Prognosis for ICU Admission in hospitalized patients with Coronovirus diseases -19 (COVID-19)

Introduction: Anew respiratory virus, SARS-CoV-2, has emerged and spread worldwide since late 2019. This study aims at analyzing clinical presentation on admission and the determinants associated with admission in intensive care units (ICUs) in hospitalized COVID-19 patients. Many clinical reports focused on laboratory parameters have been reported on COVID-19, as indicators of systemic inflammation, such as neutrophil to lymphocyte ratio (NLR), may be used to predict disease severity and outcome. Methods: Prospective observational study of PCR-confirmed COVID-19 patients hospitalized in a pulmonology department in Athens, from January 2021- February 2022. We evaluated the accuracy of clinical signs, symptoms, laboratory tests and biomarkers at clinical presentation in predicting ICU admission. Results: Of 534 included patients with COVID-19, mean age 58 years old, 267 were women (50%), 400(75%) had comorbidities, 67(12%) were smokers and 102(19%) of them were fully vaccinated. The most common comorbidities were cardiac (18%), DM (16%), pulmonological (12%) and neurological (14%) diseases. 220 (41%) patients hospitalized with severe disease in terms of acute respiratory failure, 86 (16%) admitted to ICU, 72 (14%) received High Flow Nasal Canula and 25 (5%) died. We found that obesity, age, high level of C-reactive protein (CRP), lactate dehydrogenase (LDH), Ferritin, NLR and decreased PO2/FIO2 ratio (PAFI) are associated with ICU admission. After multivariate analysis only LDH, NLR and PAFI were significantly associated with the need of mechanical ventilation. Conclusions: In hospitalized patients with COVID-19, PAFI, NLR and LDH at admission are progonostic factors for ICU admission.