Use of inflammatory markers as predictor for mechanical ventilation in COVID-19 patients with stages IIIb-V chronic kidney disease?

Harinivaas Shanmugavel Geetha; Sushmita Prabhu; Abinesh Sekar; Maya Gogtay; Yuvaraj Singh; Ajay K Mishra; George M Abraham; Suzanne Martin

doi:10.5501/wjv.v12.i5.286

Use of inflammatory markers as predictor for mechanical ventilation in COVID-19 patients with stages IIIb-V chronic kidney disease?

World J Virol. 2023 Dec 25;12(5):286-295. doi: 10.5501/wjv.v12.i5.286.

Authors

Harinivaas Shanmugavel Geetha¹, Sushmita Prabhu¹, Abinesh Sekar¹, Maya Gogtay², Yuvaraj Singh¹, Ajay K Mishra³, George M Abraham¹, Suzanne Martin⁴

Affiliations

¹ Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States.
² Hospice and Palliative Medicine, University of Texas Health-San Antonio, San Antonio, TX 78201, United States.
³ Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States. ajay.mishra@stvincenthospital.com.
⁴ Department of Nephrology, Saint Vincent Hospital, Worcester, MA 01608, United States.

Abstract

Background: Studies have shown elevated C-reactive protein (CRP) to predict mechanical ventilation (MV) in patients with coronavirus disease 2019 (COVID-19). Its utility is unknown in patients with chronic kidney disease (CKD), who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance.

Aim: To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stages IIIb-V CKD and COVID-19.

Methods: We conducted a retrospective cohort study on patients with COVID-19 and stages IIIb-V CKD. The primary outcome was the rate of invasive MV, the rate of noninvasive MV, and the rate of no MV. Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables. Cutoffs for variables were CRP: 100 mg/L, ferritin: 530 ng/mL, D-dimer: 0.5 mg/L, and lactate dehydrogenase (LDH): 590 U/L.

Results: 290 were screened, and 118 met the inclusion criteria. CRP, D-dimer, and ferritin were significantly different among the three groups. On univariate analysis for invasive MV (IMV), CRP had an odds ratio (OR)-5.44; ferritin, OR-2.8; LDH, OR-7.7; D-dimer, OR-3.9, (P < 0.05). The admission CRP level had an area under curve-receiver operator characteristic (AUROC): 0.747 for the IMV group (sensitivity-80.8%, specificity-50%) and 0.663 for the non-IMV (NIMV) group (area under the curve, sensitivity-69.2%, specificity-53%).

Conclusion: Our results demonstrate a positive correlation between CRP, ferritin, and D-dimer levels and MV and NIMV rates in CKD patients. The AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stages IIIb-V CKD. This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.

Keywords: C-reactive protein; Chronic kidney disease; Coronavirus disease 2019; Inflammatory markers; Invasive mechanical ventilation; Non-invasive mechanical ventilation.