Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Dec 25, 2023; 12(5): 286-295
Published online Dec 25, 2023. doi: 10.5501/wjv.v12.i5.286
Use of inflammatory markers as predictor for mechanical ventilation in COVID-19 patients with stages IIIb-V chronic kidney disease?
Harinivaas Shanmugavel Geetha, Sushmita Prabhu, Abinesh Sekar, Maya Gogtay, Yuvaraj Singh, Ajay K Mishra, George M Abraham, Suzanne Martin
Harinivaas Shanmugavel Geetha, Sushmita Prabhu, Abinesh Sekar, Yuvaraj Singh, George M Abraham, Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01608, United States
Maya Gogtay, Hospice and Palliative Medicine, University of Texas Health-San Antonio, San Antonio, TX 78201, United States
Ajay K Mishra, Division of Cardiology, Saint Vincent Hospital, Worcester, MA 01608, United States
Suzanne Martin, Department of Nephrology, Saint Vincent Hospital, Worcester, MA 01608, United States
Author contributions: Shanmugavel Geetha H and Martin S conceived the idea for the study; Shanmugavel Geetha H, GogtayM, Abraham GM, and Martin S designed and undertook the literature review; Shanmugavel Geetha H, Prabhu S, Sekar A, and Gogtay M collected data; Gogtay M and Singh Y performed the statistical analysis, figures, and appendix and analyzed and interpreted the data; Shanmugavel Geetha H, Prabhu S, Sekar A, Singh Y, and Gogtay M wrote the first draft of the manuscript; Shanmugavel Geetha H, Singh Y, Sekar A, Abraham GM, Martin S, Mishra AK and Gogtay M revised the subsequent drafts of the manuscript; all authors reviewed and agreed on the final draft of the manuscript.
Institutional review board statement: The study was reviewed and approved for publication by Saint Vincent-MetroWest Medical Center (approval No. 2020-035).
Informed consent statement: The requirement of informed consent was waived by Saint Vincent-MetroWest Medical Center Institutional Review Board.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Ajay K Mishra, FACP, MBBS, MD, Academic Fellow, Division of Cardiology, Saint Vincent Hospital, No. 123 Summer Street, Worcester, MA 01608, United States.
Received: September 4, 2023
Peer-review started: September 4, 2023
First decision: October 17, 2023
Revised: October 26, 2023
Accepted: November 24, 2023
Article in press: November 24, 2023
Published online: December 25, 2023

Studies have shown elevated C-reactive protein (CRP) to predict mechanical ventilation (MV) in patients with coronavirus disease 2019 (COVID-19). Its utility is unknown in patients with chronic kidney disease (CKD), who have elevated baseline CRP levels due to chronic inflammation and reduced renal clearance.


To assess whether an association exists between elevated inflammatory markers and MV rate in patients with stages IIIb-V CKD and COVID-19.


We conducted a retrospective cohort study on patients with COVID-19 and stages IIIb-V CKD. The primary outcome was the rate of invasive MV, the rate of noninvasive MV, and the rate of no MV. Statistical analyses used unpaired t-test for continuous variables and chi-square analysis for categorical variables. Cutoffs for variables were CRP: 100 mg/L, ferritin: 530 ng/mL, D-dimer: 0.5 mg/L, and lactate dehydrogenase (LDH): 590 U/L.


290 were screened, and 118 met the inclusion criteria. CRP, D-dimer, and ferritin were significantly different among the three groups. On univariate analysis for invasive MV (IMV), CRP had an odds ratio (OR)-5.44; ferritin, OR-2.8; LDH, OR-7.7; D-dimer, OR-3.9, (P < 0.05). The admission CRP level had an area under curve-receiver operator characteristic (AUROC): 0.747 for the IMV group (sensitivity-80.8%, specificity-50%) and 0.663 for the non-IMV (NIMV) group (area under the curve, sensitivity-69.2%, specificity-53%).


Our results demonstrate a positive correlation between CRP, ferritin, and D-dimer levels and MV and NIMV rates in CKD patients. The AUROC demonstrates a good sensitivity for CRP levels in detecting the need for MV in patients with stages IIIb-V CKD. This may be because of the greater magnitude of increased inflammation due to COVID-19 itself compared with increased inflammation and reduced clearance due to CKD alone.

Keywords: Coronavirus disease 2019, Chronic kidney disease, Inflammatory markers, C-reactive protein, Invasive mechanical ventilation, Non-invasive mechanical ventilation

Core Tip: Our study demonstrates a positive correlation between the levels of inflammatory markers, including C-reactive protein, ferritin, and D-dimer, and the rate of invasive and non-invasive mechanical ventilation (MV) among coronavirus disease 2019 patients with chronic kidney disease (CKD), suggesting that these biomarkers are clinically useful to predict the need for MV in the CKD population.