Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 26 , ISSUE 4 ( April, 2022 ) > List of Articles

Original Article

Inflammatory Markers as Early Predictors of Disease Severity in COVID-19 Patients Admitted to Intensive Care Units: A Retrospective Observational Analysis

Divya Gupta, Apoorv Jain, Munish Chauhan, Sandeep Dewan

Keywords : APACHE II, Conservative oxygen therapy, COVID-19 ARDS, Hypoxemia, Indian Intensive care unit, Inflammatory biomarker

Citation Information : Gupta D, Jain A, Chauhan M, Dewan S. Inflammatory Markers as Early Predictors of Disease Severity in COVID-19 Patients Admitted to Intensive Care Units: A Retrospective Observational Analysis. Indian J Crit Care Med 2022; 26 (4):484-488.

DOI: 10.5005/jp-journals-10071-24171

License: CC BY-NC 4.0

Published Online: 13-05-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Background: In pandemic situations, it is essential that the limited resources are used judiciously to achieve most benefits. Prediction of the disease severity at the earliest will help in better allocation, thus, positively affecting prognosis and treatment. Aim and objective: To investigate patient characteristics and specific biomarkers as possible early predictors of disease severity of SARS-COV-2 infection. Materials and methods: Retrospective single-centric observational study conducted at 70-bedded intensive care unit of tertiary care hospital at Haryana, India. 100 consecutive RT-PCR positive coronavirus disease-2019 (COVID-19) adult patients. Demographics, acute physiology and chronic health evaluation II (Apache-II) score, and Inflammatory markers were compared with respect to oxygenation defect (PaO2/FiO2 ratio: <300 or ≥300 mm Hg), need of invasive ventilation, ICU length of stay and 28-day mortality. Findings: Mean age was significantly more in lower PF ratio group (58.01 ± 15.33 vs 50.97 ± 13.78, p = 0.023) whereas sex ratio was comparable among patients in two groups. Significantly, higher APACHE-II score (p ≤0.001) and presence of hypertension (43.54% vs 23.68%; p = 0·045) in low PF ratio group along with higher C-reactive protein (171.78 ± 124.45 vs 101.52 ± 88.70), IL-6 (173.51 vs 53.18) and ferritin (1677.60 ± 2271.13 vs 643.54 ± 718.68) levels. Procalcitonin, lactate dehydrogenase, and creatine phosphokinase (CPK) levels were not significant. Interpretation: Age and APACHE II score and among laboratory parameters CRP, ferritin, and IL-6 levels were significantly higher in low PF ratio group, patients requiring invasive ventilation and in mortality group. Use of this triad (CRP, ferritin, and IL-6 levels) at admission may predict the disease severity early in the course. Addition of APACHE-II may further improve the accuracy of the score.

