Association between biomarkers and COVID-19 severity and mortality: a nationwide Danish cohort study
G Hodges, J Pallisgaard, AMS Olsen, P McGettigan… - BMJ open, 2020 - bmjopen.bmj.com
BMJ open, 2020•bmjopen.bmj.com
Objective To evaluate the association between common biomarkers, death and intensive
care unit (ICU) admission in patients with COVID-19. Design Retrospective cohort study.
From electronic national registry data, we used Cox analysis and bootstrapping to evaluate
associations between baseline levels of biomarkers and standardised absolute risks of
death/ICU admission, adjusted for age and gender. Setting All hospitals in Denmark.
Participants 1310 patients aged≥ 18 years admitted to hospital with COVID-19 from 27th of …
care unit (ICU) admission in patients with COVID-19. Design Retrospective cohort study.
From electronic national registry data, we used Cox analysis and bootstrapping to evaluate
associations between baseline levels of biomarkers and standardised absolute risks of
death/ICU admission, adjusted for age and gender. Setting All hospitals in Denmark.
Participants 1310 patients aged≥ 18 years admitted to hospital with COVID-19 from 27th of …
Objective
To evaluate the association between common biomarkers, death and intensive care unit (ICU) admission in patients with COVID-19.
Design
Retrospective cohort study. From electronic national registry data, we used Cox analysis and bootstrapping to evaluate associations between baseline levels of biomarkers and standardised absolute risks of death/ICU admission, adjusted for age and gender.
Setting
All hospitals in Denmark.
Participants
1310 patients aged ≥18 years admitted to hospital with COVID-19 from 27th of February to 1st of May 2020, with available biochemistry data.
Main outcome measures
A composite of death/ICU admission occurring within 30 days.
Results
Of the 1310 patients admitted to hospital (54.6% men; median age 73.6 years), 352 (26.9%) experienced the composite endpoint and 263 (20.1%) died. For the composite endpoint, the absolute risks for moderately and severely elevated C reactive protein (CRP) were significantly higher, 21.5% and 39.2%, respectively, compared with 5.0% for those with normal CRP. Moderately and severely elevated leucocytes were significantly higher, 34.5% and 46.6% risk, respectively, compared with 23.2% for those with normal leucocytes. Moderately and severely decreased estimated glomerular filtration rates (eGFR) were significantly higher, 41.5% and 45.9% risk, respectively, compared with 30.4% for those with normal/mildly decreased eGFR. Normal and elevated ureas were significantly higher, 22.3% and 40.6% risk, respectively, compared with 7.3% for those with low urea. Elevated D-dimer was significantly higher, 31.8% risk, compared with 17.5% for those with normal D-dimer. Moderately and severely elevated troponins were significantly higher, 27.7% and 57.3% risk, respectively, compared with 9.4% for those with normal troponin. Elevated procalcitonin was significantly higher, 52.1% risk, compared with 28.0% for those with normal procalcitonin.
Conclusion
In this nationwide study of patients admitted with COVID-19, elevated levels of CRP, leucocytes, procalcitonin, urea, troponins and D-dimer, and low levels of eGFR were associated with higher standardised absolute risk of death/ICU admission within 30 days.
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