Version for print Main / Articles / Predictors of mortality in patients with COVID-19

Predictors of mortality in patients with COVID-19

Scopus

Abstract

DOI: 10.32364/2587-6821-2025-9-12-4

A.E. Evdokimova¹, Kh.S. Khaertynov¹, V.A. Anokhin¹, I.S. Raginov^1,2, A.M. Sabitova¹

¹Kazan State Medical University, Kazan, Russian Federation

²Kazan (Volga Region) Federal University, Kazan, Russian Federation

Background: hyper-inflammatory reaction and hypercoagulation are associated with the development of severe forms of COVID-19. These severe forms lead to organ dysfunction, primarily acute respiratory distress syndrome (ARDS) and pulmonary vascular thrombosis, which are the main causes of fatal outcome in COVID-19.

Aim: to evaluate the prognostic value of inflammation and thrombosis markers in COVID-19 patients.

Patients and Methods: a retrospective follow-up study was conducted, which included the analysis of 136 medical records of patients with COVID-19, aged 20 to 89 years, who received inpatient treatment at A.F. Agafonov Republican Infectious Diseases Clinical Hospital between 2020 and 2023. Patients were divided into 2 groups: group 1 consisted of 84 individuals whose disease ended in recovery (survivors), and group 2 consisted of 52 patients with a fatal outcome (deceased). To assess the prognosis, the following blood parameters were considered: absolute counts of leukocytes, neutrophils, lymphocytes, neutrophil-to-lymphocyte ratio (NLR index), lactate dehydrogenase (LDH) activity, and levels of C-reactive protein (CRP), ferritin, and D-dimer. The analysis of these parameters was performed on the day of hospitalization and immediately before the disease outcome.

Results: upon hospitalization, the median values of CRP, ferritin, LDH, D-dimer, and NLR index among deceased patients were significantly higher than in the survivor group (p<0.05). The lymphocyte count in the deceased group was lower compared to the survivors (p=0.001). At the final stage of the disease, the median values of leukocytes, neutrophils, NLR index, CRP, ferritin, and D-dimer in the deceased group were statistically significantly higher compared to the comparison group (p<0.05). The most pronounced difference was observed for D-dimer, CRP, and the NLR index, whose medians among the deceased were higher by 11.8, 8.5, and 6.0 times, respectively, compared to the survivors' indices. The lymphocyte count in the deceased group was 2.2 times lower compared to the survivors (p<0.001). On admission, D-dimer (cutoff >1000 ng/mL) showed the highest sensitivity (63%), while LDH (>500 U/L) (95%) and NLR index (>10) (90%) showed the highest specificity as mortality predictors. At the final stage, D-dimer demonstrated the highest sensitivity (83%), with a blood level above 1000 mg associating with a 3.7-fold increased risk of lethal outcome. LDH (98%), CRP (96%), and ferritin (95%) possessed the highest specificity.

Conclusion: the determination of inflammation and thrombosis markers in the blood allows for the assessment of the probable prognosis in COVID-19 patients. High blood values of D-dimer, LDH, ferritin, and the NLR index have the greatest prognostic value for an unfavorable COVID-19 outcome.

Keywords: COVID-19, predictors of mortality, neutrophils, lymphocytes, C-reactive protein, ferritin, D-dimer.

For citation: Evdokimova A.E., Khaertynov Kh.S., Anokhin V.A., Raginov I.S., Sabitova A.M. Predictors of mortality in patients with COVID-19. Russian Medical Inquiry. 2025;9(12):853–859 (in Russ.). DOI: 10.32364/2587-6821-2025-9-12-4

ABOUT THE AUTHORS:

Arina E. Evdokimova — postgraduate student of the Department of Pediatric Infectious Diseases, Kazan State Medical University; 49, Butlerova str., Kazan, 420012, Russian Federation; ORCID iD 0000-0002-0293-2974

Khalit S. Khaertynov — Dr. Sc. (Med.), Associate Professor of the Department of Pediatric Infectious Diseases, Kazan State Medical University; 49, Butlerova str., Kazan, 420012, Russian Federation; ORCID iD 0000-0002-9013-4402

