Objectives: Identifying COVID-19 patients with risk of adverse outcomes at first admission to the intensive care unit has several diagnostic challenges. The concentration of acute phase proteins synthesized by the liver increases or decreases markedly in the serum following inflammation and infection. This study aimed to investigate the predictive value of acute phase proteins in critically ill COVID-19 patients and to evaluate the efficacy of inflammatory markers in predicting mortality risk in the intensive care unit.

Methods: A retrospective study was conducted in critically ill COVID-19 patients treated in the intensive care unit. Overall, 123 patients with ARDS and/or multi-organ dysfunction were included in the first 24 hours of admission to intensive care unit. After 28 days, groups of survived (n=54) and dead patient (n=69) or groups of patient with (n=83) and without (n=40) invasive mechanical ventilation were formed. Serum amyloid A, C-reactive protein, albumin, and prealbumin values considered as acute phase proteins within the first 24 hours of admission to the intensive care unit were compared between groups.

Results: Albumin and prealbumin levels significantly decreased in dead patients (p=0.011, p<0.001, respectively) and were mechanically ventilated patients (p=0.010, p=0.006, respectively). The Serum amyloid A levels in mechanically ventilated patients significantly increased (p=0.022).

Conclusion: Low prealbumin and albumin levels and high serum amyloid A levels during admission to ICU can be used as a prognostic marker of disease severity and mortality.