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
Research background

Inflammatory markers have been validated in multiple studies to help predict the severity of disease and the need for mechanical ventilation (MV). Studies have shown baseline elevation in these same inflammatory markers in patients with chronic kidney disease (CKD) alone, due to a chronic inflammatory milieu in CKD and reduced renal clearance of these inflammatory markers. The clinical utility of these inflammatory markers to predict the need for MV among patients with coronavirus disease 2019 (COVID-19) and underlying CKD is unclear.

Research motivation

The use of biomarkers has been progressively increasing since the COVID-19 pandemic and the need for establishing the utility of these biomarkers in the presence of multiple comorbidities becomes essential to establish their clinical utility. Hence there is utmost need for this study to assess use of C-reactive protein level in assessing MV risk in CKD patients.

Research objectives

Since an increased level of inflammatory markers were observed in patients with chronic kidney disease, especially amongst those with stages IIIb-V, we planned to assess the utility of inflammatory biomarkers by evaluating the rate of MV and the levels of inflammatory biomarkers in stages IIIb-V chronic kidney disease patients who are diagnosed with COVID-19.

Research methods

In order to analyze the association between inflammatory marker levels and rate of MV, we did a single-center retrospective cohort study. The patients included in the study comprised of patients with stage IIIb-V CKD admitted to a community hospital with a diagnosis of COVID-19 infection. Amongst such patients, we extracted information regarding their inflammatory marker levels and their need for invasive and non-invasive MV (IMV) (NIMV) during their hospital stay.

Research results

A total of 290 patients were admitted between the study period of December 2019 to January, 2022 and amongst them 118 met the inclusion criteria. When we compared the rates of IMV, the group with IMV patients had a greater level of inflammatory markers. We also found a similar result when we compared the inflammatory marker levels amongst NIMV patients.

Research conclusions

Our results showed that elevated inflammatory marker levels were still associated with an increased rate of IMV and NIMV even amongst stage IIIb-V CKD patients with COVID-19 disease, thereby demonstrating the clinical utility of these biomarkers in assessing disease severity despite their baseline elevated levels observed in CKD patients.

Research perspectives

Validation of these inflammatory biomarkers is key in establishing their use as predictive indices. With the clinical utility of these inflammatory markers being described, it is imperative to study the impact of different disease processes on these inflammatory markers before employing them as clinical tools to guide the diagnosis and management of acute COVID-19 infection.