Predicting COVID-19 outcomes from clinical and laboratory parameters in an intensive care facility during the second wave of the pandemic in South Africa

Brian W Allwood; Coenraad F Koegelenberg; Veranyuy D Ngah; Lovemore N Sigwadhi; Elvis M Irusen; Usha Lalla; Anteneh Yalew; Jacques L Tamuzi; Marli McAllister; Annalise E Zemlin; Thumeka P Jalavu; Rajiv Erasmus; Zivanai C Chapanduka; Tandi E Matsha; Isaac Fwemba; Alimuddin Zumla; Peter S Nyasulu; COVID-19 Research Response Collaboration

doi:10.1016/j.ijregi.2022.03.024

Predicting COVID-19 outcomes from clinical and laboratory parameters in an intensive care facility during the second wave of the pandemic in South Africa

IJID Reg. 2022 Jun:3:242-247. doi: 10.1016/j.ijregi.2022.03.024. Epub 2022 Apr 1.

Authors

Brian W Allwood¹, Coenraad F Koegelenberg¹, Veranyuy D Ngah², Lovemore N Sigwadhi², Elvis M Irusen¹, Usha Lalla¹, Anteneh Yalew^{2

3

4}, Jacques L Tamuzi², Marli McAllister², Annalise E Zemlin⁵, Thumeka P Jalavu⁵, Rajiv Erasmus⁵, Zivanai C Chapanduka⁶, Tandi E Matsha⁷, Isaac Fwemba⁸, Alimuddin Zumla^{9

10}, Peter S Nyasulu^{2

11}; COVID-19 Research Response Collaboration

Affiliations

¹ Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
² Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
³ Department of Statistics, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
⁴ National Data Management Centre for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
⁵ Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS Tygerberg Hospital, Cape Town, South Africa.
⁶ Division of Haematological Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and NHLS Tygerberg Hospital, Cape Town, South Africa.
⁷ Faculty of Health and Wellness Sciences, Peninsula University of Technology, Bellville Campus, Cape Town.
⁸ School of Public Health, University of Zambia, Lusaka, Zambia.
⁹ Division of Infection and Immunity, Centre for Clinical Microbiology, University College London Royal Free Campus, London, UK.
¹⁰ NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
¹¹ Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Abstract

Background: The second wave of coronavirus disease 2019 (COVID-19) in South Africa was caused by the Beta variant of severe acute respiratory syndrome coronavirurus-2. This study aimed to explore clinical and biochemical parameters that could predict outcome in patients with COVID-19.

Methods: A prospective study was conducted between 5 November 2020 and 30 April 2021 among patients with confirmed COVID-19 admitted to the intensive care unit (ICU) of a tertiary hospital. The Cox proportional hazards model in Stata 16 was used to assess risk factors associated with survival or death. Factors with P<0.05 were considered significant.

Results: Patients who died were found to have significantly lower median pH (P<0.001), higher median arterial partial pressure of carbon dioxide (P<0.001), higher D-dimer levels (P=0.001), higher troponin T levels (P=0.001), higher N-terminal-prohormone B-type natriuretic peptide levels (P=0.007) and higher C-reactive protein levels (P=0.010) compared with patients who survived. Increased standard bicarbonate (HCO3std) was associated with lower risk of death (hazard ratio 0.96, 95% confidence interval 0.93-0.99).

Conclusions: The mortality of patients with COVID-19 admitted to the ICU was associated with elevated D-dimer and a low HCO3std level. Large studies are warranted to increase the identification of patients at risk of poor prognosis, and to improve the clinical approach.

Keywords: Biomarkers; COVID-19; ICU; Mortality; SARS-CoV-2; Second wave.