15 (7.81-12.74) vs. 8.60 (4.80-10.30) p=0.022; NLR 15.01 (10.60-24.33) vs. 9.45 (5.10-14.90) p=0.02; SII 3712 (2240-6543) vs. 1949 (993-3720) p=0.003. The magnesium level increased significantly over time in the patients who died, while the haemoglobin level and platelet count decreased. ROC analysis showed the following AUC values: WBC 0.774; NEU 0.781; NLR 0.786; SII 0.776; D-dimer 0.741, and bilirubin 0.713. Conclusion: In this retrospective study WBC, NEU, NLR, SII, D-dimer, and bilirubin determined at hospital admission had a high value in predicting death among patients with severe COVID-19.

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