Routine Biomarkers for COVID-19 Mortality Prediction in Low-Resource Settings

Abstract

COVID-19 has placed a heavy burden on healthcare systems, especially in resource limited settings where simple and affordable tools are needed to identify patients at high risk of death. This study aimed to evaluate routine laboratory biomarkers associated with mortality among hospitalized COVID-19 patients. A retrospective cohort study was conducted using medical records of 199 adult patients with RT-PCR-confirmed COVID-19 who were admitted to Sultan Agung Islamic Hospital, Semarang, Indonesia, between December 2020 and August 2021. Patients were selected using consecutive sampling. Hematological, inflammatory, coagulation, and virological parameters measured at admission were analyzed. Differences between survivors and non-survivors were assessed using Chi-square and Mann–Whitney tests, followed by logistic regression analysis to identify independent predictors of mortality. Of the 199 patients, 156 (78.4%) survived. and 43 (21.6%) died. Non-survivors had significantly higher neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to- lymphocyte ratio, C-reactive protein, and D-dimer levels, while lymphocyte, monocyte, and basophil counts were significantly lower (p<0.05). Lymphopenia was the strongest independent predictor of mortality (aOR=4.263; 95%CI=1.661–10.945; p=0.003). Routine laboratory parameters, particularly lymphocyte count, may help identify high-risk patients and support early clinical decision-making in resource-limited hospitals.