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Clinical significance of basic laboratory parameters in predicting the use of various methods of oxygen supplementation in COVID-19


- Department of Respiratory Medicine, Allergology and Pulmonary Oncology, Poznan University of Medical Sciences, Poznan, Poland
- Department of Laboratory Diagnostics, Poznań University of Medical Sciences, Poznan, Poland
open access
Abstract
Introduction: The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection resulted in significant worldwide morbidity and mortality. The aim of our study was to evaluate the results of laboratory tests performed on patients on admission to the hospital between groups of patients requiring and not requiring oxygen supplementation, and to find predictive laboratory indicators for the use of high-flow nasal oxygen therapy (HFNOT)/continuous positive airway pressure (CPAP)/bilevel positive airway pressure (BPAP).
Materials and methods: We retrospectively analysed the data of consecutive patients hospitalised in the Pulmonology Department of the Temporary COVID Hospital in Poznan from February to May 2021. On admission to the department, the patients had a panel of laboratory blood tests.
Results: The study group consisted of 207 patients with a mean age of 59.2 ± 15.0 years of whom 179 (72%) were male. During hospitalisation, oxygen supplementation was required by 87% of patients. Patients requiring oxygen supplementation and/or the use of HFNOT/CPAP/BPAP had lower lymphocyte counts and higher levels of urea, C-reactive protein, D-dimer, troponin, glucose, lactate dehydrogenase (LDH) as well as higher white blood cell and neutrophil counts, The parameter that obtained the highest area under curve value in the receiver operator curve analysis for the necessary use of HFNOT/CPAP/BPAP or CPAP/BPAP was LDH activity.
Conclusions: Among the basic parameters assessed on admission to the temporary hospital, LDH activity turned out to be the most useful for assessing the need for CPAP/BPAP active oxygen therapy. Other parameters that may be helpful for predicting the need for HFNOT/CPAP/BPAP are serum levels of urea, D-dimer and troponin.
Abstract
Introduction: The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection resulted in significant worldwide morbidity and mortality. The aim of our study was to evaluate the results of laboratory tests performed on patients on admission to the hospital between groups of patients requiring and not requiring oxygen supplementation, and to find predictive laboratory indicators for the use of high-flow nasal oxygen therapy (HFNOT)/continuous positive airway pressure (CPAP)/bilevel positive airway pressure (BPAP).
Materials and methods: We retrospectively analysed the data of consecutive patients hospitalised in the Pulmonology Department of the Temporary COVID Hospital in Poznan from February to May 2021. On admission to the department, the patients had a panel of laboratory blood tests.
Results: The study group consisted of 207 patients with a mean age of 59.2 ± 15.0 years of whom 179 (72%) were male. During hospitalisation, oxygen supplementation was required by 87% of patients. Patients requiring oxygen supplementation and/or the use of HFNOT/CPAP/BPAP had lower lymphocyte counts and higher levels of urea, C-reactive protein, D-dimer, troponin, glucose, lactate dehydrogenase (LDH) as well as higher white blood cell and neutrophil counts, The parameter that obtained the highest area under curve value in the receiver operator curve analysis for the necessary use of HFNOT/CPAP/BPAP or CPAP/BPAP was LDH activity.
Conclusions: Among the basic parameters assessed on admission to the temporary hospital, LDH activity turned out to be the most useful for assessing the need for CPAP/BPAP active oxygen therapy. Other parameters that may be helpful for predicting the need for HFNOT/CPAP/BPAP are serum levels of urea, D-dimer and troponin.
Keywords
SARS-CoV-2, laboratory tests, high-flow nasal oxygen therapy (HFNOT), continuous positive airway pressure (CPAP), bilevel positive airway pressure (BPAP)


Title
Clinical significance of basic laboratory parameters in predicting the use of various methods of oxygen supplementation in COVID-19
Journal
Advances in Respiratory Medicine
Issue
Article type
Research paper
Pages
77-85
Published online
2022-01-28
Page views
732
Article views/downloads
119
DOI
10.5603/ARM.a2022.0016
Pubmed
Bibliographic record
Adv Respir Med 2022;90(1):77-85.
Keywords
SARS-CoV-2
laboratory tests
high-flow nasal oxygen therapy (HFNOT)
continuous positive airway pressure (CPAP)
bilevel positive airway pressure (BPAP)
Authors
Ewelina Tobiczyk
Hanna Maria Winiarska
Daria Springer
Ewa Wysocka
Szczepan Cofta


