Characterisation of prognostic and cardiovascular markers in coronavirus disease 19

  • Alexander Qichen Liu

Student thesis: Doctoral Thesis (PhD)


Coronavirus disease 19 (COVID-19) is responsible for one of the worst pandemics of our time. Clinical risk stratification plays a pivotal role in guiding patient care decisions, such as admission vs. discharge from the hospital and the allocation of therapeutic resources. The development of novel biomarkers for assessing the prognostic impact of COVID-19 on patients is a clinical priority. This retrospective observational project identified cardiac, inflammatory, and risk-score-based biomarkers, and tested their prognostic value in a UK population of COVID-19 patients encountered during the first wave of the pandemic. The biomarkers included high-sensitivity cardiac troponin T (hs-cTnT), lymphocyte-CRP ratio (LCR), ferritin-lymphocyte ratio (FLR), and the non-invasive pneumonia severity score CRB-65. The results showed that hs-cTnT achieved a high negative predictive value for ruling out inpatient mortality. LCR and FLR were not superior to CRP for predicting adverse outcomes in COVID-19. Low CRB-65 scores showed high negative predictive values for ruling out both fatal and non-fatal outcomes, independent of chest X-ray findings. Five markers were shown to be independent predictors of inpatient mortality (hs-cTnT, oxygen requirement, CRB-65, FLR, and history of ischaemic heart disease). These markers were combined into a new risk score which performed well for predicting mortality in COVID-19 patients. Oxygen requirement was the only independent predictor of escalation to non-invasive ventilation, intubation/ventilation and intensive care unit admissions. Cardiac troponins, CRB-65 and the combined risk score with oxygen requirement deserve further validation for translating into clinically viable risk stratification tools in COVID-19.
Date of Award3 Dec 2024
Original languageEnglish
Awarding Institution
  • University of St Andrews
SupervisorRobert Hammond (Supervisor), Peter Duncan Donnelly (Supervisor) & Anthony R. M. Coates (Supervisor)


  • COVID-19
  • Risk stratification
  • Prognosis
  • Biomarker
  • Inflammation
  • Myocardial injury
  • Risk score
  • Combination biomarker
  • Oxygen requirement

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