Is there Association between Trends of Inflammatory Marker to Clinical Course of Critically Ill COVID-19 Patient Require Prolong Hospitalisation?

ABSTRACT

Introduction: Severe acute respiratory syndrome by coronavirus 2 (SARS-CoV-2) pandemic first time started from Wuhan in China in December 2019, the World Health Organization on February 11, 2020, officially named this infection, coronavirus disease 2019 (COVID-19) and the virus as SARS-CoV-2. Clinical assessment is indispensable, but laboratory markers, or biomarkers, can provide additional, objective information which can significantly impact many components of patient care. There are several studies and meta-analyses that showed the relation between potential biomarkers to outcomes like mortality, need for ICU admission, mechanical ventilation, and duration of hospital stay. However, the temporal variation of biomarkers along the course of the illness is important to ascertain disease progression and therapeutic response. Objective of study 1. Trends of blood biomarkers in critically ill patients require prolonged hospitalization. 2. Relation between temporal variation in blood biomarker and course of illness. Materials and methods: This was a retrospective hospitalbased observational study, conducted between 1st May and 30 June, 2021, we included all adult patients aged >18 years with RTPCR or antigen positive COVID-19 infections, admitted in intensive care unit for at least 30 days, and discharged from the hospital. All patients admitted to our institute are investigated and treated as per the COVID treatment protocol of our institute. Blood biomarkers such as C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and D-dimer level tested at various intervals during hospitalisation details were noted along with clinical severity. To look for a trend, we took four levels of blood biomarkers at an interval of 10 days and compared then mean value (Day 1-5, Day 10-15, Day 20-25, and Day 30-35). Clinical severity is measured on basis of type of respiratory support like mechanical ventilation, non-invasive ventilation, oxygen through a non-reservoir mask or simple face mask or nasal prong. Results: Total nine patients (six males and three females) were discharged from Intensive care after >30 days of hospitalisation. Among CRP, LDH, ferritin, and D-dimer, only LDH fall and below the baseline level at the time of discharge (Table 1). Other markers have a wide fluctuation in their level and found either similar or higher levels at discharge compared to baseline level. D-dimer found to be increased during the course of illness and raised from the baseline level of 2.1-7.7 at the time of discharge. Wide fluctuation in their level found for CRP followed by LDH and lowest for ferritin during hospitalisation. CRP and ferritin initially fall around day 10 of ICU while LDH increased during the same period (Fig. 1). Out of nine patients, seven patients were on NIV support, one patient on HFNC, and one patient on a simple face mask. Even after 30 days of hospitalisation, one patient was on NRM support, five patients require oxygen through a face mask, and one patient was through nasal prong (Table 1). Conclusion: There is no association between temporal variation in blood biomarkers with the clinical course of COVID-19 disease. Among CRP, LDH, ferritin, and D-dimer, LDH is most closely associated with the clinical course of the disease.