Clinical value of laboratory indicators for predicting disease progression and death in patients with COVID-19: a retrospective cohort study

Objectives As early prediction of severe illness and death for patients with coronavirus disease 2019 (COVID-19) is important, we aim to explore the clinical value of laboratory indicators in evaluating the progression and prognosis of patients with COVID-19. Design Retrospective cohort study. Setting Hospital-based study in China. Participants Adult patients with COVID-19 from December 15, 2019 to March 15, 2020. End point Disease severity and mortality. Methods Clinical data of 638 patients with COVID-19 were collected and compared between severe and non-severe groups. The predictive ability of laboratory indicators in disease progression and prognosis of COVID-19 was analysed using the receiver operating characteristic curve. The survival differences of COVID-19 patients with different levels of laboratory indicators were analysed utilising Kaplan-Meier analysis. Results 29.8% (190/638) of patients with COVID-19 progressed to severe. Compared with patients with no adverse events, C reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and D-dimer were significantly higher in severe patients with adverse events, such as acute myocardial injury, respiratory failure, acute kidney injury, mechanical ventilation, intensive care unit admission, multiple organ dysfunction syndromes and death (all p<0.05). The multivariate logistic analysis suggested that CRP, NLR and D-dimer were independent risk factors for the disease progression of COVID-19 (all p<0.05). The model combining all of them owned the highest area under the receiver operating characteristic curve (AUC) predicting disease progression and death of COVID-19, with AUC of 0.894 (95% CI 0.857 to 0.931) and 0.918 (95% CI 0.873 to 0.962), respectively. Survival analysis suggested that the patients with a high level of CRP, NLR or D-dimer performed shorter overall survival time (all p<0.05). Conclusions The combination of CRP, NLR and D-dimer could be an effective predictor for the aggravation and death in patients with COVID-19. The abnormal expression of these indicators might suggest a strong inflammatory response and multiple adverse events in patients with severe COVID-19.

Automated summary

This study found that C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and D-dimer play important roles in disease progression and prognosis of patients with COVID-19. The abnormal expression of these indicators may suggest a strong inflammatory response and multiple adverse events in severe COVID-19 patients. The combination of CRP, NLR, and D-dimer could be an effective predictor for disease aggravation and death in COVID-19 patients.