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The Predictive Potential of Elevated Serum Inflammatory Markers in Determining the Need for Intubation in CoVID-19 Patients Cover

The Predictive Potential of Elevated Serum Inflammatory Markers in Determining the Need for Intubation in CoVID-19 Patients

The Journal of Critical Care Medicine
Volume 8 (2022): Issue 1 (January 2022)
By: Samuel Windham,  Kellen Hirsch,  Ryan Peterson,  David Douin,  Lakshmi Chauhan,  Lauren Heery,  Connor Fling,  Nemanja Vukovic,  Fernando Holguin,  Shanta Zimmer and  Kristine Erlandson  
Open Access
|Nov 2021

Figures & Tables

Fig.1

Kaplan-Meier curves for intubation-free survival of hospitalized CoVID-19 patients stratified by C-reactive protein (CRP). Patients with low CRP (<100 mg/L) have a significantly higher probability of iuntubation-free survival, as compared to patients with high CRP (≥100 mg/L) (p<0.001)
Kaplan-Meier curves for intubation-free survival of hospitalized CoVID-19 patients stratified by C-reactive protein (CRP). Patients with low CRP (<100 mg/L) have a significantly higher probability of iuntubation-free survival, as compared to patients with high CRP (≥100 mg/L) (p<0.001)

Fig. 2

Predictive model for intubation and mechanical ventilation fit via the Minimax Concave Penalty. (A) Cross-validation deviance indicates optimal model has 3 predictors, including (B) C-reactive protein (CRP), lactate dehydrogenase (LDH), and type 2 diabetes mellitus as most predictive covariates. (C) Cross validated ROC curve of logistic model (CV) along with ROC curve on the validation cohort (EV). (D) Optimal model shown as probability formula where coviariates are centered and scaled using observed mean and standard deviation. DM signifies patient has type 2 diabetes (yes=1, no=0). Both logistic regression and linear approximation formulas presented.
Predictive model for intubation and mechanical ventilation fit via the Minimax Concave Penalty. (A) Cross-validation deviance indicates optimal model has 3 predictors, including (B) C-reactive protein (CRP), lactate dehydrogenase (LDH), and type 2 diabetes mellitus as most predictive covariates. (C) Cross validated ROC curve of logistic model (CV) along with ROC curve on the validation cohort (EV). (D) Optimal model shown as probability formula where coviariates are centered and scaled using observed mean and standard deviation. DM signifies patient has type 2 diabetes (yes=1, no=0). Both logistic regression and linear approximation formulas presented.

Baseline Characteristics of Hospitalised CoVID-19 Patients

Overall (N=158)
Clinical Characteristics
          Age56.2 (16.8)
          BMI31.3 (8.0)
          Male81 (51.3%)
          Active Tobacco Use9 (5.8%)
          White, non-Hispanic30 (19.5%)
          Black53 (34.4%)
          Hispanic45 (29.2%)
          Asian11 (7.1%)
          Other15 (9.7%)
          Diabetes47 (30.3%)
          Hypertension87 (56.1%)
          COPD11 (7.1%)
          Creatinine >2 mg/dL on Admission4 (2.5%)
          Cirrhosis3 (1.9%)
          Coronary Artery Disease18 (11.6%)
          Active Cancer11 (7.1%)
          Immunosuppressed10 (6.5%)
Presenting Symptoms
          Subjective Fever111 (74.0%)
          Cough126 (82.4)
          Diarrhoea40 (26.8%)
          Nausea/Vomiting42 (28.2%)
          Myalgia34 (22.8%)
          Dyspnoea116 (75.3%)
          Duration of Symptoms6.7 (4.6)
Chest X-Ray Findings*
          Unilateral Infiltrate28 (17.8%)
          Bilateral Infiltrate102 (65%)
          Other Findings28 (17.8%)
Clinical Course
          Intubation Indicated64 (40.5%)
          Vasopressors Indicated42 (26.6%)
          Prone Positioned24 (15.2%)
          Deceased4 (2.5%)
          Discharge55 (36.9%)

Characteristics of Intubated CoVID-19 Patients

Overall (N=64)
Clinical Characteristics
          Oxygen Requirement on Admission in Litres of Oxygen5.6 (13.2)
          Highest Oxygen Requirement Stable >1 Hour within 24 Hours of Admission in Litres of Oxygen5.0 (4.1)
          Use of Non-Invasive Ventilation Before Intubation1 (1.6%)
          Oxygen Requirement within one hour of Intubation in Litres of Oxygen12.9 (12.7)
          SOFA on Intubation4.5 (2.1)
          Days Intubated11.926 (8.519)
Pa02 to Fi02 at 8 Hour Intervals
          P:F Ratio at 8h146.3 (84.1)
          P:F Ratio at 16h194.9 (69.1)
          P:F Ratio at 24h204.0 (63.4)
          P:F Ratio at 32h216.8 (65.5)
          P:F Ratio at 40h216.2 (65.9)
          P:F Ratio at 48h204.7 (75.3)
          P:F Ratio at 56h212.5 (73.9)
          P:F Ratio at 64h217.0 (71.2)
          P:F Ratio at 72h219.9 (81.4)
Pa02 to (Fi02*PEEP) at 8 Hour Intervals
          P:FP Ratio at 8h12.3 (7.4)
          P:FP Ratio at 16h17.3 (9.8)
          P:FP Ratio at 24h17.5 (8.0)
          P:FP Ratio at 32h19.1 (8.8)
          P:FP Ratio at 40h20.1 (10.8)
          P:FP Ratio at 48h18.2 (13.7)
          P:FP Ratio at 56h19.1 (9.5)
          P:FP Ratio at 64h20.6 (12.8)
          P:FP Ratio at 72h21.2 (13.0)

