Predictive value of ferritin, glucose, urea, and creatinine for COVID-19 severity and mortality in patients from Asir, Saudi Arabia

Ahmad A. Shaikh; Turki A. Mubasher; Mohammed H. Makkawi; Sultan Z. Alasmari

doi:10.15537/smj.2023.44.8.20230162

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Figure 1
- Demographic and clinical characteristics of coronavirus disease-19 (COVID-19) patients. A) Pie chart showing gender distribution of COVID-19 patients. B) Pie chart showing age distribution of COVID-19 patients. C) Pie chart showing ABO blood group distribution of COVID-19 patients. D) Pie chart showing Rh blood group distribution of COVID-19 patients. E) Pie chart showing distribution of comorbidities among COVID-19 patients.
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Figure 2
- Column bar graphs comparing ferritin, glucose, urea, and creatinine among COVID-19 positive patients. A) Column bar graph comparing ferritin, glucose, urea, and creatinine among non-intensive care unit (ICU)- and ICU-admitted coronavirus disease-19 (COVID-19)-positive patients. The mean ferritin was 1165±636.9 vs. 867.7±642.4 (p=0.004), glucose was 192.5±81.27 vs. 178.2±95.05 (p=0.17), urea was 119.3±92.07 vs. 67.75±66.77 (p=0.0001), and creatinine was 2.020±18.12 vs. 1.560±2.021 (p=0.042) in ICU-admitted versus non-ICU patients. B) Column bar graph comparing ferritin, glucose, urea, and creatinine among non-survivor and survivor COVID-19-positive patients. The mean values of these markers in non-survivors and survivors were: 1141±673.2 vs. 897.6±619.1 (p=0.021) for ferritin, 211.9±86.21 vs. 162.5±85.29 (p=0.0001) for glucose, 141.7±92.20 vs. 50.51±44.35 (p=0.0001) for urea, and 2.502±1.994 vs. 1.174±1.669 (p=0.0001) for creatinine. P-values were calculated with the unpaired Student’s T-test. *P<0.05, **p<0.01, ^***p<0.001, ^****p<0.0001, ns: non-significant
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Figure 3
- Receiver operating characteristic (ROC) curve analysis of age, ferritin, glucose, urea, and creatinine across coronavirus disease-19 (COVID-19)-positive patients. A) Intensive care unit (ICU) admission is considered a positive actual state. Receiver operating characteristic curve analysis in non-ICU-admitted vs. ICU-admitted gave the area under the curve (AUC) values of 0.536 for age (p=0.283), 0.637 for ferritin (p=0.003), 0.573 for glucose (p=0.029), 0.703 for urea (p<0.0001), and 0.657 for creatinine (p<0.0001). B) Non-survivor is considered a positive actual state. Receiver operating characteristic curve analysis in survivors vs. non-survivors gave AUC values of 0.685 for age (p<0.0001), 0.610 for ferritin (p=0.0187), 0.681 for glucose (p<0.0001), 0.856 for urea (p<0.0001), and 0.823 for creatine (p<0.0001).

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Table 1

- Comparison of demographics, clinical characteristics, and blood group between non-intensive care unit-admitted and intensive care unit-admitted coronavirus disease-19 patients.

Variables	ICU admitted				P-values
Variables	No		Yes		P-values
Gender
Male	108 (68.8)	-----	100 (73.0)	-----	0.42^†
Female	49 (31.2)	-----	37 (27.0)	-----	0.42^†
Age (year)
All	157 (53.4)	58.24±19.37	137 (46.6)	60.51±17.44	0.30^*
1-20	6 (3.8)	14.5±6.9	5 (3.6)	11.60±8.50	0.54^*
21-40	24 (15.3)	33.80±5.25	14 (10.2)	34.00±5.71	0.90^*
41-60	49 (31.2)	49.19±6.22	43(31.4)	53.84±4.51	0.0002^*
>60	78 (49.7)	74.51±9.17	75 (54.7)	72.55±8.38	0.17^*
Blood groups
O	84 (53.5)	-----	77 (56.2)	-----	0.89^†
A	55 (35.0)	-----	48 (35.0)	-----
B	15 (9.5)	-----	10 (7.3)	-----
AB	3 (2)	-----	2 (1.5)	-----
Rh
Rh +	148 (94.3)	-----	126 (92.0)	-----	0.43^†
Rh -	9 (5.7)	-----	11 (8.0)	-----	0.43^†
Comorbidities
Diabetes mellitus	17 (46.0)	-----	20 (54.0)	-----	0.39^†
Hypertension	14 (66.7)	-----	7 (33.3)	-----	0.31^†
Heart disease	4 (57.2)	-----	3 (42.8)	-----	0.89^†
Renal disease	8 (57.2)	-----	6 (42.8)	-----	0.85^†

Values are presented as numbers and percentages (%); mean±standard deviation (SD).
↵* Independent T-test.
↵^† Chi-square test. ICU: intensive care unit

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Table 2

- Comparison of demographics, clinical characteristics, and blood group between non-survivor and survivor coronavirus disease-19 patients.

Variables	Mortality				P-values
Variables	No		Yes		P-values
Gender
Male	116 (55.8)	-----	92 (44.2)	-----	0.58^†
Female	45 (52.3)	-----	41 (47.7)	-----	0.58^†
Age (year)
All	161 (54.8)	53.96±19.55	133 (45.2)	65.77±15.77	0.0001^*
1-20	9 (5.6)	13.50±7.03	2 (1.5)	8.50±10.61	0.42^*
21-40	34 (21.1)	34.24±5.07	4 (3.0)	30.75±7.50	0.22^*
41-60	56 (34.8)	50.02±5.91	36 (27.1)	53.56±5.34	0.004^*
>60	62 (38.5)	74.10±8.60	91 (68.4)	73.40±9.27	0.63^*
Blood groups
O	86 (53.4)	-----	75 (56.4)	-----	0.69^†
A	57 (35.4)	-----	46 (34.6)	-----
B	14 (8.7)	-----	11 (8.3)	-----
AB	4 (2.5)	-----	1 (0.7)	-----	0.17^†
Rh +	153 (55.8)	-----	121 (44.2)	-----
Rh -	8 (40.0)	-----	12 (60.0)	-----
Comorbidities
Diabetes mellitus	17 (45.9)	-----	20 (54.0)	-----	0.59^†
Hypertension	12 (57.1)	-----	9 (42.9)	-----	0.32^†
Heart disease	3 (42.9)	-----	4 (57.1)	-----	0.87^†
Renal disease	5 (35.7)	-----	9 (64.3)	-----	0.54^†

Values are presented as numbers and percentages (%); mean ± standard deviation (SD).
↵* Independent T-test.
↵^† Chi-square test.

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Table 3

- Association of gender, age, ferritin, glucose, urea, and creatinine with intensive care unit admission and mortality among coronavirus disease-19 patients.

Variable	ICU-admission		Mortality
Variable		P-values		P-values
Gender	0.815 (0.489-1.350)	0.4297	1.174 (0.707-1.946)	0.5327
Age	0.993 (0.981-1.006)	0.2994	0.963 (0.948-0.976)	0.0001
Ferritin	0.999 (0.998-0.999)	0.0055	0.999 (0.998-0.999)	0.0149
Glucose	0.995 (0.998-1.001)	0.1716	0.993 (0.990-0.996)	0.0001
Urea	0.991 (0.987-0.994)	0.0001	0.976 (0.970-0.982)	0.0001
Creatinine	0.877 (0.763-0.993)	0.0502	0.556 (0.442-0.682)	0.0001