Fig. 1
Laboratory parameters among survivors and non-survivors
| Survivors (n=30) | Non-Survivors (n=41) | All patients (n=71) | p-value | |
|---|---|---|---|---|
| Hemoglobin at 24 hours ( g/dl) N=71 | 13.05(11.5-13.5) | 11.9(9.85-14) | 12.4(10.6-13.7) | 0.34 |
| Hemoglobin at 48 hours( g/dl) N=70 | 12.05(10.7-12.9) | 11.05(9.45-13.15) | 11.75(9.97-12.97) | 0.112 |
| TLC at 24 hours (x10^9/L) | 11.15(8.0-15.1) | 14.3(9.3-18.2) | 12.9(8.9-16.5) | 0.046 |
| TLC at 48 hours (x10^9/L) | 11.15(8.5-14.9) | 13.95(9.3-20.0) | 12.6(12.6-16.07) | 0.133 |
| Platelets count at 24 hours(x10^9/L) | 3310(237.25-363) | 224(157.5-335.5) | 269(198-353) | 0.063 |
| Platelets count at 48 hours(x10^9/L) | 334.5(277.5-406.7)) | 212.5(132.75-317.5) | 269.5(171.25-356.25) | <0.001 |
| Blood Urea Nitrogen(mg/dl) | 25(15.75-43) | 27(22.5-51.5) | 26(19-43) | 0.159 |
| Blood Urea Nitrogen at 48 hours( mg/dl) | 26(21-49.25) | 37.5(28.25-58.25) | 35.5(22.75-54.25) | 0.057 |
| Creatinine at 24 hours ( mg/dl) | 1.25(0.9-1.65) | 1.4(1.1-2.05) | 1.4(1-1.9) | 0.111 |
| Creatinine at 48 hours(mg/dl) | 1(0.7-1.35) | 1.85(0.9-25) | 1.3(0.8-2.35) | 0.007 |
| Sodium 24 hours (mmol/L) | 138.5(131.75-141) | 139(133-143) | 139(133-142) | 0.307 |
| Sodium 48 hours(mmol/l) | 141(136.75-144) | 143(139.25-147.75) | 142.5(138-147) | 0.032 |
| Bicarbonate 24 hours (mmol/L) | 22.3(19.3-24.8) | 20.7(17.5-23.45) | 21.9(18-24) | 0.102 |
| Bicarbonate at 48 hours(mmol/L) | 22.8(21.2-26.8) | 20.65(18.75-22.5) | 21.55(19.9-24.5) | 0.002 |
| C-Reactive Protein 24 hours (n=70) (mg/L) | 160(69-236) | 165(58-203.5) | 161.5(63-214.5) | 0.948 |
| C-Reactive Protein at 48 hours (n=63) (mg/L) | 123(48.5-196) | 192.5(85.5-278) | 165(61-244) | 0.054 |
| C-Reactive Protein Max (n=60) (mg/L) | 201(169-292) | 235(162-317.5) | 230(169.25-301) | 0.6 |
| Ferritin at 24 hours (n=68) (ng/ml) | 879.5(420.75- 2518.5) | 1519(669.75-3183.5) | 1278.5(548.75-2566) | 0.159 |
| Ferritin at 48 hours (n=53) (ng/ml) | 674(304-1883.5) | 2075(896.5-3000.5) | 1287(599.5-2752.75) | 0.008 |
| Ferritin Max (n=61) (ng/ml) | 1169.5(648-4424) | 2282(1193.5-6727) | 1923(758.5-5415) | 0.088 |
| D-Dimer at 24 hours (n=69) (mg/ml) | 1.8(1.05-4) | 3.65(2.1-13.72) | 3.3(1.25-9.5) | 0.038 |
| D-Dimer at 48 hours (n=60) (mg/L ) | 3.2(1.7-11.6) | 8.1(2.35-15.4) | 5.3(1.95-15.3) | 0.045 |
| D-Dimer Max(n=61) (mg/L ) | 5.3(2.5-16.8) | 18.3(6.5-30) | 14.5(4.6-30) | 0.009 |
| Procalcitonin (n=68) (ng/ml) | 0.53(0.209-1.45) | 0.80(0.17-3.58) | 0.603(0.202-2.102) | 0.411 |
| Procalcitonin at 48 hours (n=54) (ng/ml) | 0.51(0.25-2.99) | 2.85(0.48-9.72) | 1.33(0.431-7.47) | 0.077 |
| LDH 24 hours (n=67) (I.U/L) | 650(535-774.5) | 667.5(569.75-867) | 652(569-831) | 0.40 |
| LDH48(n=58) (I.U/L) | 575(430-696.75) | 670(579.25-823) | 618(498-743.5) | 0.004 |
| pH at admission | 7.4(7.35-7.43) | 7.37 (7.25-7.43) | 7.39(7.32-7.43) | 0.21 |
