Faculty physicians in the division of hospital medicine have assumed most non-intensive care unit care for the coronavirus. Based on sparse research, they developed a protocol for ordering labs for this patient population, including routine admission labs, in addition to eight COVID-19 specific labs. The goal of their recent study, published in Hospital Practice, was to determine if COVID-19 specific admission labs have any prognostic value beyond that provided by routine admission labs and vitals, and the costs of labs with no prognostic value.
Led by Naseem Alavian, MD, and Elizabeth Stern, MD, both assistant professors in the division of hospital medicine, researchers reviewed adult patients admitted with COVID-19 from 3/2020 to 7/2020. Outcomes were mortality, ICU stay, and length of hospitalization. Multivariable logistic and linear regression were used to determine if COVID-19-specific admission labs have any prognostic value beyond that provided by vitals and routine admission labs. COVID-19-specific labs were d-Dimer, fibrinogen, ferritin, LDH, CK, pro-BNP, troponin, and CRP. Multivariable models included all routine admission labs and vitals. COVID-19-specific admission labs were included in the multivariable models if the p-value was <0.05 in the univariable analysis.
The results of the study showed that 331 patients met study criteria, inpatient mortality was 13.0%, 52.4% of patients required ICU stays and the average length of hospitalization was 8.9 days. COVID-19-specific labs showed no additional prognostic value for mortality. CRP, LDH, and d-Dimer provided additional prognostic information for ICU stay. CRP≥100 mg/dL and LDH≥900 U/L were associated with increased length of hospitalization.
Researchers concluded that only 3 of 8 admission COVID-19-specific labs recommended by UNC Health protocol had additional prognostic value beyond that provided by routine labs and vitals. The total cost of non-prognostic COVID-19-specific labs during the study period was $75,874.
Hospitalists James Sasaki-Adams, MD, assistant professor of medicine, and Carlton Moore, MD, MS, professor of medicine and associate chief for research and quality improvement also contributed to the study.
Find the study here.