Biomarker states and risk of death among individuals hospitalized with SARS-CoV-2 infection.

Publisher: BioMed Central Country of Publication: England NLM ID: 100968551 Publication Model: Electronic Cited Medium: Internet ISSN: 1471-2334 (Electronic) Linking ISSN: 14712334 NLM ISO Abbreviation: BMC Infect Dis Subsets: MEDLINE

Original Publication: London : BioMed Central, [2001-

COVID-19*/mortality ; COVID-19*/blood ; Biomarkers*/blood; Hospitalization/statistics & numerical data ; Massachusetts/epidemiology ; Humans ; Female ; Male ; Middle Aged ; Aged ; SARS-CoV-2 ; Adult ; Electronic Health Records ; Risk Factors ; Aged, 80 and over ; Proportional Hazards Models

Background: Identifying individuals hospitalized for SARS-CoV-2 infection at increased risk of death is crucial for clinical decision making. Analyses must consider simultaneously the multitude of biomarkers across several domains and how these biomarker profiles change over time.
Methods: This electronic health records-based study included individuals hospitalized at a Massachusetts General Brigham hospital for at least 24 h within 5 days prior and 30 days after diagnosis of COVID-19. K-means clustering was used to identify profiles among 20 eligible biomarkers and proportional hazards models were used to model 30-day mortality at hospitalization and 7 days after hospitalization (i.e., landmark models).
Results: Twelve thousand, nine hundred forty-two individuals were included, among whom 1,198 died within 30 days. Six states were identified, characterized by the following abnormalities: (1) normal/reference, (2) hematologic, (3) inflammatory and hematological, (4) metabolic, (5) kidney, hematologic, and metabolic, and (6) cardio-thrombotic, liver, and metabolic. Risk of death within 30 days was higher in States 3, 4, 5, and 6 (adjusted hazard ratios ranging from 3.6 to 7.8) compared to individuals in State 1 at hospitalization. Landmark model findings were similar.
Conclusions: Distinct sub-phenotypes based on biomarker profiles were identified among patients hospitalized with SARS-CoV-2 infection, and certain phenotypes are associated with greater risk of 30-day mortality.
(© 2025. The Author(s).)

Declarations. Ethics approval and consent to participate: This study was performed in line with the principles of the Declaration of Helsinki. The Partners HealthCare Institutional Review Board (IRB) (#2022P002986) approved collection of curated data based on data extractions from the EHRs on patients who receive care through the Mass General Brigham (formerly Partners) system. The IRB approved this study and a waiver of informed consent was granted. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

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R01 GM127862 United States GM NIGMS NIH HHS; R01 HL162373 United States HL NHLBI NIH HHS; NIH/NHLBI R01 HL162373 National Institutes of Health/National Heart Lung and Blood Institute; NIH/NIGMS R01GM127862 United States GM NIGMS NIH HHS

Keywords: Biomarkers; COVID-19; Hospitalization; Mortality; SARS-CoV-2

0 (Biomarkers)

Date Created: 20250224 Date Completed: 20250510 Latest Revision: 20250510

20260130

PMC11849268

10.1186/s12879-025-10651-w

39994606