  2. JHU CSSE COVID-19 Data.
  3. Tay MZ, Poh CM, Renia L, MacAry PA, Ng LFP. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol 2020;20(6):1–12. DOI: 10.1038/s41577-020-0311-8.
  4. Intensive Care National Audit & Research Centre. COVID-19 report. May 22, 2020. Available from: [Accessed June 11, 2020].
  5. Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: origin, transmission, and characteristics of human coronaviruses. J Adv Res 2020;24:91–98. DOI: 10.1016/j.jare.2020.03.005.
  6. Nicholls JM, Poon LL, Lee KC, Ng WF, Lai ST, Leung CY, et al. Lung pathology of fatal severe acute respiratory syndrome. Lancet 2003;361(9371):1773–1778. DOI: 10.1016/s0140-6736(03)13413-7.
  7. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020;8(4):420–422. DOI: 10.1016/S2213-2600(20)30076-X.
  8. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel corona virus pneumonia Wuhan, China: a descriptive study. Lancet 2020;395(10223):507–513. DOI: 10.1016/S0140-6736(20)30211-7.
  9. Dudley JP, Lee NT. Disparities in age-specific morbidity and mortality from SARS-CoV-2 in China and the Republic of Korea. Clin Infect Dis 2020;71(15):863–865. DOI: 10.1093/cid/ciaa354.
  10. Gebhard C, Regitz-Zagrosek V, Neuhauser HK, Morgan R, Klein SL. Impact of sex and gender on COVID-19 outcomes in Europe. Biol Sex Differ 2020;11(1):29. DOI: 10.1186/s13293-020-00304-9.
  11. Haitao T, Vermunt JV, Abeykoon J, Ghamrawi R, Gunaratne M, Jayachandran M, et al. COVID-19 and sex differences: mechanisms and biomarkers. Mayo Clin Proc 2020;95(10):2189–2203. DOI: 10.1016/j.mayocp.2020.07.024.
  12. Wang Y, Lu X, Li Y, Chen H, Chen T, Su N, et al. Clinical course and outcomes of 344 intensive care patients with COVID-19. Am J Respir Crit Care Med 2020;201(11):1430–1434. DOI: 10.1164/rccm.202003-0736LE.
  13. Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angiotensin-converting enzyme 2 (ACE2) as a SARS-CoV-2 receptor: molecular mechanisms and potential therapeutic target. Intensive Care Med 2020;46(4):586–590. DOI: 10.1007/s00134-020-05985-9.
  14. Yang J, Zheng Y, Gou X, Pu K, Chen Z, Guo Q, et al. Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis. Int J Infect Dis 2020;94:91–95. DOI: 10.1016/j.ijid.2020.03.017.
  15. Bames PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J 2009;33(5):1165–1185. DOI: 10.1183/09031936.00128008.
  16. Zou X, Li S, Fang M, Hu M, Bian Y, Ling J, et al. Acute physiology and chronic health evaluation II score as a predictor of hospital mortality in patients of coronavirus disease 2019. Crit Care Med 2020;48(8):e657–e665. DOI: 10.1097/CCM.0000000000004411.
  17. Zhou B, She J, Wang Y, Ma X. Utility of ferritin, procalcitonin, and C-reactive protein in severe patients with 2019 novel coronavirus disease. Res Square 2020. DOI: 10.21203/
  18. Upadhyay J, Tiwari N, Ansari MN. Role of inflammatory markers in corona virus disease (COVID-19) patients: a review. Exp Biol Med (Maywood) 2020;245(15):1368–1375. DOI: 10.1177/1535370 220939477.
  19. Wooldridge KG, Williams PH. Iron uptake mechanisms of pathogenic bacteria. FEMS Microbiol Rev 1993;12(4):325. DOI: 10.1111/j.1574-6976.1993.tb00026.x.
  20. Zeng F, Huang Y, Guo Y, Yin M, Chen X, Xiao L, et al. Association of inflammatory markers with the severity of COVID-19: a meta-analysis. Int J Infect Dis 2020;96:467–474. DOI: 10.1016/j.ijid.2020.05.055.
  21. Manson JJ, Crooks C, Naja M, Ledlie A, Goulden B, Liddle T, et al. COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study. Lancet Rheumatol 2020;2(10):e594–e602. DOI: 10.1016/S2665-9913(20)30275-7.
  22. Conti P, Ronconi G, Caraffa A, Gallenga CE, Ross R, Frydas I, et al. Induction of proinflammatory cytokines (IL-1 and IL-6) and lung inflammation by coronavirus 19 (COVID19 or SARS-CoV-2): anti-inflammatory strategies. J Biol Regul Homeost Agents 2020;34(2):1. DOI: 10.23812/CONTI-E.
  23. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: are retrospective cohort study. Lancet 2020;395(10229): 1054–1062. DOI: 10.1016/S0140-6736(20)30566-3.
  24. Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med 2020;46(5):846–848. DOI: 10.1007/s00134-020-05991-x.
  25. Channappanavar R, Periman S. Pathogenic human coronavirus infections causes and consequences of cytokines storm and immunopathology. Semin Immunopathol 2017;39(5):529–539. DOI: 10.1007/s00281-017-0629-x.
  26. Chousterman BG, Swirski FS, Weber GF. Cytokine storm and sepsis disease pathogenesis. Semin Immunopathol 2017;39(5):517–528. DOI: 10.1007/s00281-017-0639-8.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.