JOMPAC
Journal of Medicine and Palliative Care

Journal of Medicine and Palliative Care (JOMPAC) is an open access scientific journal with independent, unbiased, and double-blind review under international guidelines. The purpose of JOMPAC is to contribute to the literature by publishing articles on health sciences and medicine.

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Original Article
Importance and comparison of inflammatory biomarkers in COVID-19 patients follow-up in intensive care unit
Abstract
Aims: This study aimed to determine the power of laboratory parameters and biomarkers in predicting the prognosis of patients admitted to the intensive care units (ICU) with COVID-19 in a state hospital.
Methods: In this retrospective study, the hospital automation system of all patients admitted to Bolu İzzet Baysal State Hospital’s ICUs because of COVID-19 between March 2020 and December 2021 were recorded and examined. Demographic data, blood tests, APACHE II score, and inflammatory biomarkers were also recorded. The results of patients who survived and did not survive were compared.
Results: The study included 452 patients and the mortality was 72.6%. Exitus patients had higher APACHE II scores and age. The mortality rate was significantly higher in patients with neurological disorders. For patients who did not survive, blood leukocyte, procalcitonin, LDH, and creatinine levels were higher, whereas blood lymphocyte and thrombocyte levels were lower. Based on the ROC analyses, the lymphocyte count AUC was 0.624, APACHE II score AUC was 0.618, serum procalcitonin level AUC was 0.584, and platelet count was 0.560. Age, APACHE II score, neutrophil-to-lymphocyte ratio, and lymphocyte count were associated with mortality according to a univariate logistic regression analysis. Age (OR (95 CI%)1.02 (1.00-1.04, p=0.018)), APACHE II (OR (95 CI%)1.05 (1.01-1.09, p=0.018)), and neutrophil to lymphocyte ratio (OR (95 CI%) 1.02 (1.01-1.03, p=0.003)) were associated with mortality according to multivariate logistic regression
Conclusion: For patients admitted to the ICU, laboratory parameters and inflammatory biomarkers can help in diagnosis, follow-up, and prognosis in COVID-19. We believe that combinations of hemogram parameters are effective in predicting clinical follow-up and prognosis.

Keywords : Intensive care unit, mortality, COVID-19, lymphocyte, neutrophil-to-lymphocyte ratio