- Johns Hopkins University & Medicine. COVID-19 Map Johns Hopkins University & Medicine. https://coronavirus.jhu.edu/map.html (Accessed 30/6/2021).
- Polish Society of Epidemiology and Physicians of Infectious Diseases. http://www.pteilchz.org.pl/wp-content/uploads/2020/12/%C5%9Amiertelno%C5%9B%C4%87-w-COVID-19-SARSTer-6-12-2020.pdf (Accessed 30/6/2021).
- Rees EM, Nightingale ES, Jafari Y, et al. COVID-19 length of hospital stay: a systematic review and data synthesis. BMC Med. 2020; 18(1): 270.
- Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in china: summary of a report of 72 314 cases from the Chinese center for disease control and prevention. JAMA. 2020; 323(13): 1239–1242.
- Velavan TP, Meyer CG. Mild versus severe COVID-19: Laboratory markers. Int J Infect Dis. 2020; 95: 304–307.
- Herold T, Jurinovic V, Arnreich C, et al. Elevated levels of IL-6 and CRP predict the need for mechanical ventilation in COVID-19. J Allergy Clin Immunol. 2020; 146(1): 128–136.e4.
- Czajkowska-Malinowska M, Kania A, Kuca PJ, et al. Treatment of acute respiratory failure in the course of COVID-19. Practical hints from the expert panel of the Assembly of Intensive Care and Rehabilitation of the Polish Respiratory Society. Adv Respir Med. 2020; 88(3): 245–266.
- Coronavirus Disease 2019 (COVID-19) Treatment Guidelines [Internet]. Bethesda (MD): National Institutes of Health (US); 2021 Apr 21–2021 Sep 15. .
- Zheng Z, Peng F, Xu B, et al. Risk factors of critical & mortal COVID-19 cases: a systematic literature review and meta-analysis. J Infect. 2020; 81(2): e16–e25.
- De Vita N, Scotti L, Cammarota G, et al. for COVID-19 Eastern Piedmont Network. Predictors of intubation in COVID-19 patients treated with out-of-ICU continuous positive airway pressure. Pulmonology. 2021 [Epub ahead of print].
- Nicolini A, Piroddi IM, Barlascini C, et al. Predictors of non-invasive ventilation failure in severe respiratory failure due to community acquired pneumonia. Tanaffos. 2014; 13(4): 20–28.
- Choi KW, Chau TN, Tsang O, et al. Princess Margaret Hospital SARS Study Group. Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong. Ann Intern Med. 2003; 139(9): 715–723.
- Markert CL. Lactate dehydrogenase. Biochemistry and function of lactate dehydrogenase. Cell Biochem Funct. 1984; 2(3): 131–134.
- Laterza OF, Modur VR, Ladenson JH. Biomarkers of tissue injury. Biomark Med. 2008; 2(1): 81–92.
- Poggiali E, Zaino D, Immovilli P, et al. Lactate dehydrogenase and C-reactive protein as predictors of respiratory failure in CoVID-19 patients. Clin Chim Acta. 2020; 509: 135–138.
- Rostami M, Mansouritorghabeh H. D-dimer level in COVID-19 infection: a systematic review. Expert Rev Hematol. 2020; 13(11): 1265–1275.
- Paliogiannis P, Mangoni AA, Dettori P, et al. D-Dimer concentrations and COVID-19 severity: a systematic review and meta-analysis. Front Public Health. 2020; 8: 432.
- Li C, Hu B, Zhang Z, et al. D-dimer triage for COVID-19. Acad Emerg Med. 2020; 27(7): 612–613.
- Huang I, Pranata R, Lim MA, et al. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis. 2020; 14: 1753466620937175.
- Gaze DC. Clinical utility of cardiac troponin measurement in COVID-19 infection. Ann Clin Biochem. 2020; 57(3): 202–205.
- Malik P, Patel U, Patel NH, et al. Elevated cardiac troponin I as a predictor of outcomes in COVID-19 hospitalizations: a meta-analysis. Infez Med. 2020; 28(4): 500–506.
- British Thoracic Society Standards of Care Committee. BTS Guidelines for the Management of Community Acquired Pneumonia in Adults. Thorax. 2021; 56(Suppl 4): IV1-64.