Analyzing Trend of Inflammatory Markers in Covid-19 Patients

ABSTRACT

INTRODUCTION: COVID-19 is often associated with hyper-inflammatory state reported as cytokine storm. Various markers have been proposed for early identification of developing cytokine storm and prognostication. Specifically, high ferritin levels have been shown to be an independent predictor of severity and in-hospital mortality. This study explores the trend of inflammatory markers on COVID-19 patients in hopes to provide clinical correlation with patient outcomes. METHOD(S) An IRB-approved retrospective study was done on 141 patients admitted for COVID-19 from March to April 2020. CRP, ferritin, and lactate dehydrogenase (LDH) levels were obtained on initial presentation and trended during hospitalization. Time to peak using Wilcox Signed Rank Test and area under the curve (AUC) was calculated. A subgroup analysis was done on patients who received high versus standard dose steroids to analyze effects on inflammatory markers. This is defined by at least 6 mg dexamethasone, 32mg methylprednisolone, or 40 mg prednisone daily for at least 3 days. Primary outcome of this study is to assess the trend of inflammatory markers throughout admission and clinically correlate with outcomes. RESULT(S) Time to peak for ferritin was slightly later[3.46 days+/-1.69(pCRP-Ferritin0.046,pLDH-Ferritin0.038)] compared to CRP(3.15 +/- 1.49) and LDH(3.04 +/- 1.75). AUC for CRP was significantly decreased(coef.-581CI[- 1029to-133]p0.013) for patients who received high dose steroids compared to those who received standard doses. There was no significant difference between AUC for LDH and ferritin. Peak CRP,LDH, and ferritin for survivors was 245(158-301), 604(448 -776), 1216(654-2478) respectively;and for non-survivors was 272(207-331) p0.049, 872(624-1220)p< 0.001, 2326(1016-3710)p0.012 respectively. CONCLUSION(S) Inflammatory markers have been a central topic of study in finding predictors of outcomes for COVID-19. This study showed that ferritin peak occurred slightly later than CRP and LDH. We can anticipate ferritin to have a slightly longer course to peak. AUC is suggestive of persistence of inflammation over time. We showed that CRP was significantly lower for patients who received high dose steroids compared with standard dose. Non-survivors had significantly increased peak levels of ferritin, LDH, and CRP.