Inflammatory Biomarkers Demonstrate Predictive Capacity for Mortality in COVID-19-Related ARDS Patients Receiving High-Dose Corticosteroids: A Longitudinal Analysis
Katrijn Daenen,1,2 Anders Boyd,3– 5 Jilske A Huijben,1 Sara CM Stoof,1 Lieuwe DJ Bos,6,7 Diederik Gommers,1 Eric CM van Gorp,2,8 Virgil ASH Dalm,9,10 Henrik Endeman1,11 1Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands; 2Department of Viroscience, Erasmus U...
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Dove Medical Press
2025-02-01
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| Series: | Journal of Inflammation Research |
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| Online Access: | https://www.dovepress.com/inflammatory-biomarkers-demonstrate-predictive-capacity-for-mortality--peer-reviewed-fulltext-article-JIR |
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| author | Daenen K Boyd A Huijben JA Stoof SCM Bos LDJ Gommers D van Gorp ECM Dalm VASH Endeman H |
| author_facet | Daenen K Boyd A Huijben JA Stoof SCM Bos LDJ Gommers D van Gorp ECM Dalm VASH Endeman H |
| author_sort | Daenen K |
| collection | DOAJ |
| description | Katrijn Daenen,1,2 Anders Boyd,3– 5 Jilske A Huijben,1 Sara CM Stoof,1 Lieuwe DJ Bos,6,7 Diederik Gommers,1 Eric CM van Gorp,2,8 Virgil ASH Dalm,9,10 Henrik Endeman1,11 1Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands; 2Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands; 3Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands; 4Stichting HIV Monitoring, Amsterdam, The Netherlands; 5Infectious Diseases, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands; 6Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; 7Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; 8Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; 9Department of Immunology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands; 10Department of Internal Medicine, Division of Allergy & Clinical Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands; 11Department of Intensive Care, OLVG, Amsterdam, The NetherlandsCorrespondence: Katrijn Daenen, Erasmus University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands, Email k.daenen@erasmusmc.nlPurpose: Patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) who lack clinical improvement are frequently treated with high-dose corticosteroids (HDS). Since HDS is used to reduce hyperinflammation in these patients, levels of (pro-)inflammatory biomarkers after commencing HDS treatment could be useful in predicting mortality. This study aims to evaluate biomarker levels after commencing HDS over time, along with their capacity to predict mortality.Patients and Methods: This retrospective cohort study included patients with COVID-19 ARDS treated with HDS in the intensive care unit (ICU) at an academic hospital in the Netherlands between March 2020-March 2022. Inflammatory biomarkers (ie, C-reactive protein (CRP), D-dimer, ferritin, leukocyte count, interleukin-6 (IL-6), lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), and procalcitonin (PCT)) were assessed daily from start of HDS (ie baseline) until day 7. Associations between biomarker levels and all-cause-hospital-mortality were evaluated each day using logistic regression, with cut-offs identified by optimizing sensitivity (Se) and specificity (Sp).Results: Of the 122 patients included, 53 (43.4%) died during hospitalization. HDS was initiated for a median 7 days (IQR=1– 11) after ICU admission. At baseline, a moderately high predictive capacity for mortality was observed at a ferritin level > 1281 μg/L (Se=62%/Sp=64%), leukocyte count > 13.7 × 109/L (Se=42%/Sp=79%), and NLR > 12.1 (Se=61%/Sp=77%). During follow-up, CRP > 50 mg/L on day 6 (Se=50%/Sp=75%) and > 42 mg/L on day 7 (Se=50%/Sp=75%), ferritin > 1082 μg/L on day 6 (Se 63%/Sp=71%) and > 1852 μg/L on day 7 (Se=31%/Sp=79%), IL-6 > 67 mg/L on day 7 (Se=56%/Sp=79%) and LDH > 396U/L on day 6 (Se=38%/Sp=83%) and > 373 U/L on day 7 (Se=47%/Sp=72%) showed moderate capacity to predict mortality. NLR was consistently associated with mortality for all days, except day 1 (Se=36– 68%/Sp=72-92%).Conclusion: In COVID-19 ARDS patients receiving HDS, several clinically available inflammatory biomarkers moderately predicted all-cause-hospital-mortality after the start of HDS, particularly on days 6 and 7. NLR demonstrated the most consistent association with mortality over time. The use of these markers requires validation in larger cohorts.Keywords: infectious diseases, virology, severity, prediction |
| format | Article |
| id | doaj-art-802f6f6e2f2b460d93da6c810f628581 |
| institution | DOAJ |
| issn | 1178-7031 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Inflammation Research |