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1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3
2. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5
3. Machado-Alba JE, Valladales-Restrepo LF, Machado-Duque ME, et al. Factors associated with admission to the intensive care unit and mortality in patients with COVID-19, Colombia. PLoS ONE. 2021;16(11): e0260169. doi:10.1371/journal.pone.0260169
4. Kim L, Garg S, O'Halloran A, et al. Risk factors for intensive care unit admission and in-hospital mortality among hospitalized adults identified through the US coronavirus disease 2019 (COVID-19)-associated hospitalization surveillance network (COVID-NET). Clin Infect Dis. 2021;72(9):e206-e214. doi:10.1093/cid/ciaa1012
5. Uzundere O, Kıvılcım Kaçar C, Erdal Erbatur M, et al. Yoğun bakım ünitesinde coronavirüs hastalığı-2019 olan kritik hastaların mortalitesini etkileyen faktörler. J Turk Soc Yoğun Bakım. 2021;19:54-61.
6. Martins-Filho PR, Tavares CSS, Santos VS. Factors associated with mortality in patients with COVID-19. A quantitative evidence synthesis of clinical and laboratory data. Eur J Intern Med. 2020;76:97-99. doi:10. 1016/j.ejim.2020.04.043
7. Lorente L, Martín MM, Argueso M, et al. Association between red blood cell distribution width and mortality of COVID-19 patients. Anaesth Crit Care Pain Med. 2021;40(1):100777. doi:10.1016/j.accpm.2020.10.013
8. Konya PŞ, Demirtürk N, Korkmaz D, Tünay H, Koşar EB. Evaluation of clinical and laboratory characteristics and factors affecting mortality in 500 hospitalized COVID-19 patients: a retrospective study. Saudi Med J. 2022;43(11):1254-1259. doi:10.15537/smj.2022.43.11.20220641
9. Lee J, Park SS, Kim TY, Lee DG, Kim DW. Lymphopenia as a biological predictor of outcomes in COVID-19 patients: a nationwide cohort study. Cancers (Basel). 2021;13(3):471. doi:10.3390/cancers13030471
10. Toori KU, Qureshi MA, Chaudhry A. Lymphopenia: a useful predictor of COVID-19 disease severity and mortality. Pak J Med Sci. 2021;37(7): 1984-1988. doi:10.12669/pjms.37.7.4085
11. Feng T, James A, Doumlele K, et al. Procalcitonin levels in COVID-19 patients are strongly associated with mortality and ICU acceptance in an underserved, inner city population. Medicina (Kaunas). 2021;57(10): 1070. doi:10.3390/medicina57101070
12. Jackson I, Jaradeh H, Aurit S, et al. Role of procalcitonin as a predictor of clinical outcomes in hospitalized patients with COVID-19. Int J Infect Dis. 2022;119:47-52. doi:10.1016/j.ijid.2022.03.044
13. Zattera L, Veliziotis I, Benitez-Cano A, et al. Early procalcitonin to predict mortality in critically ill COVID-19 patients: a multicentric cohort study. Minerva Anestesiol. 2022;88(4):259-271. doi:10.23736/S0375-9393.22.15942-0
14. Imran MM, Ahmad U, Usman U, Ali M, Shaukat A, Gul N. Neutrophil/lymphocyte ratio-a marker of COVID-19 pneumonia severity. Int J Clin Pract. 2021;75(4):e13698. doi:10.1111/ijcp.13698
15. King AH, Mehkri O, Rajendram P, Wang X, Vachharajani V, Duggal A. A high neutrophil-lymphocyte ratio is associated with increased morbidity and mortality in patients with coronavirus disease 2019. Crit Care Explor. 2021;3(5):e0444. doi:10.1097/CCE.0000000000000444
16. Moradi EV, Teimouri A, Rezaee R, et al. Increased age, neutrophil-to-lymphocyte ratio (NLR) and white blood cells count are associated with higher COVID-19 mortality. Am J Emerg Med. 2021;40:11-14. doi:10. 1016/j.ajem.2020.12.003
17. Yildiz H, Castanares-Zapatero D, Pierman G, et al. Validation of neutrophil-to-lymphocyte ratio cut-off value associated with high in-hospital mortality in COVID-19 patients. Int J Gen Med. 2021;14:5111-5117. doi:10.2147/IJGM.S326666
18. Wang ZH, Fu BQ, Lin YW, et al. Red blood cell distribution width: a severity indicator in patients with COVID-19. J Med Virol. 2022;94(5): 2133-2138. doi:10.1002/jmv.27602
19. Kalabin A, Mani VR, Valdivieso SC, Donaldson B. Does C reactive protein/albumin ratio have prognostic value in patients with COVID-19. J Infect Dev Ctries. 2021;15(8):1086-1093. doi:10.3855/jidc.14826
20. El-Shabrawy M, Alsadik ME, El-Shafei M, et al. Interleukin-6 and C-reactive protein/albumin ratio as predictors of COVID-19 severity and mortality. Egypt J Bronchol. 2021;15(1):5. doi:10.1186/s43168-021-00054-1
21. Milligan C, Atassi N, Babu S, et al. Tocilizumab is safe and tolerable and reduces C-reactive protein concentrations in the plasma and cerebrospinal fluid of ALS patients. Muscle Nerve. 2021;64(3):309-320. doi:10.1002/mus.27339
22. Vicka V, Januskeviciute E, Miskinyte S, et al. Comparison of mortality risk evaluation tools efficacy in critically ill COVID-19 patients. BMC Infect Dis. 2021;21(1):1173. doi:10.1186/s12879-021-06866-2
23. Ferrando C, Mellado-Artigas R, Gea A, et al. Patient characteristics, clinical course and factors associated to ICU mortality in critically ill patients infected with SARS-CoV-2 in Spain: a prospective, cohort, multicentre study. Rev Esp Anestesiol Reanim (Engl Ed). 2020;67(8):425-437. doi:10.1016/j.redar.2020.07.003
1. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3
2. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5
3. Machado-Alba JE, Valladales-Restrepo LF, Machado-Duque ME, et al. Factors associated with admission to the intensive care unit and mortality in patients with COVID-19, Colombia. PLoS ONE. 2021;16(11): e0260169. doi:10.1371/journal.pone.0260169
