Tehran University of Medical Sciences Journal of Pharmaceutical Care 2322-4630 13 3 2025 12 01 180 187 Reza Pourfallah Department of Anesthesia and Intensive Care‎, Sina Hospital‎, Tehran University of Medical Sciences, Tehran, ‎Iran Matin Badrbani Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran Behrad Azadmehr Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran Babak Jahangirifard Department of Anesthesia and Intensive Care‎, School of Medicine‎, Aja University of Medical Sciences, Tehran, ‎Iran Reza Mourtami Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran Reza Shariat Moharari Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. Pejman Pourfakhr Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran. Hamidreza Sharifnia Department of Anesthesia and Critical Care, Sina Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mojtaba Mojtahedzadeh Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran Atabak Najafi Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran Parisa Kianpour Anesthesia, Critical Care, and Pain Management Research Center, Tehran University of Medical Sciences, Tehran, Iran 2025 05 24 2025 09 24 Background: Severe COVID-19 is often associated with systemic inflammation and coagulopathy, which may influence clinical outcomes. Identifying prognostic biomarkers at ICU admission can aid in risk stratification and management. Methods: In this retrospective study, 363 ICU-admitted patients with severe COVID-19 were evaluated. The primary outcome was in-hospital mortality; secondary outcomes included associations between inflammatory/coagulation biomarkers and mortality, and comparison of derived ratios with their individual components. Results: Mortality was 62.8%. Non-survivors had significantly higher D-dimer (p = 0.047), ferritin (p = 0.057), ESR (p = 0.018), and PCT (p = 0.049), with lower lymphocyte counts (p = 0.058) and vitamin D levels (p = 0.002). NLR was markedly elevated in non-survivors (p = 0.037) and showed the best predictive value (AUC = 0.66), outperforming neutrophil and lymphocyte counts individually. PLR provided limited discrimination. Diabetes and hypertension were also associated with increased mortality. Conclusion: Inflammatory and coagulation markers—particularly NLR, D-dimer, ferritin, ESR, PCT, lymphocyte count, and vitamin D—are useful predictors of mortality in critically ill COVID-19. Early recognition of these parameters may aid triage and optimize ICU resource allocation. https://jpc.tums.ac.ir/index.php/jpc/article/view/854 https://jpc.tums.ac.ir/index.php/jpc/article/download/854/429