George Washington University (GW) researchers found five biomarkers associated with higher odds of clinical deterioration and death in COVID-19 patients. These findings will help physicians better predict outcomes for COVID-19 patients in the US.
“When we first started treating COVID-19 patients, we watched them get better or get worse, but we didn’t know why,” said Dr Juan Reyes, co-author of the study and assistant professor of medicine at the GW School of Medicine and Health Sciences. “Some initial studies had come out of China showing certain biomarkers were associated with bad outcomes. There was a desire to see if that was true for our patients here in the US.”
The research team evaluated 299 patients diagnosed with COVID-19 admitted to GW Hospital between 12 March and 9 May, 2020. Of these patients, 200 had all five biomarkers being evaluated – IL-6, D-dimer, CRP, LDH and ferritin. Elevated levels of these biomarkers were associated with inflammation and bleeding disorder, showing an independent increased risk for ICU admission, invasive ventilatory support, and death. The highest odds of death occurred when the LDH level was greater than 1200 units/l and a D-dimer level was greater than 3 μg/ml.
“We hope these biomarkers help physicians determine how aggressively they need to treat patients, whether a patient should be discharged, and how to monitor patients who are going home, among other clinical decisions,” said Dr Shant Ayanian, first author of the study and assistant professor of medicine at the GW School of Medicine and Health Sciences.
Currently, physicians determine risk for COVID-19 deterioration and death based on age and certain underlying medical conditions, like having an immuno-compromised state, obesity, and heart disease. Performing a simple blood test for patients admitted to the emergency department, then also making decisions based on biomarkers present, may further aid point-of-care clinical decision making.
Reyes, Ayanian, and the GW research team will continue to analyse this data to help physicians make more informed decisions for patients, as well as help hospitals that may need to stratify resources.
Abstract
Aim: To describe the association between D-dimer, CRP, IL-6, ferritin, LDH and the clinical outcomes in a cohort of 299 novel coronavirus disease (COVID-19) patients treated on the inpatient medical service at a university hospital in the District of Columbia (DC, USA).
Methodology/results: In this retrospective study, we included all laboratory confirmed COVID-19 adults admitted to the inpatient medicine service at the George Washington University Hospital between March 12, 2020 and May 9, 2020. We analyzed the association of biomarkers on intensive care unit transfer, intubation and mortality. Threshold values for all biomarkers were found to be statistically significant and independently associated with higher odds of clinical deterioration and death.
Conclusion: Laboratory markers of inflammation and coagulopathy can help clinicians identify patients who are at high risk for clinical deterioration in COVID-19.
Authors
Shant Ayanian, Juan Reyes, Lei Lynn,Karolyn Teufel
[link url="https://smhs.gwu.edu/news/blood-test-may-point-patients-higher-risk-covid-19-deterioration-death"]George Washington University School of Medicine and Health Sciences[/link]
[link url="https://www.futuremedicine.com/doi/10.2217/bmm-2020-0309"]Future Medicine abstract[/link]