We conducted a retrospective hospital cohort study on patients ≥ 18 years old with confirmed COVID-19, who were admitted to our hospital between 03/15/2020 and 05/25/2020. Study individuals were recruited if they had a complete CBC profile and inflammatory markers such as CRP, ferritin, D-dimer and LDH, as well as a well-defined clinical outcomes (discharged alive or expired). Demographic, clinical and laboratory data were reviewed and retrieved. Univariate and multivariate logistic regression methods were employed to identify prognostic markers associated with mortality.
Results: Out of the 344 confirmed COVID-19 hospitalized patients during the study period, 31 who did not have a complete blood profile were excluded; 303 patients were included in the study, 89 (29%) expired, and 214 (71%) were discharged alive. Demographic analysis was tabulated in Table 1.
The univariate analysis showed a significant association of death with absolute neutrophil count (ANC, p=0.022), NLR (p=002), neutrophil-monocyte ratio (NMR, p=< 0.0001), LCR (p=0.007), lymphocyte-LDH ratio (LLR, p=< 0.0001), lymphocyte-D-dimer ratio (LDR, p=< 0.0001), lymphocyte-ferritin ratio (LFR, p=< 0.0001), and platelets (p=0.037) with mortality. With multivariable logistic regression analysis, the only values that had an odds of survival were high LDR (odds ratio [OR] 1.763; 95% confidence interval [CI], 1.20-2.69), and a high LFR (OR 1.136, CI 1.01-1.34).
We further build up a model which can predict >85% mortality in our cohorts with the utilization of D-dimer ( >500 ng/ml), Ferritin ( >200 ng/ml), LDR (< 1.6), LFR (< 4) and ANC ( >2.5). This new model has a ROC of 0.68 (p< 0.0001).
Table 1: Analysis of Clinical Characteristic and Demographics
Conclusion: This retrospective cohort study of hospitalized patients with COVID-19 suggests LDR and LFR as potential independent prognostic indicators. A new model with combination of D-dimer, Ferritin, LDR, LFR and ANC, was able to predict >85% mortality in our cohort with ROC of 0.68, it will need to be validated in a prospective cohort study.
Amr Ramahi, MD
internal medicine resident
saint michael's medical center
Union, NJ
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Kok Hoe Chan, MD
Resident
Saint Michael's Medical Center
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Laxminarayan Prabhakar, MD
internal medicine resident
Saint Michael's Medical Center
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Iyad Farouji, MD
Resident
Saint Michael's Medical Center
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Divya Thimmareddygari, MD
Resident
Saint Michael's Medical Center
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Theodore R. DaCosta, DO
DO
Saint Michael’s medical center
West Orange, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Sahithi Chittamuri, MD
Medical resident
Saint Michaels medical center
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Kinjal D. Patel, MD
Resident physician
Saint Michael’s Medical Center
Caldwell, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Bishnu Poudel, n/a
Medical Resident
Saint Michael’s Medical Center
Langhorne, Pennsylvania
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Bader I. Al Omour, MD, MD
Resident
St. Micheals Medical Center
West NewYork, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Amy Paige, DO, MPH
Dr. Amy Paige
Saint Micheal’s Medical Center
Harrison, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Ormena Joseph, MD
New Prognostic Markers for COVID-19 Disease
Saint-Michael's Medical Center
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Khamoshi Patel, DO
Resident
Saint Michael Medical Center
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Nilam Bhavsar, DO
Internal Medicine Resident
Saint Michael's Medical Center
Bloomfield, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Hamid S. Shaaban, MD
Attending
Saint Michael's Medical Center
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
Jihad Slim, MD
Chief, Division of Infectious Diseases
Saint Michael's Medical Center
Newark, New Jersey
Disclosure: Abbvie (Speaker's Bureau)Gilead (Speaker's Bureau)Jansen (Speaker's Bureau)Merck (Speaker's Bureau)ViiV (Speaker's Bureau)
