Biomarkers of Multiorgan Failure in COVID-19: A Predictive Framework for Disease Severity and Clinical Outcomes

Abstract

Objective: To investigate the predictive value of inflammatory, liver, renal, and cardiac biomarkers in relation to the progression of multiorgan failure (MOF) in COVID-19 patients. A primary goal was to identify which of these markers served as the most discriminative predictors of disease severity. Methods: A retrospective cohort study was carried out between December 2020 and February 2023 to collect data from 1,803 COVID-19 patients from data records in different hospitals in Makkah, Saudi Arabia. The ROC curve analysis evaluated the diagnostic and predictive performance of selected biomarkers. Results: Inflammatory markers such as CRP and D-dimer were evaluated, but ferritin showed only a moderate discriminatory ability for disease severity with moderate predictive value (AUC 0.621). Liver enzymes, especially AST (aspartate aminotransferase), and ALT (alanine aminotransferase), emerged as strong MOF predictors, with AST achieving an AUC of 1.000, indicating perfect sensitivity and specificity as a predictor. Renal markers like creatinine and BUN showed limited predictive power. Among cardiac biomarkers, LDH (lactate dehydrogenase), showing a robust predictive capability for MOF, demonstrated high predictive capability (AUC 0.969), and CK also performed well. Conclusion: The AST and LDH were identified as the most reliable predictors of MOF in COVID-19 patients. These findings emphasize the importance of biomarker profiling in clinical risk assessment and early intervention. Liver and cardiac markers should be prioritized in evaluating severe COVID-19 cases to support better patient management and outcomes.