Prognostic Markers in COVID-19 Patients in Intensive Care: Can Hemostatic Parameters Predict Mortality?

Abstract

Objective: Our study aimed to investigate whether primarily hemostasis parameters and secondarily demographic, clinical, and laboratory values could predict the mortality of critically ill Coronavirus Disease 2019 (COVID-19) patients. Methods: We retrospectively examined 180 laboratory-confirmed adult intensive care unit (ICU) patients with COVID-19. A total of 145 patients with complete records were included in the study. The patients were divided into two groups: deceased (n=58) and discharged (n=87). The demographic and clinical characteristics of the two groups, use of vasopressor therapy, requirement for invasive mechanical ventilation (IMV), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, duration of ICU stay, and the relationship between laboratory values on ICU admission and mortality were evaluated using cutoff values. Results: Among hemostatic parameters, only D-dimer>1.08 mg L-1 was found to be a significant predictor of mortality (p=0.04), while platelet, prothrombin time (PT), activated partial thromboplastin time (aPTT), International Normalized Ratio (INR) and fibrinogen values were not significantly associated with mortality (p>0.05). In addition, age >76 years, hypertension (HT), need for IMV, APACHE II score >23, procalcitonin (PCT) >0.21 μg L-1, lymphocytes <0.4 109 L-1, interleukin 6 (IL-6) >93 pg mL-1 were found to be predictors of mortality (p<0.05). Neutrophil and C-reactive protein (CRP) values were not significantly associated with mortality (p>0.05). ABSTRACT Conclusion: Our study determined that advanced age, HT, high APACHE II score, requirement for IMV, vasopressor therapy, PCT, lymphocyte count, IL-6, and D-dimer levels could serve as predictors of mortality. Identifying predictors of mortality in COVID-19 is valuable for early recognition of disease progression and management of potential complications. Keywords: COVID-19, mortality, hemostasis, clinical markers, laboratory markers