tetano
Editor, Senior Moderator
World J Virol
. 2023 Dec 25;12(5):286-295.
doi: 10.5501/wjv.v12.i5.286. Use of inflammatory markers as predictor for mechanical ventilation in COVID-19 patients with stages IIIb-V chronic kidney disease?
Harinivaas Shanmugavel Geetha[SUP] 1 [/SUP], Sushmita Prabhu[SUP] 1 [/SUP], Abinesh Sekar[SUP] 1 [/SUP], Maya Gogtay[SUP] 2 [/SUP], Yuvaraj Singh[SUP] 1 [/SUP], Ajay K Mishra[SUP] 3 [/SUP], George M Abraham[SUP] 1 [/SUP], Suzanne Martin[SUP] 4 [/SUP]
Affiliations
Background: Studies have shown elevated C-reactive protein (CRP) to predict mechanical ventilation (MV) in patients with coronavirus disease 2019 (COVID-19). Its utility is unknown in patients with chronic kidney disease (CKD), who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance.
Aim: To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stages IIIb-V CKD and COVID-19.
Methods: We conducted a retrospective cohort study on patients with COVID-19 and stages IIIb-V CKD. The primary outcome was the rate of invasive MV, the rate of noninvasive MV, and the rate of no MV. Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables. Cutoffs for variables were CRP: 100 mg/L, ferritin: 530 ng/mL, D-dimer: 0.5 mg/L, and lactate dehydrogenase (LDH): 590 U/L.
Results: 290 were screened, and 118 met the inclusion criteria. CRP, D-dimer, and ferritin were significantly different among the three groups. On univariate analysis for invasive MV (IMV), CRP had an odds ratio (OR)-5.44; ferritin, OR-2.8; LDH, OR-7.7; D-dimer, OR-3.9, (P < 0.05). The admission CRP level had an area under curve-receiver operator characteristic (AUROC): 0.747 for the IMV group (sensitivity-80.8%, specificity-50%) and 0.663 for the non-IMV (NIMV) group (area under the curve, sensitivity-69.2%, specificity-53%).
Conclusion: Our results demonstrate a positive correlation between CRP, ferritin, and D-dimer levels and MV and NIMV rates in CKD patients. The AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stages IIIb-V CKD. This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.
Keywords: C-reactive protein; Chronic kidney disease; Coronavirus disease 2019; Inflammatory markers; Invasive mechanical ventilation; Non-invasive mechanical ventilation.
. 2023 Dec 25;12(5):286-295.
doi: 10.5501/wjv.v12.i5.286. Use of inflammatory markers as predictor for mechanical ventilation in COVID-19 patients with stages IIIb-V chronic kidney disease?
Harinivaas Shanmugavel Geetha[SUP] 1 [/SUP], Sushmita Prabhu[SUP] 1 [/SUP], Abinesh Sekar[SUP] 1 [/SUP], Maya Gogtay[SUP] 2 [/SUP], Yuvaraj Singh[SUP] 1 [/SUP], Ajay K Mishra[SUP] 3 [/SUP], George M Abraham[SUP] 1 [/SUP], Suzanne Martin[SUP] 4 [/SUP]
Affiliations
- PMID: 38187498
- PMCID: PMC10768391
- DOI: 10.5501/wjv.v12.i5.286
Background: Studies have shown elevated C-reactive protein (CRP) to predict mechanical ventilation (MV) in patients with coronavirus disease 2019 (COVID-19). Its utility is unknown in patients with chronic kidney disease (CKD), who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance.
Aim: To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stages IIIb-V CKD and COVID-19.
Methods: We conducted a retrospective cohort study on patients with COVID-19 and stages IIIb-V CKD. The primary outcome was the rate of invasive MV, the rate of noninvasive MV, and the rate of no MV. Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables. Cutoffs for variables were CRP: 100 mg/L, ferritin: 530 ng/mL, D-dimer: 0.5 mg/L, and lactate dehydrogenase (LDH): 590 U/L.
Results: 290 were screened, and 118 met the inclusion criteria. CRP, D-dimer, and ferritin were significantly different among the three groups. On univariate analysis for invasive MV (IMV), CRP had an odds ratio (OR)-5.44; ferritin, OR-2.8; LDH, OR-7.7; D-dimer, OR-3.9, (P < 0.05). The admission CRP level had an area under curve-receiver operator characteristic (AUROC): 0.747 for the IMV group (sensitivity-80.8%, specificity-50%) and 0.663 for the non-IMV (NIMV) group (area under the curve, sensitivity-69.2%, specificity-53%).
Conclusion: Our results demonstrate a positive correlation between CRP, ferritin, and D-dimer levels and MV and NIMV rates in CKD patients. The AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stages IIIb-V CKD. This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.
Keywords: C-reactive protein; Chronic kidney disease; Coronavirus disease 2019; Inflammatory markers; Invasive mechanical ventilation; Non-invasive mechanical ventilation.