Primary Indicators of Critical Illness in Corovavirus Disease-2019

Abstract Background: Many studies discussed numerous predictors of severity in Coronavirus disease-2019 (COVID-19) patients. However, very limited number of these studies concerned with finding indicators of disease progression, ICU admission and life-threatening complications in such patients. Aim of Study: To determine some of the baseline indicators that lead COVID-19 patients to develop the critically ill form of the disease. Patients and Methods: This cross sectional study was conducted during the period from January 2021 to March 2021. It included 40 patients with COVID-19 infection, proved by positive reverse trascriptase real-time PCR (rt RT-PCR) admitted to Al-Hussein and Bab Al-Sha'reia University Hos-pitals (quarantine sectors) . Studied patients were divided into two equal groups, based on the classification of the Chinese Centers of Disease Control and Prevention (CDC): (1) Severe (non-critically ill) group and (2) Critically ill group. Demo-graphic data and co-morbidities of all participants were recorded and BMI was calculated. Baseline CBC, AST, ALT, ESR, CRP, ferritin, D-dimer and HRCT chest were done for all patients. Results: Age, sex, BMI, smoking habit, CBC indices, ALT, AST and CRP did not show significant differences between severe and critically ill groups. However, ESR, D-dimer, ferritin, HRCT chest score, hypertension and diabetes mellitus showed statistically significant assosciation with the critically ill patients (p-value <0.05). HRCT chest score and hypertension were proved to be independent variables signif-icantly associated with critical illness, unlike ESR which is a dependent variable. Hypertensive patients were 40 times more likely to be critically ill compared to non-hypertensive COVID-19 patients (adjusted OR=40.238). Additionally, for every increase in HRCT chest score by one point, the odds of being critically ill among COVID-19 patients increased twice (adjusted OR=2.1). Conclusion: Hypertension and diabetes mellitus increase the risk of developing critical illness in COVID-19 patients. Elevated ESR, D-dimer, ferritin levels and the more the percentage of HRCT chest involvement are associated with critical illness as well.