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Clinical and Biochemical Predictors of Mortality of COVID-19 Cases from Pakistan

Aasia Khaliq, Fouzia Ashraf, Saamia Tahir, Shahzeb Javed, Saher Shahid, Huda Abbas

Coronavirus Disease 2019 (COVID-19) is an infectious respiratory disease with several biochemical alterations reflecting the main pathophysiological characteristics associated with the disease severity and mortality. We have reported clinical and biochemical predictors of mortality among 200 patients: 57 survivors and 143 non-survivors. Data on patient’s demographic characteristics, radiological findings, laboratory findings and comorbidities was collected. Categorical variables were expressed as percentages (frequencies) while continuous variables were reported as mean ± SD (Standard Deviation). Mann-Whitney t-test, One-way ANOVA, Pearson’s correlation and ROC curves were used for statistical analysis with a p-value of 0.05. Out of 200 patients, 64% were male, and 36% were female. The median age for deceased and recovered cases was 61 (IQR: 24,70) and 36 (IQR: 26,52) years, respectively. Among co-morbid conditions hypertension (p-value 0.079) and cardiac vascular disease (p-value 0.064) was significantly higher in deceased cases. Lymphopenia, GGO, fever, cough are the hallmarks of disease were observed frequently. Increased level of inflammatory biomarkers including CRP (p-value<0.0001), ESR (p-value<0.0001), Ferritin (p-value 0.001), LDH (p-value<0.0001) and PCT (p-value 0.022), coagulation factors such as D-Dimers (p-value 0.0003), Fibrinogen (p-value<0.0001), increased prothrombin time and decreased activated partial thromboplastin time were associated with disease severity. Among serum electrolytes decreased levels of potassium (p-value 0.0004), sodium (p-value<0.0001), chloride (p-value 0.0011) and calcium (p-value 0.0021) but increased level of magnesium (p-value 0.0002) were observed in non-surviving COVID-19 patients. Among hepatocytic biomarkers increased levels of ALT (p-value 0.0001), AST (p-value 0.0011), albumin (p-value 0.0044), alkaline phosphatase (p-value 0.0260) and bilirubin (p-value<0.0001) were observed in non-survivors. The SARS-CoV-2 infection is characterized by several biochemical alterations, which can be recognized by specific biomarkers. Among all biomarkers associated with disease severity and mortality lymphopenia, thrombocytopenia, CRP, ESR, PCT, LDH, AST, ALT, D-dimer, CK, albumin, creatinine phosphatase represents the most predictive parameters of severe COVID-19 infection.