Trending Proinflammatory Markers to Prognosticate Mechanical Ventilation in COVID-19

Abstract

Abstract Background Proinflammatory markers and clinical assessment have been used to help identify patients who need closer monitoring and possible mechanical ventilation (MV) in patients diagnosed with COVID-19. Retrospective analysis of proinflammatory markers before and after MV may aid in identifying proinflammatory markers that are most useful for predicting MV. Methods The study is a retrospective observational study at a single hospital in a community setting from May 2020 to June 2021. The population includes all adult patients hospitalized with COVID-19 with more than 1 measured value of white blood cell count (WBC), C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, and d-dimer. If the patient did not require MV, admission proinflammatory markers were compared with the maximum proinflammatory marker during the hospital stay. If a patient did require MV, admission proinflammatory markers were compared with proinflammatory marker level on the day of intubation or the first available level after intubation. Results Among 242 hospitalized patients with polymerase chain reaction–confirmed COVID-19 diagnosis, an increase in LDH (P = 0.01458) and d-dimer (P = 0.00284) were associated with patients requiring MV. An increase in WBC (P = 0.19428), CRP (P = 0.58770), or ferritin (P = 0.09302) was not significantly associated with an increased need for MV during our study period. Conclusions Serial monitoring LDH and d-dimer can serve as biochemical markers in identifying patients at high risk for MV. WBC, ferritin, and CRP trends may not have utility in determining risk of MV. Cessation of indiscriminate trending of these markers may be an avenue for cost savings.