| pH 48 hours | 7.41(7.36-7.45) | 7.34 (7.27-7.41) | 7.39(7.315-7.43) | 0.001 |
Complications observed in patients during the hospital stay
| Complications | Frequency | Percentage(%) |
|---|---|---|
| Septic Shock | 44 | 62.0 |
| Multi-organ Dysfunction | 31 | 43.7 |
| Myocardial injury | 30 | 42.3 |
| Thrombotic complications | 2 | 2.8 |
| Acute kidney Injury | 57 | 80.3 |
| Renal replacement therapy | 16 | 22.5 |
| CRRT | 2.8 | |
| Both CRRT/ Hemodialysis | 8.5 | |
| Intermittent Hemodialysis | 11.3 | |
| Hospital-acquired Pneumonia/VAP. | 38 | 53.5 |
| Acinetobacter | 14 | |
| Stenotrophomonas | ||
| Pseudomonas | ||
| Klebsiella | ||
| E.coli | ||
| Fungal infections | 28 | 39.4 |
| Bacteremia | 13 | 18.3 |
| Catheter-associated urinary tract infection | 8 | 11.3 |
| Pneumothorax | 11 | 15.5 |
| Subcutaneous emphysema | 9 | 12.7 |
| Critical illness myopathy | 5 | 7.2 |
| Bed scores | 2 | 2.9 |
| GI Bleed | 17 | 24.6 |
| Re-intubation | 4 | 5.8 |
| Arrhythmias(new-onset) | 20 | 28.1 |
| CPR with ROSC | 12 | 16.9 |
| Diabetic ketoacidosis | 6 | 8.45 |
Multi-variate regression analysis of predictors of mortality
| Variable | p-value | Odds ratio (95% Confidence interval) |
|---|---|---|
| SOFA score Admission | 0.26 | 1.19(0.8-1.64) |
| APACHE-II score Admission | 0.012 | 1.18(1.03-1.34) |
| PF (PA02/Fi02) ratio Admission | 0.20 | 0.99(0.98-1.003) |
| Dimer>1.5 mg/L | 0.037 | 5.15(1.108-23.96) |
| Acute kidney injury | 0.75 | 0.76(0.13-4.26) |
| PEEP at admission (cmH20) | 0.26 | 1.17(0.88-1.57) |
Univariate analysis of predictors of mortality
| Variable | p-value | Odds ratio (95% Confidence interval) | |
|---|---|---|---|
| Age | 0.52 | 1.01 (0.97-1.04) | |
| Age>60 | 0.65 | 1.24 (0.48-3.21) | |
| PEEP at 48 hours | 0.009 | 1.3 (1.06-1.6) | |
| PEEP at 24 hours | 0.32 | 1.09 (0.91-1.32) | |
| PF ratio admission | 0.032 | 0.99 (0.98-0.99) | |
| PF ratio at 48 hours | 0.56 | 0.99 (0.99-1.003) | |
| APACHE-II at 24 hours | 0.000 | 1.19 (1.08-1.31) | |
| APACHE-II 48 hours | 0.000 | 1.17 (1.07-1.27) | |
| SOFA score at 24 hours | 0.000 | 1.48 (1.19-1.85) | |
| SOFA score at 48 hours | 0.000 | 1.47 (1.2-1.8) | |
| Hypertension | 0.81 | 1.11 (0.434-2.87) | |
| Acute kidney injury | 0.019 | 4.62 (1.28-16.64) | |
| Myocardial injury | 0.416 | 1.49(0.56-3.90) | |
| TLC at 24 hours (x10^9/L | 0.079 | 1.06 (0.99-1.14) | |
| Platelets count at 48 hours(x10^9/L) | 0.001 | 0.99 (0.98-099) | |
| Dimer>1.5 mg/L | 0.031 | 3.1 (1.11-8.71) | |
| D-Dimer Maximum | 0.017 | 1.06 (1.01-1.12) | |
| D-Dimer at 24 hours (n=69) (mg/ml) | 0.067 | 1.05 (0.996-1.12) | |
| D-Dimer at 48 hours (n=60) (mg/L ) | 0.089 | 1.05 (0.99-1.12) | |
| C-Reactive Protein 24 hours (n=70)(mg/L) | 0.923 | 1 (0.996-1.005) | |
| C-Reactive Protein >180 mg/L | 0.80 | 1.12 (0.43-2.9) | |
| Procalcitonin >1 ng/ml | 0.236 | 1.82 (0.67-4.93) | |
| LDH 24 hours (n=67) (I.U/L) | 0.212 | 1.001 (1.00-1.002) | |
