Aspirantskiy Vestnik PovolzhiyaAspirantskiy Vestnik PovolzhiyaАспирантский вестник Поволжья2072-23542410-3764Samara State Medical University62636510.35693/AVP626365INFECTIOUS DISEASESИНФЕКЦИОННЫЕ БОЛЕЗНИResearch ArticlePredictors of lethal COVID-19 in patients of intensive care unitПредикторы летального исхода COVID-19 у пациентов отделения интенсивной терапииhttps://orcid.org/0000-0002-4871-3013GubaidullinaOlesya V.ГубайдуллинаО. В.
Russian Federation

anesthesiologist-intensive care physician

врач анестезиолог-реаниматолог

manovaolesya@yandex.ruhttps://orcid.org/0000-0003-4518-9233AleksankinArtem V.АлексанкинА. В.
Russian Federation

Head of the Department of Anesthesiology and Intensive Care No. 2

заведующий отделением анестезиологии и реанимации №2

aleksankin10@mail.ruSamara State Medical UniversityФГБОУ ВО «Самарский государственный медицинский университет»191120240812202424211200102202424092024Copyright ©; 2024, Gubaidullina O.V., Aleksankin A.V.Copyright ©; 2024, Губайдуллина О.В., Алексанкин А.В.2024Gubaidullina O.V., Aleksankin A.V.Губайдуллина О.В., Алексанкин А.В.https://creativecommons.org/licenses/by/4.0https://aspvestnik.ru/2410-3764/article/view/626365

Aim – to identify potential independent routine laboratory predictors of lethal COVID-19 in critically ill patients admitted to the ICU.

Material and methods. This single-centered study included 120 critically ill adult patients with COVID-19 admitted to ICU of the Samara Regional Clinical Hospital named after V.D. Seredavin from August 1 to October 31, 2021. Data on demographics, chest computed tomography, echocardiography, lower extremity venous ultrasound, laboratory tests upon admission to ICU, and clinical outcomes were collected. Data of laboratory tests between survived and deceased patients were compared to identify risk factors of lethality. Univariable and multivariable logistic regression analyses were performed to examine the association of different laboratory parameters with mortality.

Results. As a result of our study, we obtained a multiple logistic regression model that can predict lethal outcomes (AUC=0.820) with relatively high sensitivity (85%) and specificity (85%).

According to our model, elevations in LDH (OR, 0.99; 95% CI, 0.99-1.2), Urea (OR, 0.82; 95% CI, 0.68-0.96), Glucose (OR, 0.99; 95% CI, 0.84-1.15), ASAT (OR, 0.97; 95% CI, 0.94-0.99), and also lymphopenia (lymphocytes count <3.00 × 109/L, OR, 2.53; 95% CI, 0.99-6.93) were predictive for lethal outcome of critically ill COVID-19 patients. Besides, by previously reported data, older age, a high percentage of lung damage on CT, and low heart output also were associated with high mortality risk.

Conclusion. Thus, LDH, Urea, ASAT, Glucose, and lymphocyte levels in COVID-19 patients upon ICU admission should be considered by physicians as independent predictors of the negative outcome.

Цель – выявление потенциальных независимых рутинных лабораторных предикторов летального исхода от COVID-19 у пациентов в критическом состоянии, поступивших в отделения интенсивной терапии.

Материал и методы. В моноцентровое исследование были включены 120 взрослых пациентов с COVID-19 в критическом состоянии, поступивших в отделение интенсивной терапии Самарской областной клинической больницы имени В.Д. Середавина с 1 августа по 31 октября 2021 года. Были собраны данные по демографическим данным, компьютерной томографии грудной клетки, эхокардиографии, УЗИ вен нижних конечностей, лабораторным исследованиям при поступлении в отделение интенсивной терапии и клиническим результатам. Данные лабораторных исследований выживших и умерших пациентов сравнивались с целью выявления факторов риска летальности. Для изучения связи различных лабораторных параметров со смертностью был проведен одновариантный и многовариантный логистический регрессионный анализ.

Результаты. В результате нашего исследования мы получили модель множественной логистической регрессии, позволяющую прогнозировать летальные исходы (AUC=0,820) с относительно высокой чувствительностью (85%) и специфичностью (85%). По нашей модели повышенные ЛДГ (ОШ, 0,99; 95% ДИ, 0,99-1,2), мочевины (ОШ, 0,82; 95% ДИ, 0,68-0,96), глюкозы (ОШ, 0,99; 95% ДИ, 0,84-1,15), АСАТ (ОШ, 0,97; 95% ДИ, 0,94-0,99), а также лимфопения (количество лимфоцитов <3,00 × 109/л, ОШ, 2,53; 95% ДИ, 0,99-6,93) были прогностическими для летального исхода больных COVID в критическом состоянии. Кроме того, пожилой возраст, высокий процент поражения легких по данным КТ и низкий сердечный выброс также были связаны с высоким риском смертности.

Заключение. Уровни ЛДГ, мочевины, АСАТ, глюкозы и лимфоцитов у пациентов с COVID-19 при поступлении в отделение интенсивной терапии должны рассматриваться врачами как независимые предикторы отрицательного исхода.

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