INFLAMMATORY MARKERS AS PREDICTORS OF INTUBATION IN PATIENTS WITH COVID-19

Abstract

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Common diseases such as hypertension and diabetes mellitus have been shown to increase the risk for mortality in patients with COVID-19. Several biomarkers such as Troponin, D-Dimer, and C-reactive protein (CRP) have been associated with increased mortality. There has been insufficient data to help predict the need for intubation in COVID-19. We aimed to assess the performance of common biomarkers of disease severity in COVID-19 with intubation risk and assess the prediction of early and late intubation in patients hospitalized with COVID-19. METHODS: We retrospectively reviewed consecutive patients hospitalized with COVID-19 in two medical centers in Washington, DC, from March to April 2020. Our primary outcome was time of intubation - early (occurring within 48 hours of admission) and late (occurring after 48 hours of admission). Secondary outcomes included overall intubation status. Our independent variables consisted of initial values for D-dimer, Troponin, and CRP. Covariates included demographics, comorbidities, and APACHE II score on admission. Descriptive analyses calculated median and IQR for continuous variables. For bivariate analyses, the median value was used to dichotomize continuous variables;the Mann-Whitney U test was used for skewed and Student T-Test for normally distributed variables. The Chi-Square test was used for categorical predictor and outcome variables. Logistic regression was used for multivariable analyses. All variables significant in bivariate analyses (P 0.017 ng/ml) and D-dimer (> 1.175 μg/ml) levels were associated with overall subsequent intubation (p=0.0008;p=0.00061, respectively) during hospitalization. Only initial CRP level (> 92.2 mg/L) was associated with overall, early, and late intubation (p=0.003, p=0.03, p=0.0002, respectively). Comorbidities associated with increased mortality in COVID-19 were not predictors of intubation risk. CRP and APACHE II score at time of admission remained independently associated with intubation risk in multivariable modeling (OR=2.47 and p=0.0136;OR=4.82 and p<0.0001, respectively). CONCLUSIONS: In patients hospitalized with COVID-19, initial elevated CRP level identifies patients at increased risk for early and late intubation. Although predictive of intubations within 48 hours of admission, initial troponin, D-dimer, and APACHE II score were not associated with intubation occurring greater than 48 hours after admission. CLINICAL IMPLICATIONS: In patients admitted with COVID-19 who are not intubated within 48 hours of admission, the admission CRP value may help clinicians identify patients still at significant risk for respiratory decompensation and predict the need for intubation during hospitalization. DISCLOSURES: No relevant relationships by Sant Kumar, source=Web Response No relevant relationships by Alex Montero, source=Web Response No relevant relationships by Ilan Vavilin, source=Web Response