Early “Red Flags” in hospitalized patients with COVID-19

Relevance. Among the studies during the COVID-19 pandemic, a special role is played by studies examining the prognostic value of clinical, laboratory and instrumental markers in patients. Biomarkers with absolute sensitivity and specificity for predicting the outcome of a new coronavirus infection have not been identified yet.

Aim: To identify early clinical and laboratory predictors of severity and mortality in hospitalized patients with COVID-19 and to evaluate the effectiveness of the pharmacotherapy in outpatient and early hospital settings.

Methodology and research methods. A retrospective, comparative study was carried out. Medical data from 745 adult patients with COVID-19, hospitalized in the respiratory hospital of the Siberian State Medical University (Tomsk) from 05/16/2020 to 09/30/2020 were included. The main group consists of patients who were discharged from the hospital. The comparison group included patients with a fatal outcome of the disease.

Results. The group of deceased patients was characterized by older age and a greater number of comorbid diseases (р < 0.0001), the presence of pneumonia during the year preceding COVID-19 (р < 0.0001) and risk factors for the development of Pseudomonas aeruginosa infection (р < 0.005). Early admission to the hospital (р = 0.0110), severe dyspnea (р < 0.0001) with a decrease in oxygen saturation below reference values (р < 0.0001) are also associated with the risk of a fatal outcome. Anosmia was significantly more common in the group of surviving patients.

The number of platelets, the absolute number of lymphocytes, amounts of total protein, albumin (р < 0.0001), sodium (р = 0.0013) in the first 48 hours of hospitalization in the main group were significantly higher. The number of leukocytes (p = 0.0078), neutrophils (p < 0.0001), neutrophil-lymphocyte ratio (p < 0.0001), concentrations of glucose, aspartate aminotransferase, urea, creatinine, C-reactive protein and lactate dehydrogenase were significantly lower in the main group. Serum procalcitonin levels > 0.5 ng/ml were 5 times higher in deceased patients during early period of hospitalization.

Conclusion. Clinical, anamnestic and laboratory factors were identified through this study. These factors may be useful in the early period of hospitalization for accurate assessment of risks of severe ill, effective disease management and reduction of mortality in hospitalized patients with COVID-19.

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