Prognostic accuracy of inflammatory markers in predicting risk of ICU admission for COVID-19: application of time-dependent receiver operating characteristic curves. Issue 6 (June 2022)

• Record Type: Journal Article
• Authors: Geraili, Zahra; Hajian-Tilaki, Karimollah; Bayani, Masomeh; Hosseini, Seyed Reza; Khafri, Soraya; Ebrahimpour, Soheil; Javanian, Mostafa; Babazadeh, Arefeh; Shokri, Mehran
• Is Part Of: Journal of international medical research. Volume 50:Issue 6(2022)
• Publication Date: 2022-06
• Subjects: Neutrophil-to-lymphocyte ratio -- C-reactive protein -- time-dependent area under the receiver operating characteristic curve -- COVID-19 -- intensive care unit admission -- time-dependent ROC curve; Medicine -- Periodicals; Pharmacology -- Periodicals; 610.5
• DOI: 10.1177/03000605221102217
• Languages: English
• ISSNs: 0300-0605

Abstract

Objective: Intensive care unit (ICU) admission occurs at different times during hospitalization among patients with COVID-19. We aimed to evaluate the time-dependent receive operating characteristic (ROC) curve and area under the ROC curve, AUC(t), and accuracy of baseline levels of inflammatory markers C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) in predicting time to an ICU admission event in patients with severe COVID-19 infection. Methods: In this observational study, we evaluated 724 patients with confirmed severe COVID-19 referred to Ayatollah Rohani Hospital, affiliated with Babol University of Medical Sciences, Iran. Results: The AUC(t) of CRP and NLR reached 0.741 (95% confidence interval [CI]: 0.661–0.820) and 0.690 (95% CI: 0.607–0.772), respectively, in the first 3 days after hospital admission. The optimal cutoff values of CRP and NLR for stratification of ICU admission outcomes in patients with severe COVID-19 were 78 mg/L and 5.13, respectively. The risk of ICU admission was significantly greater for patients with these cutoff values (CRP hazard ratio = 2.98; 95% CI: 1.58–5.62; NLR hazard ratio = 2.90; 95% CI: 1.45–5.77). Conclusions: Using time-dependent ROC curves, CRP and NLR values at hospital admission were important predictors of ICU admission. This approach is more efficient than using standard ROC curves.