Abstract
Certain biomarkers predict death due to acute respiratory distress syndrome in COVID-19 patients. We retrospectively analyzed biomarkers associated with time to mechanical ventilation for respiratory failure due to COVID-19 (time-to-mechanical ventilation) in 135 consecutive patients in our hospital. We analyzed biomarkers that were elevated immediately (at admission) and later (3 days after admission) using Cox proportional hazards regression analysis. Independent biomarkers of time-to-mechanical ventilation were high C-reactive protein (CRP), interleukin (IL)-6, and Krebs von den Lungen-6 (KL-6) concentrations at admission and elevated CRP, high-mobility group box-1 protein (HMGB-1), and d-dimer levels and low platelets 3 days after admission. Receiver operating characteristic analysis for detecting the association between independent biomarkers associated with time-to-event in multivariate analyses and the start of mechanical ventilation revealed that these biomarkers had area under the curve values higher than 0.700. The present study suggests that CRP was the only biomarker associated with time-to-mechanical ventilation both at admission and 3 days after admission. Moreover, IL-6 (an inflammatory cytokine), HMGB-1 (a late inflammatory mediator), and KL-6 (reflecting injury and/or remodeling of type II pneumocytes) were associated with outcomes in COVID-19 as reported previously. In conclusion, increased CRP, IL-6, KL-6, HMGB-1, and d-dimer levels and decreased platelet counts were associated with the start of mechanical ventilation due to COVID-19.
Highlights
The viral pneumonia outbreak that began in Wuhan, China, in December 2019 is presently ongoing, and the novel pathogen linked to this disease has been named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
This study focused on determining biomarkers associated with the start of Mechanical ventilation (MV) measured early after admission for COVID-19
The comparison of biomarker levels at admission showed that more severe disease was significantly associated with higher neutrophil counts, C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, IL-6, Krebs von den Lungen-6 (KL-6), and D-dimer and lower lymphocyte counts
Summary
The viral pneumonia outbreak that began in Wuhan, China, in December 2019 is presently ongoing, and the novel pathogen linked to this disease has been named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Pneumonia caused by this virus, named coronavirus disease 2019 (COVID-19), has spread rapidly worldwide [1,2]. The main cause of death in COVID-19 is the development of acute lung injury/acute respiratory distress syndrome (ALI/ARDS) [1,2,3,4]. Predicting the development of critical respiratory failure and stratifying patients early after admission may reduce this risk. Some predictive blood biomarkers and risk factors, including older age, smoking, obesity, hypertension, diabetes mellitus, and coronary heart disease, have been reported, predictors of critical respiratory failure have not yet been established [3,4,5]
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