| spelling | doaj-art-802f6f6e2f2b460d93da6c810f6285812025-08-20T02:48:42ZengDove Medical PressJournal of Inflammation Research1178-70312025-02-01Volume 1823952408100323Inflammatory Biomarkers Demonstrate Predictive Capacity for Mortality in COVID-19-Related ARDS Patients Receiving High-Dose Corticosteroids: A Longitudinal AnalysisDaenen KBoyd AHuijben JAStoof SCMBos LDJGommers Dvan Gorp ECMDalm VASHEndeman HKatrijn Daenen,1,2 Anders Boyd,3– 5 Jilske A Huijben,1 Sara CM Stoof,1 Lieuwe DJ Bos,6,7 Diederik Gommers,1 Eric CM van Gorp,2,8 Virgil ASH Dalm,9,10 Henrik Endeman1,11 1Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands; 2Department of Viroscience, Erasmus University Medical Center, Rotterdam, The Netherlands; 3Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands; 4Stichting HIV Monitoring, Amsterdam, The Netherlands; 5Infectious Diseases, Amsterdam University Medical Centers, Location University of Amsterdam, Amsterdam, The Netherlands; 6Department of Intensive Care, Amsterdam University Medical Centers, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; 7Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers, Location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands; 8Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands; 9Department of Immunology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands; 10Department of Internal Medicine, Division of Allergy & Clinical Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands; 11Department of Intensive Care, OLVG, Amsterdam, The NetherlandsCorrespondence: Katrijn Daenen, Erasmus University Medical Center Rotterdam, Doctor Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands, Email k.daenen@erasmusmc.nlPurpose: Patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS) who lack clinical improvement are frequently treated with high-dose corticosteroids (HDS). Since HDS is used to reduce hyperinflammation in these patients, levels of (pro-)inflammatory biomarkers after commencing HDS treatment could be useful in predicting mortality. This study aims to evaluate biomarker levels after commencing HDS over time, along with their capacity to predict mortality.Patients and Methods: This retrospective cohort study included patients with COVID-19 ARDS treated with HDS in the intensive care unit (ICU) at an academic hospital in the Netherlands between March 2020-March 2022. Inflammatory biomarkers (ie, C-reactive protein (CRP), D-dimer, ferritin, leukocyte count, interleukin-6 (IL-6), lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), and procalcitonin (PCT)) were assessed daily from start of HDS (ie baseline) until day 7. Associations between biomarker levels and all-cause-hospital-mortality were evaluated each day using logistic regression, with cut-offs identified by optimizing sensitivity (Se) and specificity (Sp).Results: Of the 122 patients included, 53 (43.4%) died during hospitalization. HDS was initiated for a median 7 days (IQR=1– 11) after ICU admission. At baseline, a moderately high predictive capacity for mortality was observed at a ferritin level > 1281 μg/L (Se=62%/Sp=64%), leukocyte count > 13.7 × 109/L (Se=42%/Sp=79%), and NLR > 12.1 (Se=61%/Sp=77%). During follow-up, CRP > 50 mg/L on day 6 (Se=50%/Sp=75%) and > 42 mg/L on day 7 (Se=50%/Sp=75%), ferritin > 1082 μg/L on day 6 (Se 63%/Sp=71%) and > 1852 μg/L on day 7 (Se=31%/Sp=79%), IL-6 > 67 mg/L on day 7 (Se=56%/Sp=79%) and LDH > 396U/L on day 6 (Se=38%/Sp=83%) and > 373 U/L on day 7 (Se=47%/Sp=72%) showed moderate capacity to predict mortality. NLR was consistently associated with mortality for all days, except day 1 (Se=36– 68%/Sp=72-92%).Conclusion: In COVID-19 ARDS patients receiving HDS, several clinically available inflammatory biomarkers moderately predicted all-cause-hospital-mortality after the start of HDS, particularly on days 6 and 7. NLR demonstrated the most consistent association with mortality over time. The use of these markers requires validation in larger cohorts.Keywords: infectious diseases, virology, severity, predictionhttps://www.dovepress.com/inflammatory-biomarkers-demonstrate-predictive-capacity-for-mortality--peer-reviewed-fulltext-article-JIRinfectious diseasesvirologyseverityprediction. |
| spellingShingle | Daenen K Boyd A Huijben JA Stoof SCM Bos LDJ Gommers D van Gorp ECM Dalm VASH Endeman H Inflammatory Biomarkers Demonstrate Predictive Capacity for Mortality in COVID-19-Related ARDS Patients Receiving High-Dose Corticosteroids: A Longitudinal Analysis Journal of Inflammation Research infectious diseases virology severity prediction. |
| title | Inflammatory Biomarkers Demonstrate Predictive Capacity for Mortality in COVID-19-Related ARDS Patients Receiving High-Dose Corticosteroids: A Longitudinal Analysis |
| title_full | Inflammatory Biomarkers Demonstrate Predictive Capacity for Mortality in COVID-19-Related ARDS Patients Receiving High-Dose Corticosteroids: A Longitudinal Analysis |
| title_fullStr | Inflammatory Biomarkers Demonstrate Predictive Capacity for Mortality in COVID-19-Related ARDS Patients Receiving High-Dose Corticosteroids: A Longitudinal Analysis |
| title_full_unstemmed | Inflammatory Biomarkers Demonstrate Predictive Capacity for Mortality in COVID-19-Related ARDS Patients Receiving High-Dose Corticosteroids: A Longitudinal Analysis |
| title_short | Inflammatory Biomarkers Demonstrate Predictive Capacity for Mortality in COVID-19-Related ARDS Patients Receiving High-Dose Corticosteroids: A Longitudinal Analysis |
| title_sort | inflammatory biomarkers demonstrate predictive capacity for mortality in covid 19 related ards patients receiving high dose corticosteroids a longitudinal analysis |
| topic | infectious diseases virology severity prediction. |
| url | https://www.dovepress.com/inflammatory-biomarkers-demonstrate-predictive-capacity-for-mortality--peer-reviewed-fulltext-article-JIR |
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