Peak Thromboinflammatory Biomarkers and ICU Mortality in Severe Viral Pneumonia

Introduction: Risk stratification in severe viral pneumonia requiring intensive care may benefit from integrating clinical variables and thromboinflammatory biomarkers. This study aim to evaluated the association of peak D-dimer, C-reactive protein (CRP), fibrinogen, and interleukin-6 (IL-6) with ICU mortality. Methods: This retrospective cohort study used secondary data from confirmed SARS-CoV-2-related severe viral pneumonia patients admitted to the ICU from July to August 2021. Peak biomarker values during ICU care were analyzed with baseline clinical covariates. The primary outcome was ICU mortality. Bivariable testing, logistic regression using log-transformed biomarkers, and receiver operating characteristic analysis were performed. Results: Forty-one patients were included; 32 (78.0%) died. Median D-dimer and CRP were higher among non-survivors, but biomarker differences did not reach statistical significance. Mechanical ventilation was strongly associated with mortality (96.3% vs 42.9%; p<0.001) and remained significant in an adjusted model (OR 60.20; 95% CI 3.52-1029.34; p=0.005). The clinical model yielded an AUC of 0.712, while adding biomarkers increased AUC to 0.788. Conclusion: In this small ICU cohort, peak thromboinflammatory biomarkers showed directional risk signals but were not statistically significant independent predictors. Requirement for mechanical ventilation was the strongest clinical marker of ICU mortality.