| LDH 48 hours (I.U/L) | 0.017 | 1.005(1.001-1.008) |
Demographic and clinical features of the study population
| Variables Median (Interquartile ranges) | Survivors (n=30) | Non-Survivors (n=41) | All patients (n=71) | P-value |
|---|---|---|---|---|
| Age (years) | 55(47.5-64) | 59(46-65) | 56(48-64) | 0.35 |
| Age (years) | 0.86 | |||
| <40 | 41.7%(5) | 58.3%(7) | 16.9%(12) | |
| 41-50 | 55.6%(5) | 44.4%(4) | 12.7%(9) | |
| 51-59 | 41.2%(7) | 58.8%(10) | 23.9%(17) | |
| >60 | 39.4%(13) | 60.6%(20) | 46.5%(33) | |
| Diabetes Mellitus | 38.5%(15) | 61.5%(24) | 54.9%(39) | 0.47 |
| Hypertension | 41%(16) | 59%(23) | 54.9%(39) | 0.81 |
| Ischemic heart disease | 41.7%(10) | 58.3%(14) | 33.8%(24) | 0.94 |
| Chronic kidney disease | 33.3%(3) | 66.7%(6) | 12.7%(9) | 0.72 |
| Proning | 43.9%(18) | 56.1%(23) | 57.7%(41) | 0.74 |
| Vasopressors requirement | 37.5%(15) | 62.5%(25) | 56.3%(40) | 0.35 |
| BMI (kg/m2) | 29.5 (24.04-28.53) | 25.95 (24.04-28.5) | 25.95 (24.22-27.68) | 0.7 |
| ICU Admission SOFA score | 5(4-7) | 12(9-14) | 7(5-9) | <0.001 |
| 48 hours SOFA score | 4(2-6) | 10(9-12) | 6(4-10) | <0.001 |
| ICU Admission APACHE II score | 8(7-10) | 21(14-28) | 15(11-24) | <0.001 |
| APACHE II 48 score hours | 9 (6- 11) | 20 (12-25) | 13(9-23) | <0.001 |
| PEEP ICU Admission | 8(8-10) | 8(6-10) | 10(8-10) | 0.217 |
| PEEP 48 hours | 10(8-11) | 10(8-12) | 10(7.75-12) | 0.007 |
| Tidal volume (ml/kg) at ICU admission | 6(5.62-6.43) | 6.42(5.62-6.84) | 6.17(5.62-6.57) | 0.674 |
| Tidal volume at 48 hours | 6.35(5.9-6.86) | 6.13(5.62-6.85) | 6.27(5.7-6.85) | 0.548 |
| PF ratio ICU admission (PA02/Fi02) | 118(81.09-219.31) | 107.37(65.75-141.25) | 112.5(76.75-160) | 0.041 |
| PF ratio 48 hours(PA02/Fi02) | 164.7(115.03-221.41) | 141.41(108.03-192.75) | 154.55(108.75-199.25) | 0.208 |
| Duration of symptom onset to ER | 7(4-10) | 7(5-10) | 7(4-10) | 0.313 |
| presentation | ||||
| Symptom onset to ICU admission | 9(5.7-11.25) | 9(7-12) | 9(7-12) | 0.472 |
| Length of ICU stay | 6(4-9) | 8(4-11.5) | 8(4-10) | 0.177 |
| Length of ICU stay with IMV | 4.5(3-7) | 8(4-11) | 6(3-10) | 0.008 |
| The total length of stay | 17(10.75-21.25) | 9(7.5-15) | 11(8-20) | 0.001 |
| Acute kidney injury | 66.6%(20) | 90.2%(37) | 80.3%(57) | 0.014 |
Area under ROC curve and cut-off values of APACHE II and SOFA score for prediction of mortality
| Scoring variable | Area under ROC curve (95% confidence interval) | Standard error | p-value | Cut-of value | Sensitivity | Specificity |
|---|---|---|---|---|---|---|
| Admission APACHE II score | 0.803(0.697-0.908) | .054 | 0.000016 | 13.5 | 0.775 | 0.70 |
| 48 hour APACHE II score | 0.795(0.687-0.903) | .055 | 0.000027 | 12.5 | 0.75 | 0.80 |
| Admission SOFA score | 0.763(0.649-0.876) | .058 | 0.000181 | 6.5 | 0.775 | 0.67 |
| 48 hour SOFA score | 0.805(0.699-0.910) | .054 | 0.000014 | 5.5 | 0.80 | 0.70 |