Abstract
Background: Inflammatory markers are often elevated in patients with COVID-19. The objective of this study is to assess the prognostic capability of these tests in predicting clinical outcomes.
Methods: This was a retrospective cohort study including all patients at least 16 years old with COVID-19 who were admitted from one of five Emergency Departments between March 6th and April 4th, 2020. We included 1123 laboratory-confirmed cases of COVID-19. We analyzed white blood cell count (WBC), absolute lymphocyte count (ALC), lactate dehydrogenase (LDH), C-reactive protein (CRP), procalcitonin (PCT), D-dimer, ferritin, and erythrocyte sedimentation rate (ESR). We looked at clinical outcomes including death, the need for endotracheal intubation (ETT), the need for renal replacement therapy (RRT), and ICU admission. We report Spearman’s ρ 2 and statistical significance for each correlation with outcomes. We also report positive predictive value, negative predictive value, sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios.
Results: The mean age of our patient population was 62 (SD 16). Thirty-seven percent of patients self-reported Spanish/Hispanic/Latino ethnicity, 47% reported their race as Black or African-American, and 10% reported their race as non-Hispanic white. Inter-rater reliability was 96%. There was no laboratory value that had both sensitivity and specificity of at least 0.90, or that had a positive predictive value and negative predictive value of at least 0.90, or that had likelihood ratios that could reliably predict a severe course of disease.
Conclusion: Inflammatory markers drawn within 48 h of arrival, though often correlated with clinical outcomes, are not individually highly predictive of which patients in a predominantly older and minority population will die or require intubation, RRT, or ICU admission.
Keywords: COVID-19; Inflammatory markers; Prognosis.
【저자키워드】 COVID-19, inflammatory markers, Prognosis., 【초록키워드】 Prognosis, reliability, inflammatory markers, LDH, intubation, C-reactive protein, CRP, D-dimer, ferritin, procalcitonin, lactate dehydrogenase, clinical outcomes, Predictive value, Laboratory, Clinical outcome, outcomes, lymphocyte, sensitivity, specificity, Positive predictive value, White blood cell, Sensitivity and specificity, Patient, ICU admission, death, age, ESR, WBC, prognostic, correlation, disease, predict, marker, renal replacement therapy, Absolute lymphocyte count, Lactate, Emergency, Negative predictive value, Endotracheal intubation, Emergency Departments, erythrocyte sedimentation, blood cell, Predictive, replacement therapy, retrospective cohort study, black, RRT, erythrocyte sedimentation rate, Older, sedimentation rate, statistical significance, white blood cell count, likelihood ratio, Department, positive, laboratory-confirmed, patient population, Spearman, FIVE, PCT, likelihood, Course, analyzed, reported, elevated, correlated, ALC, patients with COVID-19, with COVID-19, 【제목키워드】 Clinical outcome, marker, Predictive, hospitalized patient, with COVID-19,