Original article
Decrease in hemoglobin level predicts increased risk for severe respiratory failure in COVID-19 patients with pneumonia

https://doi.org/10.1016/j.resinv.2020.10.009Get rights and content

Abstract

Background

In December 2019, the coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), emerged in Wuhan, China, and has since spread throughout the world. This study aimed to investigate the association between the change in laboratory markers during the three days after pneumonia diagnosis and severe respiratory failure in COVID-19 patients.

Methods

Data of 23 COVID-19 patients with pneumonia, admitted to the Kumamoto City Hospital between February and April 2020 were retrospectively analyzed.

Results

Among the 23 patients, eight patients received mechanical ventilation (MV) (MV group), and the remaining 15 comprised the non-MV group. The levels of hemoglobin (Hb) and albumin (Alb) decreased in the MV group during the three days after pneumonia diagnosis more than in the non-MV group (median Hb: 1.40 vs. −0.10 g/dL, P = 0.015; median Alb: 0.85 vs. −0.30 g/dL, P = 0.020). Univariate logistic regression analysis showed that the decrease in Hb was associated with receiving MV care (odds ratio: 0.313, 95% confidence interval: 0.100–0.976, P = 0.045). Receiver operating characteristic curve analyses showed that the optimal cut-off value for the decrease in Hb level was −1.25 g/dL, with sensitivity and specificity values of 0.867 and 0.750, respectively.

Conclusions

The decrease in Hb level during the short period after pneumonia diagnosis might be a predictor of worsening pneumonia in COVID-19 patients.

Keywords

Coronavirus disease 2019
Severe acute respiratory syndrome coronavirus-2
Intermittent positive pressure ventilation
Hemoglobin
Albumin

Abbreviations

COVID-19
coronavirus disease 2019
SARS-CoV-2
severe acute respiratory syndrome coronavirus-2
ARDS
acute respiratory distress syndrome
ICU
intensive care unit
MV
mechanical ventilation
Hb
hemoglobin, Alb albumin
CI
confidence interval
WBC
white blood cells
AST
aspartate aminotransferase
ALT
alanine aminotransferase
LDH
lactate dehydrogenase
IL-6
interleukin-6
CRP
C-reactive protein
PCT
procalcitonin
CT
computed tomography
BUN
blood urea nitrogen
Plt
platelets
Cr
creatinine
ROC
receiver operating characteristic
AUC
area under the ROC curve
SpO2
oxygen saturation
AML
acute myeloid leukemia

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