Prediction of Cytokine Storm and Mortality in Patients with COVID-19 Admitted to ICU: Do Markers Tell the Story?

Nadeem, Rashid; Elhoufi, Ashraf Mahmoud; Iqbal, Naheed Elahi; Obaida, Zainab Abdulameer; Elgohary, Doaa Mohamed; Singh, Mukesh Kumar; Zoraey, Shymaa Farouk; Abdalla, Rami M.; Eltayeb, Sara Yousif; Danthi, Crystal Sharon; Azaza, Nouha; Ahmed, Waleed Mohamed; Hafeez, Muzammil; AlSada, Maryam; Mir, Fatima Farid

INTRODUCTION: COVID-19 has caused approximately one million deaths worldwide as of November 24, 2020. Markers of disease activity like ferritin, C-reactive protein (CRP), and D-dimers are frequently monitored to detect the best opportunity for intensive treatment. METHODS: All patients of >18 years of age were included. The primary variables of interest, ferritin, CRP, and D-dimers, for each patient throughout hospitalization were recorded. Primary clinical outcomes of length of stay in ICU and survival were recorded. DEMOGRAPHICS: age, gender, BMI, and nationality. Ferritin, CRP, and D-dimers were recorded daily if available for the whole ICU stay, and all other variables were recorded on admission day to ICU. RESULTS: The sample includes 235 records. More than 95% of patients have all markers on the day of admission to ICU were ferritin (median 1,278; IQR 1,424), D-dimer 1.21 (3.4), and CRP 129.5 (121). Daily average levels of markers were different from their admission day level: ferritin 1,395 (1,331), D-dimer 3.11 (5.52), and CRP 107 (75.8). Multiple logistic regression analysis determined that average CRP during the stay was the only predictor of survival. DISCUSSION: Data on markers utilization to detect the acute phase of inflammation help clinicians focus on the opportunity window for intensive treatment. CONCLUSION: Average CRP during the stay in ICU is higher than CRP on admission. Average CRP is the only factor that predicts survival.