Association of hematological, coagulation and biochemical with respiratory insufficiency and mortality in severe COVID-19 patients: A prospective observational study

Introduction: Some changes in the peripheral blood and arterial blood gas (ABG) parameters will occur in patients with severe COVID-19 infections. These changes have the potential to provide clues or guidance for the diagnosis, treatment, and prognosis of COVID-19 patients. The aim of this study was to evaluate the association of hemodynamic, peripheral blood markers and arterial blood gas parameters with respiratory insufficiency and mortality rate in severe COVID-19 patients. Methods: This single-center, prospective observational study was conducted on severe COVID-19 patients admitted to the general ICU of a university affiliated hospital in the northwest of Iran. Hemodynamic, hematological, coagulation, biochemical and ABG parameters were compared between survivors and non-survivors and also between patients with mild to moderate and severe respiratory insufficiently. Unadjusted and adjusted binary logistic regression analyses were employed to identify risk factors related to the respiratory insufficiency and mortality. Results: In adjusted binary logistic regression, low oxygen saturation (odds ratio [OR]: 0.763, 95% CI: 0.037-0.990, P=0.008), elevated polymorphonuclear leukocyte (PMN)/lymphocyte ratio (OR: 1.999, 95% CI: 1.224-3.008, P=0.008), elevated lactate dehydrogenase [LDH] (OR: 1.711, 95% CI: 1.222-2.051, P=0.045), elevated creatine phosphokinase [CPK] (OR: 1.712, 95% CI: 1.323-2.004, P=0.038), high level of [FiO2] (OR: 1.736, 95% CI: 1.419-2.052, P<0.001) and low level of partial pressure of oxygen (PaO2)/FiO2 ratio (OR: 0.894, 95% CI: 0.387-1, P=0.047) had increased risk of ICU mortality. Conclusion: The potential risk factors of high LDH, CPK, PMN/lymphocyte ratio, FiO2, low SpO2 and PaO2/FiO2 ratio could help clinicians identify patients at high risk of death early in the ICU admission.