Predicting Covid-19 Sepsis Outcomes: IL-6, Cardiac Biomarkers, and Clinical Factors in Eastern Europe

(1) Background: COVID-19 sepsis, marked by hyperinflammation and cardiac injury, poses significant challenges in high-comorbidity populations. This prospective cohort study evaluates the prognostic value of IL-6, troponin, NT-proBNP, and radiological findings for mortality and critical outcomes in a post-2022 Eastern European cohort. (2) Methods: At "Victor Babes" Hospital, Timisoara, Romania (September 2022–December 2024), 207 adults with COVID-19 sepsis (Sepsis-3 criteria) were enrolled. Baseline IL-6, troponin, NT-proBNP, CRP, PCT, D-dimers, and chest CT lung involvement were measured. Unfavorable outcomes (in-hospital death, ICU transfer, mechanical ventilation, or vasopressor use) were analyzed using logistic and linear regression. (3) Results: Among 207 patients (mean age 68.7 years, 54.1% male), 52 (25.1%) experienced unfavorable outcomes. Multivariable analysis identified IL-6 (OR 1.016, p = 0.013), troponin (OR 1.013, p = 0.017), NT-proBNP (OR 1.009, p = 0.049), >50% lung involvement (OR 1.835, p = 0.011), unvaccinated status (OR 2.312, p = 0.002), and higher BMI (OR 1.112, p = 0.005) as independent predictors of critical outcomes. Tocilizumab use (n=12) was associated with reduced mortality (p = 0.041). IL-6 (cut-off 39.0 pg/mL, AUC 0.91) and troponin (cut-off 111.3 ng/L, AUC 0.88) showed strong predictive accuracy. (4) Conclusions: Elevated IL-6, troponin, NT-proBNP, severe lung involvement, unvaccinated status, and higher BMI predict adverse outcomes in COVID-19 sepsis. Tocilizumab may offer survival benefits, warranting larger trials. These findings support targeted risk stratification in high-comorbidity populations.