Prognostic Role of Inflammatory and Coagulation Factors in Severe COVID-19: A Descriptive Analysis from an Intensive Care Unit

Reza  Pourfallah; Matin  Badrbani; Behrad  Azadmehr; Babak  Jahangirifard; Reza  Mourtami; Reza Shariat  Moharari; Pejman  Pourfakhr; Hamidreza  Sharifnia; Atabak  Najafi; Mojtaba  Mojtahedzadeh; Parisa  Kianpour

doi:10.18502/jpc.v13i3.20321

Reza Pourfallah Department of Anesthesia and Critical Care, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Matin Badrbani Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Behrad Azadmehr Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Babak Jahangirifard Department of Anesthesia and Critical Care, School of Medicine, Aja University of Medical Sciences, Tehran, Iran.
Reza Mourtami Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Reza Shariat Moharari Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Pejman Pourfakhr Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Hamidreza Sharifnia Department of Anesthesia and Critical Care, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Atabak Najafi Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Mojtaba Mojtahedzadeh Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Parisa Kianpour Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/jpc.v13i3.20321

Keywords: COVID-19; Inflammation; Coagulopathy; Mortality; ICU; D-dimer; Ferritin; NLR; Lymphopenia

Abstract

Background: Severe COVID-19 is often associated with systemic inflammation and coagulopathy, which may influence clinical outcomes. Identifying prognostic biomarkers at ICU admission can aid in risk stratification and management.

Methods: In this retrospective study, 363 ICU-admitted patients with severe COVID-19 were evaluated. The primary outcome was in-hospital mortality; secondary outcomes included associations between inflammatory/coagulation biomarkers and mortality, and comparison of derived ratios with their individual components.

Results: Mortality was 62.8%. Non-survivors had significantly higher D-dimer (p = 0.047), ferritin (p = 0.057), ESR (p = 0.018), and PCT (p = 0.049), with lower lymphocyte counts (p = 0.058) and vitamin D levels (p = 0.002). NLR was markedly elevated in non-survivors (p = 0.037) and showed the best predictive value (AUC = 0.66), outperforming neutrophil and lymphocyte counts individually. PLR provided limited discrimination. Diabetes and hypertension were also associated with increased mortality.

Conclusion: Inflammatory and coagulation markers—particularly NLR, D-dimer, ferritin, ESR, PCT, lymphocyte count, and vitamin D—are useful predictors of mortality in critically ill COVID-19. Early recognition of these parameters may aid triage and optimize ICU resource allocation.