Vladimir A. Anokhin — Dr. Sc. (Med.), Professor, Head of the Department of Pediatric Infectious Diseases, Kazan State Medical University; 49, Butlerova str., Kazan, 420012, Russian Federation; ORCID iD 0000-0003-1050-9081

Ivan S. Raginov — Dr. Sc. (Med.), Associate Professor of the Department of General Pathology, Kazan State Medical University; 49, Butlerova str., Kazan, 420012, Russian Federation, Kazan (Volga Region) Federal University; 18, Kremlevskaya str., Kazan, 420008, Russian Federation; ORCID iD 0000-0002-5279-2623

Alfiya M. Sabitova — C. Sc. (Med.), Associate Professor of the Department of Pediatric Infectious Diseases, Kazan State Medical University; 49, Butlerova str., Kazan, 420012, Russian Federation; ORCID iD 0000-0001-9394-5879

Contact information: Khalit S. Khaertynov, e-mail: khalit65@yandex.ru

Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.

There is no conflict of interest.

Received 12.09.2025.

Revised 07.10.2025.

Accepted 30.10.2025.

References

1. Oboza P., Ogarek N., Olszanecka-Glinianowicz M., Kocelak P. The main causes of death in patients with COVID-19. Eur Rev Med Pharmacol Sci. 2023;27:2165–2172. DOI: 10.26355/eurrev_202303_31589 2. Гареева Д.Ф., Лакман И.А., Агапитов А.А. и др. Динамика госпитальной смертности в пандемию COVID-19. Терапевтический архив. 2024;96(1):29–35. DOI: 10.26442/00403660.2024.01.202558Gareeva D.F., Lakman I.A., Agapitov A.A. et al. Dynamics of hospital mortality in the COVID-19 pandemic. Тherapeutic archive. 2024;96(1):29–35 (in Russ.). DOI: 10.26442/00403660.2024.01.202558 3. Lauring A.S., Tenforde M.W., Chappell J.D. et al. Clinical severity of, and effectiveness of mRNA vaccines against, COVID-19 from omicron, delta, and alpha SARS-CoV-2 variants in the United States: prospective observational study. BMJ. 2022;376:e069761. DOI: 10.1136/bmj-2021-069761 4. El-Shabasy R.M., Nayel M.A., Taher M.M. et al. Three waves changes, new variant strains, and vaccination effect against COVID-19 pandemic. Int J Biol Macromol. 2022;204:161–168. DOI: 10.1016/j.ijbiomac.2022.01.118 5. Zhang J.J., Dong X., Liu G.H., Gao Y.D. Risk and protective factors for COVID 19 morbidity, severity, and mortality. Clin Rev Allergy Immunol. 2023;64:90–107. DOI: 10.1007/s12016-022-08921-5 6. Castelli V., Cimini A., Ferri C. Cytokine storm in COVID-19: when you come out of the storm, you won't be the same person who walked in. Front Immunol. 2020;11:2132. DOI: 10.3389/fimmu.2020.02132 7. Gu S.X., Tyagi T., Jain K. et al. Thrombocytopathy and endotheliopathy: crucial contributors to COVID-19 thromboinflammation. Nat Rev Cardiol. 2021;18(3):194–209. DOI: 10.1038/s41569-020-00469-1 8. Önal U., Güçlü Ö.A., Akalın H. et al. Prognostic factors for COVID-19 patients. J Infect Dev Ctries. 2022;16(3):409–417. DOI: 10.3855/jidc.15845 9. Steinberg E., Balakrishna A., Habboushe J. et al. Calculated decisions: COVID-19 calculators during extreme resource-limited situations. Emerg Med Pract. 2020;22(4 Suppl):CD1–CD5. 10. Memon R.A., Rashid M.A., Avva S. et al. The Use of the SMART-COP score in predicting severity outcomes among patients with community-acquired pneumonia: a meta-analysis. Cureus. 2022;14(7):e27248. DOI: 10.7759/cureus.27248 11. Cevik M., Kuppalli K., Kindrachuk J., Peiris M. Virology, transmission, and pathogenesis of SARS-CoV-2. BMJ. 2020;23:371. DOI: 10.1136/bmj.m3862 12. Stringer D., Braude P., Myint P.K. et al. The role of C-reactive protein as a prognostic marker in COVID-19. Int J Epidemiol. 