Association of Dynamic Changes in Illness Severity Scores Biochemical and Inflammatory Markers with Outcomes in Invasively Ventilated COVID-19 in Resource-limited Settings: A Time-course Study
Citation Information :
Pednekar A, Bajpe S, Sonawane S, Shinde S, Vaishnav Y, Jha S, Wani P, Sanwalka N. Association of Dynamic Changes in Illness Severity Scores Biochemical and Inflammatory Markers with Outcomes in Invasively Ventilated COVID-19 in Resource-limited Settings: A Time-course Study. Indian J Respir Care 2023; 12 (3):222-229.
Background and objectives: No information is available from India on the kinetics of biochemical and inflammatory markers on the outcomes of invasively ventilated coronavirus disease 2019 (COVID-19) patients.
Patients and methods: In a retrospective study on invasively ventilated COVID-19 patients we performed a time-course design to look at the development of organ dysfunction and its association with survival.
Results: A total of 156 patients were studied. Higher acute physiology and chronic health evaluation (APACHE) II scores on day 1 and Sequential Organ Failure Assessment (SOFA)/Simplified Acute Physiology Score (SAPS) II scores were noted in nonsurvivors. Nonsurvivors had significantly higher blood urea nitrogen, neutrophil-lymphocyte ratio, serum ferritin, interleukin (IL)—6, and D dimer levels as compared to survivors (p < 0.05) as a baseline. A higher percentage of nonsurvivors had serum sodium, serum chloride, blood urea nitrogen (BUN), and serum creatinine levels both above and below limits as compared to survivors. A significantly higher percentage of nonsurvivors had higher arterial pressure of carbon dioxide (PaCO2), lower platelet and absolute lymphocyte counts, and multiorgan dysfunction syndrome (MODS) as compared to survivors (p < 0.05). Positive fluid balance was associated with higher mortality.
Conclusion: Variables recorded at baseline and their dynamics during the period of invasive ventilation were correlated with survival.
Botta M, Tsonas AM, Pillay J, et al. Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID): a national, multicentre, observational cohort study. Lancet Respir Med 2021;9(2):139–148. DOI: 10.1016/S2213-2600(20)30459-8
Tan LY, Komarasamy TV, Rmt Balasubramaniam V. Hyperinflammatory immune response and COVID-19: a double edged sword. Front Immunol 2021;12:742941. DOI: 10.3389/fimmu.2021.742941
Oussalah A, Gleye S, Urmes IC, et al. The spectrum of biochemical alterations associated with organ dysfunction and inflammatory status and their association with disease outcomes in severe COVID-19: A longitudinal cohort and time-series design study. EClinicalMedicine 2020;27:100554. DOI: 10.1016/j.eclinm.2020.100554
Schneider M. The role of biomarkers in hospitalized COVID-19 patients with systemic manifestations. Biomark Insights 2022;17:11772719221108909. DOI: 10.1177/11772719221108909
Pitamberwale A, Mahmood T, Ansari AK, et al. Biochemical parameters as prognostic markers in severely ill COVID-19 patients. Cureus 2022;14(8):e28594. DOI: 10.7759/cureus.28594
Sabaka P, Koščálová A, Straka I, et al. Role of interleukin 6 as a predictive factor for a severe course of Covid-19: retrospective data analysis of patients from a long-term care facility during Covid-19 outbreak. BMC Infect Dis 2021;21(1):308. DOI: 10.1186/s12879-021-05945-8
Kumar H, Dixit S, Shakya S, et al. Clinico-demographic, hematological, and comorbidity profile of COVID-19 patients admitted at tertiary care center. Indian J Respir Care 2021;10(2):213–215. DOI: 10.4103/ijrc.ijrc_3_21
Vadi S, Pednekar A, Suthar D, et al. Association of mortality with lymphocyte subset in patients with covid-19-associated acute respiratory failure: a subgroup analysis. Indian J Crit Care Med 2023;27(1):52–56. DOI: 10.5005/jp-journals-10071-24392
Legrand M, Bell S, Forni L, et al. Pathophysiology of COVID-19-associated acute kidney injury. Nat Rev Nephrol 2021;17(11):751–764. DOI: 10.1038/s41581-021-00452-0
Ahuja S, de Grooth HJ, Paulus F, et al. Association between early cumulative fluid balance and successful liberation from invasive ventilation in COVID-19 ARDS patients - insights from the PRoVENT-COVID study: a national, multicenter, observational cohort analysis. Crit Care 2022;26(1):157. DOI: 10.1186/s13054-022-04023-y
Rosenberg AL, Dechert RE, Park PK, et al. Review of a large clinical series: association of cumulative fluid balance on outcome in acute lung injury: a retrospective review of the ARDSnet tidal volume study cohort. J Intensive Care Med 2009;24(1):35–46. DOI: 10.1177/0885066608329850
Shi R, Lai C, Teboul JL, et al. COVID-19 ARDS is characterized by higher extravascular lung water than non-COVID-19 ARDS: the PiCCOVID study. Crit Care 2021;25(1):186. DOI: 10.1186/s13054-021-03594-6
Ware LB, Matthay MA. Alveolar fluid clearance is impaired in the majority of patients with acute lung injury and the acute respiratory distress syndrome. Am J Respir Crit Care Med 2001;163(6):1376–1383. DOI: 10.1164/ajrccm.163.6.2004035
Nuckton TJ, Alonso JA, Kallet RH, et al. Pulmonary dead-space fraction as a risk factor for death in the acute respiratory distress syndrome. N Engl J Med 2002;346(17):1281–1286. DOI: 10.1056/NEJMoa012835
Harbut P, Prisk GK, Lindwall R, et al. Intrapulmonary shunt and alveolar dead space in a cohort of patients with acute COVID-19 pneumonitis and early recovery. Eur Respir J 2023;61(1): DOI: 10.1183/13993003.01117-2022
Fayed M, Patel N, Angappan S, et al. Sequential Organ Failure Assessment (SOFA) score and mortality prediction in patients with severe respiratory distress secondary to covid-19. Cureus 2022;14(7):e26911. DOI: 10.7759/cureus.26911
Beigmohammadi MT, Amoozadeh L, Rezaei Motlagh, et al. Mortality predictive value of APACHE II and SOFA scores in COVID-19 patients in the intensive care unit. Can Respir J 2022;2022:5129314. DOI: 10.1155/2022/5129314
