Abstract
Objective: Intensive care unit (ICU) admission occurs at different times during hospitalization among patients with COVID-19. We aimed to evaluate the time-dependent receive operating characteristic (ROC) curve and area under the ROC curve, AUC(t), and accuracy of baseline levels of inflammatory markers C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) in predicting time to an ICU admission event in patients with severe COVID-19 infection.
Methods: In this observational study, we evaluated 724 patients with confirmed severe COVID-19 referred to Ayatollah Rohani Hospital, affiliated with Babol University of Medical Sciences, Iran.
Results: The AUC(t) of CRP and NLR reached 0.741 (95% confidence interval [CI]: 0.661-0.820) and 0.690 (95% CI: 0.607-0.772), respectively, in the first 3 days after hospital admission. The optimal cutoff values of CRP and NLR for stratification of ICU admission outcomes in patients with severe COVID-19 were 78 mg/L and 5.13, respectively. The risk of ICU admission was significantly greater for patients with these cutoff values (CRP hazard ratio = 2.98; 95% CI: 1.58-5.62; NLR hazard ratio = 2.90; 95% CI: 1.45-5.77).
Conclusions: Using time-dependent ROC curves, CRP and NLR values at hospital admission were important predictors of ICU admission. This approach is more efficient than using standard ROC curves.
Keywords: C-reactive protein; COVID-19; Neutrophil-to-lymphocyte ratio; intensive care unit admission; time-dependent ROC curve; time-dependent area under the receiver operating characteristic curve.
【저자키워드】 COVID-19, C-reactive protein, Neutrophil-to-lymphocyte ratio, intensive care unit admission, time-dependent ROC curve, time-dependent area under the receiver operating characteristic curve., 【초록키워드】 Stratification, intensive care, severe COVID-19, Hospitalization, neutrophil, intensive care unit, inflammatory markers, C-reactive protein, risk, CRP, outcome, observational study, ICU, Neutrophil-to-lymphocyte ratio, lymphocyte, Iran, ROC, Accuracy, COVID-19 infection, Patient, ICU admission, Hospital admission, Inflammatory marker, predictor, characteristic, university, Admission, Care, NLR, intensive care unit admission, ROC Curve, referred to, receiver operating characteristic, C-reactive protein (CRP, Severe COVID-19 Infection, 95% CI, 95% confidence interval, Medical Sciences, hazard ratio, receiver operating characteristic curve, baseline levels, ROC curves, cutoff value, approach, greater, evaluate, significantly, evaluated, occur, reached, baseline level, receive, Ayatollah, patients with COVID-19, 【제목키워드】 risk, Accuracy, Inflammatory marker, characteristic,