Baseline characteristics and changes of biomarkers in disease course predict prognosis of patients with COVID-19

Intern Emerg Med. 2021 Aug;16(5):1165-1172. doi: 10.1007/s11739-020-02560-4. Epub 2021 Feb 10.


The outbreak of coronavirus disease (COVID-19) has brought great challenges to the world. The objectives of this study were to describe the baseline characteristics and changes of biomarkers of these COVID-19 patients and identify predictive value of the above markers for patient death. Using patient death as the observational endpoints, clinical data of inpatients in a special ward for COVID-19 in Wuhan, China were retrospectively collected. Univariate and multivariate Cox regression analyses were used to evaluate prognostic value of baseline characteristics and laboratory data changes. This study included clinical data of 75 patients. Age, c-reactive protein (CRP) and interleukin-6 levels were independent predictors of patient death. Survivors were characterized as having declining neutrophil counts, D-dimer, N-terminal pronatriuretic peptide, troponin I (TnI) and c-reactive protein levels, while counts of lymphocyte gradually came back. Non-survivors were characterized with increasing white blood cell counts (WBC) and neutrophil counts. Changes of WBC, TnI and interleukin-6 were also independently associated with patient death. Older age, baseline CRP and IL-6 levels may be used as meaningful predictors to identify patients with poor prognosis. Changes of biomarkers should be closely monitored in the management of patients with COVID-19, while constantly increasing levels of WBC, TnI and interleukin-6 in the disease course also predict patient death.

Keywords: C-reactive protein; COVID-19; Interleukin-6; Leukocyte count; Troponin I.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Analysis of Variance
  • Biomarkers / analysis*
  • Biomarkers / blood
  • Blood Cell Count / methods
  • Blood Cell Count / statistics & numerical data
  • COVID-19 / blood*
  • COVID-19 / epidemiology
  • COVID-19 / mortality*
  • China / epidemiology
  • Disease Progression
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Humans
  • Lymphocytes / microbiology
  • Male
  • Middle Aged
  • Natriuretic Peptide, Brain / analysis
  • Natriuretic Peptide, Brain / blood
  • Neutrophils / microbiology
  • Peptide Fragments / analysis
  • Peptide Fragments / blood
  • Prognosis
  • Proportional Hazards Models
  • ROC Curve
  • Retrospective Studies
  • Troponin I / analysis
  • Troponin I / blood


  • Biomarkers
  • Fibrin Fibrinogen Degradation Products
  • Peptide Fragments
  • Troponin I
  • fibrin fragment D
  • pro-brain natriuretic peptide (1-76)
  • Natriuretic Peptide, Brain