Prognostic value of biochemical parameters among severe COVID-19 patients admitted to an intensive care unit of a tertiary hospital in South Africa

Annalise E Zemlin; Brian Allwood; Rajiv T Erasmus; Tandi E Matsha; Zivanai C Chapanduka; Thumeka P Jalavu; Vera Ngah; Lovemore N Sigwadhi; Coenraad F Koegelenberg; Elvis Irusen; Usha Lalla; Anteneh Yalew; Nicola Baines; Jacques L Tamuzi; Anne K Barasa; Valerie Kemunto Magutu; Caroline Njeru; Angela Amayo; Marianne Wanjiru Mureithi; Mary Mungania; Musa Sono-Setati; Alimuddin Zumla; Peter S Nyasulu

doi:10.1016/j.ijregi.2022.01.012

Prognostic value of biochemical parameters among severe COVID-19 patients admitted to an intensive care unit of a tertiary hospital in South Africa

IJID Reg. 2022 Mar:2:191-197. doi: 10.1016/j.ijregi.2022.01.012. Epub 2022 Jan 23.

Authors

Annalise E Zemlin¹, Brian Allwood², Rajiv T Erasmus¹, Tandi E Matsha³, Zivanai C Chapanduka⁴, Thumeka P Jalavu¹, Vera Ngah⁵, Lovemore N Sigwadhi⁵, Coenraad F Koegelenberg², Elvis Irusen², Usha Lalla², Anteneh Yalew^{5

6

7}, Nicola Baines², Jacques L Tamuzi⁵, Anne K Barasa⁸, Valerie Kemunto Magutu⁸, Caroline Njeru⁸, Angela Amayo⁸, Marianne Wanjiru Mureithi⁸, Mary Mungania⁹, Musa Sono-Setati¹⁰, Alimuddin Zumla¹¹, Peter S Nyasulu^{5

12}

Affiliations

¹ Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS Tygerberg Hospital, Cape Town, South Africa.
² Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
³ Faculty of Health and Wellness Sciences, Peninsula University of Technology, Bellville Campus, Cape Town, South Africa.
⁴ Division of Haematological Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS Tygerberg Hospital, Cape Town, South Africa.
⁵ Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
⁶ Department of Statistics, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
⁷ National Data Management Centre for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
⁸ Department of Human Pathology, School of Medicine, University of Nairobi, Nairobi, Kenya.
⁹ Department of Pathology, Kenyatta National Hospital, Nairobi, Kenya.
¹⁰ Department of Public Health Medicine, Department of Health, Limpopo, South Africa.
¹¹ Center for Clinical Microbiology, Division of Infection and Immunity, University College London, NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom.
¹² Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

Background: Data on biochemical markers and their association with mortality rates in patients with severe coronavirus disease 2019 (COVID-19) admitted to intensive care units (ICUs) in sub-Saharan Africa are scarce. An evaluation of baseline routine biochemical parameters was performed in COVID-19 patients admitted to the ICU, in order to identify prognostic biomarkers.

Methods: Demographic, clinical, and laboratory data were collected prospectively from patients with PCR-confirmed COVID-19 admitted to the adult ICU of a tertiary hospital in Cape Town, South Africa, between October 2020 and February 2021. Robust Poisson regression methods and the receiver operating characteristic (ROC) curve were used to explore the association of biochemical parameters with severity and mortality.

Results: A total of 82 patients (median age 53.8 years, interquartile range 46.4-59.7 years) were enrolled, of whom 55 (67%) were female and 27 (33%) were male. The median duration of ICU stay was 10 days (interquartile range 5-14 days); 54/82 patients died (66% case fatality rate). Baseline lactate dehydrogenase (LDH) (adjusted relative risk 1.002, 95% confidence interval 1.0004-1.004; P = 0.016) and N-terminal pro B-type natriuretic peptide (NT-proBNP) (adjusted relative risk 1.0004, 95% confidence interval 1.0001-1.0007; P = 0.014) were both found to be independent risk factors of a poor prognosis, with optimal cut-off values of 449.5 U/l (sensitivity 100%, specificity 43%) and 551 pg/ml (sensitivity 49%, specificity 86%), respectively.

Conclusions: LDH and NT-proBNP appear to be promising predictors of a poor prognosis in COVID-19 patients in the ICU. Studies with a larger sample size are required to confirm the validity of this combination of biomarkers.

Keywords: ACE, angiotensin-converting enzyme; ALT, alanine aminotransferase; ARDS, acute respiratory distress syndrome; AST, aspartate aminotransferase; AUC, area under the curve; Biochemical parameters; Biomarkers; CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; COVID-19; COVID-19, coronavirus disease 2019; CRP, C-reactive protein; HbA1c, haemoglobin A1c; ICU; ICU, intensive care unit; IL, interleukin; IQR, interquartile range; K+, potassium; KDIGO, Kidney Disease Improving Global Outcomes; LDH, lactate dehydrogenase; NHLS, National Health Laboratory Service; NT-proBNP, N-terminal pro B-type natriuretic peptide; Na+, sodium; PCR, polymerase chain reaction; PCT, procalcitonin; Prognostic; ROC, receiver operating characteristic; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; TnT, troponin T; eGFR, estimated glomerular filtration rate; hs-TnT, high-sensitivity troponin T.