4. Kim L, Garg S, O'Halloran A, et al. Risk factors for intensive care unit admission and in-hospital mortality among hospitalized adults identified through the US coronavirus disease 2019 (COVID-19)-associated hospitalization surveillance network (COVID-NET). Clin Infect Dis. 2021;72(9):e206-e214. doi:10.1093/cid/ciaa1012
5. Uzundere O, Kıvılcım Kaçar C, Erdal Erbatur M, et al. Yoğun bakım ünitesinde coronavirüs hastalığı-2019 olan kritik hastaların mortalitesini etkileyen faktörler. J Turk Soc Yoğun Bakım. 2021;19:54-61.
6. Martins-Filho PR, Tavares CSS, Santos VS. Factors associated with mortality in patients with COVID-19. A quantitative evidence synthesis of clinical and laboratory data. Eur J Intern Med. 2020;76:97-99. doi:10. 1016/j.ejim.2020.04.043
7. Lorente L, Martín MM, Argueso M, et al. Association between red blood cell distribution width and mortality of COVID-19 patients. Anaesth Crit Care Pain Med. 2021;40(1):100777. doi:10.1016/j.accpm.2020.10.013
8. Konya PŞ, Demirtürk N, Korkmaz D, Tünay H, Koşar EB. Evaluation of clinical and laboratory characteristics and factors affecting mortality in 500 hospitalized COVID-19 patients: a retrospective study. Saudi Med J. 2022;43(11):1254-1259. doi:10.15537/smj.2022.43.11.20220641
9. Lee J, Park SS, Kim TY, Lee DG, Kim DW. Lymphopenia as a biological predictor of outcomes in COVID-19 patients: a nationwide cohort study. Cancers (Basel). 2021;13(3):471. doi:10.3390/cancers13030471
10. Toori KU, Qureshi MA, Chaudhry A. Lymphopenia: a useful predictor of COVID-19 disease severity and mortality. Pak J Med Sci. 2021;37(7): 1984-1988. doi:10.12669/pjms.37.7.4085
11. Feng T, James A, Doumlele K, et al. Procalcitonin levels in COVID-19 patients are strongly associated with mortality and ICU acceptance in an underserved, inner city population. Medicina (Kaunas). 2021;57(10): 1070. doi:10.3390/medicina57101070
12. Jackson I, Jaradeh H, Aurit S, et al. Role of procalcitonin as a predictor of clinical outcomes in hospitalized patients with COVID-19. Int J Infect Dis. 2022;119:47-52. doi:10.1016/j.ijid.2022.03.044
13. Zattera L, Veliziotis I, Benitez-Cano A, et al. Early procalcitonin to predict mortality in critically ill COVID-19 patients: a multicentric cohort study. Minerva Anestesiol. 2022;88(4):259-271. doi:10.23736/S0375-9393.22.15942-0
14. Imran MM, Ahmad U, Usman U, Ali M, Shaukat A, Gul N. Neutrophil/lymphocyte ratio-a marker of COVID-19 pneumonia severity. Int J Clin Pract. 2021;75(4):e13698. doi:10.1111/ijcp.13698
15. King AH, Mehkri O, Rajendram P, Wang X, Vachharajani V, Duggal A. A high neutrophil-lymphocyte ratio is associated with increased morbidity and mortality in patients with coronavirus disease 2019. Crit Care Explor. 2021;3(5):e0444. doi:10.1097/CCE.0000000000000444
16. Moradi EV, Teimouri A, Rezaee R, et al. Increased age, neutrophil-to-lymphocyte ratio (NLR) and white blood cells count are associated with higher COVID-19 mortality. Am J Emerg Med. 2021;40:11-14. doi:10. 1016/j.ajem.2020.12.003
17. Yildiz H, Castanares-Zapatero D, Pierman G, et al. Validation of neutrophil-to-lymphocyte ratio cut-off value associated with high in-hospital mortality in COVID-19 patients. Int J Gen Med. 2021;14:5111-5117. doi:10.2147/IJGM.S326666
18. Wang ZH, Fu BQ, Lin YW, et al. Red blood cell distribution width: a severity indicator in patients with COVID-19. J Med Virol. 2022;94(5): 2133-2138. doi:10.1002/jmv.27602
19. Kalabin A, Mani VR, Valdivieso SC, Donaldson B. Does C reactive protein/albumin ratio have prognostic value in patients with COVID-19. J Infect Dev Ctries. 2021;15(8):1086-1093. doi:10.3855/jidc.14826
20. El-Shabrawy M, Alsadik ME, El-Shafei M, et al. Interleukin-6 and C-reactive protein/albumin ratio as predictors of COVID-19 severity and mortality. Egypt J Bronchol. 2021;15(1):5. doi:10.1186/s43168-021-00054-1
21. Milligan C, Atassi N, Babu S, et al. Tocilizumab is safe and tolerable and reduces C-reactive protein concentrations in the plasma and cerebrospinal fluid of ALS patients. Muscle Nerve. 2021;64(3):309-320. doi:10.1002/mus.27339
22. Vicka V, Januskeviciute E, Miskinyte S, et al. Comparison of mortality risk evaluation tools efficacy in critically ill COVID-19 patients. BMC Infect Dis. 2021;21(1):1173. doi:10.1186/s12879-021-06866-2
23. Ferrando C, Mellado-Artigas R, Gea A, et al. Patient characteristics, clinical course and factors associated to ICU mortality in critically ill patients infected with SARS-CoV-2 in Spain: a prospective, cohort, multicentre study. Rev Esp Anestesiol Reanim (Engl Ed). 2020;67(8):425-437. doi:10.1016/j.redar.2020.07.003
Article available in :
Volume 6, Issue 3, 2025
Page : 183-187
https://doi.org/10.47582/jompac.1650421
Article Information
Received : 03 Mar 2025
Accepted : 12 Nis 2025
Published : 18 Haz 2025
Corresponding Author :

Mustafa Deniz: Department of Intensive Care, İzzet Baysal State Hospital, Bolu, Turkiye

[email protected]
Citation : Deniz M, Özdemir E. Importance and comparison of inflammatory biomarkers in COVID-19 patients follow-up in intensive care unit. J Med Palliat Care. 2025;6(3):183-187. doi:10.47582/jompac.1650421

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