Factors Affecting Duration of Hospital Stay in Deceased COVID-19 Patients

Abstract

Objective

Extensive research has been conducted to identify the predictive criteria for COVID-19 disease. White blood cell, C-reactive protein, CRP/albumin ratio, neutrophil-to-lymphocyte ratio and ferritin are among the indicators of increased inflammatory response; hence, they could be used to determine the prognosis of COVID-19 cases. Within the scope of this study, we aimed to elucidate the predictivity of NLR, CAR and other laboratory parameters on the duration of hospital stay and mortality in patients with COVID-19.

Materials and Method

The data of 1516 COVID-19 patients who were hospitalized in our institution have been analyzed retrospectively. Patients were divided into two groups those who deceased within the first 10 days of hospitalization (Group I, ≤10 days) and those who deceased in the later period (Group II, >10 days). Age, gender, time to mortality after hospitalization, neutrophil count, CRP, neutrophil-to-lymphocyte ratio (NLR), CRP/albumin ratio (CAR), and d-dimer values were obtained from blood samples taken during hospitalization.

Results

NLR and CAR values were significantly higher in those who died in the first 10 days compared to the other group (p<0.02 and p<0.001, respectively). In addition, WBC, neutrophil, CRP and d-dimer levels were statistically significantly higher than the other group (p<0.05). Logistic regression analysis results for NLR and CAR were significant. The cut-off values were calculated (5.74 and 4.27, respectively) for both parameters. Among the most common comorbid diseases were hypertension (HT) in 41%, coronary artery disease (CAD) in 41.7%, asthma-chronic obstructive pulmonary disease (COPD) in 36.7%, diabetes mellitus (DM) in 36.1%.

Conclusion

NLR and CAR may have a decisive influence in determining the length of stay in hospital for patients who die in hospital due to COVID-19. In addition, it is recommended that COVID-19 cases with diabetes be followed closely.

Keywords:

• COVID-19
• neutrophil-to-lymphocyte ratio
• CRP/albumin ratio
• hospital mortality
• predictive value

Abbreviations

AUC, area under the curve; CAD, coronary artery disease; CAR, CRP/albumin ratio; COPD, chronic obstructive pulmonary disease; CRF, chronic renal failure; CRP, C-reactive protein; CT, computerized thoracic tomography; CVD, cardiovascular diseases; DIC, disseminated intravascular coagulopathy; DM, diabetes mellitus; HT, hypertension; ICU, intensive care unit; IQR, interquartile range; NLR, neutrophil-to-lymphocyte ratio; OR, odds ratio; ROC, receiver operating characteristics; RT-PCR, real-time reverse transcriptase polymerase chain reaction; SARS CoV-2, severe acute respiratory syndrome coronavirus-2; SPSS, statistical package for the social sciences; WBC, white blood cells; WHO, World Health Organization.

Ethical Declaration

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008. Ethics committee approval has been granted by our institution, and informed consent has been obtained from all participants.

Acknowledgments

The editorial support of this article has been conducted by QA Executive Consultancy, Ozan Batigun MD, MBA in 2023.

Disclosure

The authors declare that they have no competing interests in this work.

Additional information

Funding

There is no specific funding related to this research.