Characteristics of Hospitalised CoVID-19 Patients Stratified by Intubation Status

Not Intubated (N=94)Intubated (N=64)N-Missing (Not intubated/ Intubated)p-value
Clinical Characteristics
          Age55.36 (17.33)57.32 (15.90)0/10.415
          BMI30.85 (7.84)32.01 (8.2)5/00.436
          Male45 (47.9%)36 (56.2%)NA0.333
          Active Tobacco Use4 (4.3%)5 (8.1%)NA0.485
          Non-White Race and/or Hispanic71 (76.3%)53 (86.9%)NA0.145
          Ethnicity
          Diabetes21 (22.3%)26 (42.6%)NA0.012
          Hypertension52 (55.3%)35 (57.4%)NA0.869
          COPD6 (6.4%)5 (8.2%)NA0.753
          Creatinine >2 mg/dL on Admission1 (1.1%)3 (4.8%)NA0.303
          Cirrhosis1 (1.1%)2 (3.3%)NA0.562
          Coronary Artery Disease12 (12.8%)6 (9.8%)NA0.620
          Active Cancer6 (6.4%)5 (8.2%)NA0.753
          Immunosuppressed8 (8.6%)2 (3.3%)NA0.317
Presenting Symptoms
          Subjective Fever72 (77.4%)39 (68.4%)NA0.253
          Cough75 (79.8%)51 (86.4%)NA0.385
          Diarrhoea30 (32.3%)10 (17.9%)NA0.059
          Nausea/Vomiting33 (35.5%)9 (16.1%)NA0.014
          Myalgia20 (21.5%)14 (25%)NA0.688
          Dyspnoea74 (78.7%)42 (70%)NA0.253
          Duration of Symptoms6.7 (4.53)6.57 (4.81)1/60.796
Chest X-Ray Findings*
          Clear12 (13.8%)4 (6.3%)NA0.192
          Unilateral Infiltrate21 (22.3%)7 (11.1%)NA0.090
          Bilateral Infiltrate51 (54.3%)51 (81%)NA<0.001
          Pleural Effusion0 (0%)2 (3.2%)NA0.159
          Other Finding6 (6.4%)3 (4.8%)NA0.741
Laboratory Findings*
          CRP mg/L70.34 (60.5)142.50 (83.36)2/6<0.001
          LDH U/L311.53 (102.3)415.37 (160.22)5/13<0.001
          D-dimer FEU1199.23 (1692.86)4475.20 (14140.16)15/140.033
          Ferritin ng/mL428.47 (426.81)790.62 (1236.12)7/170.079
          Neutrophils x10^9/L4.55 (2.11)7.20 (3.68)59/24<0.001
          Lymphocytes x10^9/L3.60 (14.03)1.08 (0.63)59/240.067
          NLR4.20 (2.41)8.33 (6.51)59/24<0.001
Clinical Course
          Deceased2 (2.1%)2 (3.1%)NA1.00
          Discharged53 (57.6%)2 (3.5%)NA<0.001

Covariate Effects on Odds of Intubation

Unadjusted Adjusted *
TermOR95% CIp-valueOR95% CIp-value
1 SD change in CRP (78.0 mg/L)3.05(1.9, 4.8)<0.0012.81(1.8, 4.5)<0.001
1 SD change in LDH (135.6 U/L)2.31(1.5, 3.6)<0.0012.10(1.3, 3.3)0.002
1 SD change in Log D-Dimer (0.94 log FEU)1.47(1, 2.2)0.0481.33(0.8, 2.1)0.22
1 SD change in NLR (5.4)1.94(1.1, 3.5)0.0312.21(1.1, 4.5)0.033
1 SD change in Log Ferritin (1.12 log ng/mL)1.45(1, 2.1)0.0551.29(0.9, 1.9)0.23
1 SD change in BMI (8.0 kg/m2)1.15(0.8, 1.6)0.391.07(0.7, 1.6)0.71
1 SD change in age (16.8 years)1.13(0.8, 1.6)0.451.15(0.8, 1.7)0.48
Symptom Duration0.99(0.9, 1.1)0.860.99(0.9, 1.1)0.72
DM2.52(1.3, 5.1)0.0101.98(0.9, 4.3)0.081
Ethnicity/Race is Non-White2.08(0.9, 5)0.101.96(0.8, 5.1)0.17
Bilateral Infiltrate on X-Ray3.6(1.7, 7.6)0.0013.39(1.5, 7.6)0.003
DOI: https://doi.org/10.2478/jccm-2021-0035 | Journal eISSN: 2393-1817 | Journal ISSN: 2393-1809
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Language: English
Page range: 14 - 22
Submitted on: Dec 15, 2020
Accepted on: Aug 31, 2021
Published on: Nov 13, 2021
Published by: University of Medicine, Pharmacy, Science and Technology of Targu Mures
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
intubation,
CoVID-19,
SARS-CoV-2,
inflammatory markers
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Internal medicine, other,
Surgery,
Surgery, other,
Anaesthesiology,
Emergency medicine and intensive-care medicine

© 2021 Samuel Windham, Kellen Hirsch, Ryan Peterson, David Douin, Lakshmi Chauhan, Lauren Heery, Connor Fling, Nemanja Vukovic, Fernando Holguin, Shanta Zimmer, Kristine Erlandson, published by University of Medicine, Pharmacy, Science and Technology of Targu Mures
This work is licensed under the Creative Commons Attribution 4.0 License.

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