2021;50(2):420–429. DOI: 10.1093/ije/dyab012 13. Paranga T.G., Pavel-Tanasa M., Constantinescu D. et al. Comparison of C-reactive protein with distinct hyperinflammatory biomarkers in association with COVID-19 severity, mortality and SARS-CoV-2 variants. Front Immunol. 2023;14:1213246. DOI: 10.3389/fimmu.2023.1213246 14. Аlroomi M., Rajan R., Omar A.A. et al. Ferritin level: A predictor of severity and mortality in hospitalized COVID-19 patients. Immun Inflamm Dis. 2021;9(4):1648–1655. DOI: 10.1002/iid3.517 15. Rawson T.M., Moore L.S.P., Zhu N. et al. Bacterial and fungal coinfection in individuals with coronavirus: a rapid review to support COVID-19 antimicrobial prescribing. Clin Infect Dis. 2020;71(9):2459–2468. DOI: 10.1093/cid/ciaa530 16. Lingscheid T., Lippert L.J., Hillus D. et al. Characterization of antimicrobial use and co-infections among hospitalized patients with COVID-19: a prospective observational cohort study. Infection. 2022;50(6):1441–1452. DOI: 10.1007/s15010-022-01796-w 17. Zuo Y., Yalavarthi S., Shi H. et al. Neutrophil extracellular traps in COVID-19. JCI Insight. 2020;5(11):e138999. DOI: 10.1172/jci.insight.138999 18. Tang N., Li D., Wang X., Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844–847. DOI: 10.1111/jth.14768 19. Хаертынов Х.С., Анохин В.А., Халиуллина С.В., Салахова Э.А. Воспаление и гемостаз у пациентов с тяжелой формой коронавирусной инфекции COVID-19. Медицинский вестник Башкортостана. 2023;18(4):11–17.Khaertynov Kh.S., Anokhin V.A., Khaliullina S.V., Salakhova E.A. Inflammation and hemostasis in patients with severe COVID-19 coronavirus infection. Medical Bullet of Bashkortostan. 2023;18(4):11–17 (in Russ.). 20. Lee J., Park S.S., Kim T.Y. et al. Lymphopenia as a Biological Predictor of Outcomes in COVID-19 Patients: A Nationwide Cohort Study. Cancers (Basel). 2021;13(3):471. DOI: 10.3390/cancers13030471 21. Rubio-Rivas M., Corbella X., Formiga F. et al. On Behalf Of The Semi-Covid-Network. Risk categories in COVID-19 based on degrees of inflammation: data on more than 17.000 patients from the Spanish SEMI-COVID-19 registry. J Clin Med. 2021;10(10):2214. DOI: 10.3390/jcm10102214 22. Подзолков В.И., Волчкова Е.В., Покровская А.Е. и др. Гематологические индексы как доступный инструмент в диагностике неблагоприятного течения COVID-19. Терапевтический архив. 2024;96(11):1028–1034. DOI: 10.26442/00403660.2024.11.202996Podzolkov V.I., Volchkova E.V., Pokrovskaya A.E. et al. Hematological indices as an accessible tool in the diagnosis of an unfavorable course of COVID-19. Therapeutic archive. 2024;96(11):1028–1034 (in Russ.). DOI: 10.26442/00403660.2024.11.202996 23. Liu J., Liu Y., Xiang P. et al. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. J Transl Med. 2020;18(1):206. DOI: 10.1186/s12967-020-02374-0 24. Lagunas-Rangel F.A. Neutrophil-to-lymphocyte ratio and lymphocyte-to-C-reactive protein ratio in patients with severe coronavirus disease 2019 (COVID-19): A meta-analysis. J Med Virol. 2020;92(10):1733–1734. DOI: 10.1002/jmv.25819

This work is licensed under a Creative Commons «Attribution» 4.0 License.

Read the article in PDF in Russian

Clinical and laboratory patterns of COVI...

868

Pioneering methods in managing acute res...

925

All articles