ABSTRACT
Introduction: COVID-19 is an emerging public health problem. It comprises of a large virus family causing varying infection ranging from common cold to more severe infection. Classification of cases into mid, moderate, severe helps for effective management and treatment. CRP is a highly sensitive biomarker for inflammation, tissue damage. Materials and Methods: A retrospective cohort study was done during March 2020 to Feb 2021. Total 2,239 patients were included in the study. CRP levels were measured in hospitalized patients on the day of admission. Statistical Analysis: Continuous variables are presented as Mean ± standard deviation and Median (Q1, Q3). Qualitative variables are presented as frequency and percentage. The continuous variables were compared using independent t test, one-way analysis of variance or Kruskal-Wallis test. Receiver operating characteristic curves (ROC) were constructed to identify the predictability and best cut-offs of variables to differentiate moderate illness from severe-critical illness, severe illness from critical illness, and survivors from non-survivors. A two-tailed P value <0.05 was considered statistically significant. Results: We found a significant increase in CRP values in patients with critical illness in wave-1 and wave-2. The levels of CRP increased as the severity of disease progressed. The CRP had a sensitivity of 71.3% and specificity of 59.8% in critically ill patients in wave-1. In wave-2, the sensitivity of 70.10% and specificity of 56% in critically ill patients. In wave-3, the sensitivity of 75% and specificity of 20.3% in severely ill patients. This indicates that CRP can be used as a marker for disease progression. The Youden index J is 0.3978 and the association criterion is >1.85. Conclusion: CRP is a simple test that helps in initiating primary care. It indicates the severity of disease in COVID-19 infection. CRP can be used as a marker for disease progression and also indicates the severity of lung involvement. © 2022 by the Author(s).
ABSTRACT
INTRODUCTION: SARS-CoV-2 has been associated with high rates of severe hypoxemic respiratory failure. Severe COVID-19 is characterized by rapid development of acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. ARDS is considered a heterogeneous disorder and the presence of a uniform inciting agent with SARS-CoV-2 allows us to investigate subphenotypes of ARDS. We hypothesized that subphenotypes based on early lung compliance in patients with COVID-ARDS may be associated with disease outcomes including mortality. We sought to test this hypothesis in patients with COVID-ARDS. METHODS: Patients in the Yale New Haven Health System from 3/15/2020 to 5/14/2020 were included if they had a positive SARS-CoV-2 test and required intubation. After exclusion for missing data or transfer from satellite facilities, 140 of patients were included for analysis. Clinical, demographic, ventilator, and laboratory parameters were abstracted from the EMR. To identify ARDS subphenotypes, we implemented unsupervised clustering using a partitioning around medoids (PAM) algorithm on average compliance over the three days following intubation. Clustering was also performed on the NHLBI ALVEOLI cohort for use as comparator. RESULTS: Patients received a median of 6.2 cc/kg of IBW on day 1 and 6.2 on day 3. Plateau pressure was less than 30cm H2O in 81% patients and driving pressure was less than 15 in 69% of patients. Median lung compliances were day 1: 30.4 mL/cm H2O [23.0-36.1];day 2: 28.7 mL/cm H2O [21.6-36.8];and day 3: 29.7 mL/cm H2O [23.2-37.6]. By Berlin criteria, 21% of patients had mild ARDS, 46% moderate, and 26% were severe. 61% of patients were proned. Using PAM, three distinct clusters based on compliance were identified (low [LC], medium [MC], and high [HC]). Median day 1 compliance in HC group was 38.0 mL/cm H2O [33.1-44.2], 29.3 [25.2-32.3] in MC, and 19.5 mL/cm H2O [16.7-22.8] in LC. Compared to the HC group, there were no differences in PEEP, day 1 P/F ratio or tidal volume, and ventilatory ratio. HC group had higher P/F ratio day 3, lower tidal volume day 3, and lower driving pressures. There were no differences in biomarkers, comorbidities, vasopressors, paralytics, or sedatives between groups. However, Kaplan-Meier plot demonstrated higher mortality in the HC group. Cox regression model demonstrated persistence of higher mortality in the HC compared to MC group. These differences were not present in the ALVEOLI cohort. CONCLUSION: In COVID-ARDS, a subphenotype characterized by early high compliance was associated with higher mortality when compared to non-COVIDARDS patients.