Development and Validation of a Clinical Protocol in COVID-19 Patients to Assess Disease Severity and Outcomes

Background: The coronavirus disease 2019 (COVID-19) pandemic showed the need to evaluate disease severity promptly at the time of hospital admission. Objectives: To establish an admission protocol, which included clinical and laboratory findings. Methods: We conducted a retrospective study at Wolfson Medical Center, Israel, for a period of 19 months (20202021). We established a protocol for patients who were admitted with COVID-19 infection. The protocol parameters included demographic data, co-morbidities, immune status, oxygen level at room air on admission, oxygen demand, lymphopenia, C-reactive protein (CRP) level, lactate dehydrogenase, D-dimer, creatinine, aspartate transferase, alanine aminotransferase, and ferritin. Based on this protocol, we defined the severity of COVID-19 at the beginning of hospitalization and started treatment without delay. This distinctive protocol included ferritin levels as a guide to severity and outcome of patients. A database was established for all the parameters of the patients included in the study. Results: The study included 407 patients; 207 males (50.9%), 200 females (49.1%). The age range was 18-101 years. Hyperferritinemia (> 1000 ng/dl) was one of the strongest and most significant predictors for severe disease in these patients (P < 0.001). Lymphopenia, high levels of CRP, alanine aminotransferase, aspartate transferase, lactate dehydrogenase, and creatinine also correlated with severe disease, complications, and death. Conclusions: Elevated ferritin levels were a very significant and clear indicator of the development of severe COVID-19. The addition of ferritin levels to our protocol aided in finding which patients were at increased risk for morbidity and mortality.