Cytokine storm syndrome in patients with COVID-19 is mediated by pro-inflammatory cytokines resulting in acute lung injury and multiorgan failure. Elevation in serum ferritin and D-dimer is observed in COVID-19 patients. To determine prognostic values of optimal serum cutoff with trajectory plots for both serum ferritin and D-dimer in COVID-19 patients with invasive ventilator dependence and in-hospital mortality. We used retrospective longitudinal data from the Cerner COVID-19 de-identified cohort. COVID-19 infected patients with valid repeated values of serum ferritin and D-dimer during hospitalization were used in mixed-effects logistic-regression models. Among 52,411 patients, 28.5% (14,958) had valid serum ferritin and 28.6% (15,005) D-dimer laboratory results. Optimal cutoffs of ferritin (714 ng/mL) and D-dimer (2.1 mg/L) revealed AUCs ≥ 0.99 for in-hospital mortality. Optimal cutoffs for ferritin (502 ng/mL) and D-dimer (2.0 mg/L) revealed AUCs ≥ 0.99 for invasive ventilator dependence. Optimal cutoffs for in-house mortality, among females, were lower in serum ferritin (433 ng/mL) and D-dimer (1.9 mg/L) compared to males (740 ng/mL and 2.5 mg/L, respectively). Optimal cutoffs for invasive ventilator dependence, among females, were lower in ferritin (270 ng/mL) and D-dimer (1.3 mg/L) compared to males (860 ng/mL and 2.3 mg/L, respectively). Optimal prognostic cutoffs for serum ferritin and D-dimer require considering the entire trajectory of laboratory values during the disease course. Females have an overall lower optimal cutoff for both serum ferritin and D-dimer. The presented research allows health professionals to predict clinical outcomes and appropriate allocation of resources during the COVID-19 pandemic, especially early recognition of COVID-19 patients needing higher levels of care.
【저자키워드】 COVID-19, Cytokine storm, D-dimer, ferritin, trajectory, optimal prognostic cutoffs, 【초록키워드】 Cytokines, Mortality, Hospitalization, COVID-19 pandemic, D-dimer, ferritin, cytokine, Cytokine storm syndrome, Lung injury, clinical outcomes, acute lung injury, Laboratory, Clinical outcome, serum, Cohort, Health, Laboratory results, male, Research, pro-inflammatory cytokines, prognostic, resource, Care, patients, predict, in-hospital mortality, COVID-19 patients, retrospective, COVID-19 patient, AUC, Longitudinal data, Prognostic value, Serum ferritin, ventilator, house, disease course, multiorgan failure, syndrome, dimer, Elevation, Cutoff, pro-inflammatory cytokine, professional, females, repeated, invasive, Course, resulting, the disease, were used, determine, Cerner, COVID-19 infected patient, logistic-regression models, patients with COVID-19, 【제목키워드】 value, with COVID-19,