The Role of Laboratory Parameters in Assessment of Disease Severity and Outcome in COVID-19 patients – A Retrospective Study in a Tertiary Care Centre in Southern India
DOI:
https://doi.org/10.21276/apalm.3066Keywords:
COVID-19, Computed tomography, Laboratory biomarkers, Macrophage activation syndrome, Severe acute respiratory syndrome, SARS –CoV-2Abstract
Background: Corona Virus Disease 2019 (COVID19) is a global pandemic, the outbreak of which started in China in December 2019. Apart from the clinical symptoms and pulmonary computed tomography (CT) findings, several laboratory biomarkers also play an important role in management of these patients so that immediate attention can be given to those with severe disease and critical illness. In this study we tried to find the association of various laboratory biomarkers in COVID-19 patients, analyzed around the time of admission, with the severity of the disease and outcome.
Methods: In this study 1048 COVID19 positive cases admitted in our hospital during the study period from April 2020 to October 2020 were included. The cases were clinically assessed based on the severity of the disease at the time of presentation and during the course in hospital and categorized into 3 categories as Mild, Moderate and Severe according to our hospital protocol for management of COVID 19 patients. The clinical and laboratory data were retrieved from electronic medical records. The levels of various laboratory parameters at/around the time of admission were compared with clinical categories, severity and outcome of the disease.
Result: We found a statistically significant association of severity and outcome of COVID-19 with various laboratory parameters. There were significantly higher levels of D-dimer, LDH, CK, CRP, Sr Ferritin, cTnI, NT pro BNP, PCT, IL-6 and lower ALC in non survivors compared to survivors and in severe disease compared to mild disease with a p value of <0.05.
Conclusion: In this study we propose that along with the initial clinical assessment, age and concurrent co-morbidities of COVID-19 patients which determine the need for their admission to ICUs, the initial assessment of several laboratory parameters is helpful in triaging the patients who need intensive care so that proper allocation of resources can be done.
References
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507–13.
Ghahramani S, Tabrizi R, Lankarani KB.,Amin Kashani SM, Rezaei S, Zeidi N, et al. Laboratory features of severe vs. non-severe COVID-19 patients in Asian populations: a systematic review and meta-analysis. Eur J Med Res 2020;30.
Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Military Med Res 2020;7:4.
Vakili S, Savardashtaki A, Jamalnia S, Tabrizi R, Nematollahi MH, Jafarinia M, et al. Laboratory fndings of COVID-19 infection are conficting in diferent age groups and pregnant women: a literature review. Arch Med Res 2020;51:603-7.
Wang L. C-reactive protein levels in the early stage of COVID-19. Med Mal Infect. 2020;50: 332-4.
General office of the national health commission of China. Covid-19 diagnostic and therapeutic regimen (trial 7th, edition). J Cardiopulm Rehabil Prev 2020;39:103–7.
Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol. 2017;39:529–39.
Shang W, Li Y, Li H, Li W, Li C, Cai Y, et al. Correlaion between laboratory parameters on admission and outcome of COVID-19 in maintenance hemodialysis patients. Int Urol Nephrol. 2021;53:165-9.
Huang C, Wang Y, Li X et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506.
Deng Y, Liu W, Liu K , Fang YY, Shang J, Zhou L et al. Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 in Wuhan, China: a retrospective study, Chinese Medical Journal 2020;133:1261-7
Ely EW, Wheeler AP, Thompson BT, Ancukiewicz M, Steinberg KP, Bernard GR. Recovery rate and prognosis in older persons who develop acute lung injury and the acute respiratory distress syndrome. Ann Intern Med 2002;136:25–36.
Tang N, Li D, Wang X, Sun Z.J Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J. Thromb Haemost. 2020;18:844-7.
Borobia AM, Carcas AJ, Arnalich F, Alvarez-Sala R, Monserrat- Villatoro J, Quintana M, et al. A cohort of patients with COVID-19 in a major teaching hospital in Europe. J Clin Med 2020;9:E1733.
Dong X, Sun L, Li Y. Prognostic value of lactate dehydrogenase for in-hospital mortality in severe and critically ill patients with COVID-19. Int J Med Sci. 2020 ;17:2225-31.
Linkins LA, Takach Lapner S. Review of D-dimer testing: good, bad, and ugly. Int J Lab Hematol. 2017;39(S1):98–103.
Yao, Y, Cao J, Wang Q, Shi Q, Liu K, Luo Z, et al. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study. J. Intensive care 2020;8:49.
Velavan TP, Meyer CG. Mild versus severe COVID-19: Laboratory markers. Int J Infect Dis. 2020 Jun;95:304-307.
Garcia-Tardon N, Abbes AP, Gerrits A, Robbert J, Slingerland RJ, Besten G. Laboratory parameters as predictors of mortality in COVID-19 patients on hospital admission. Journal of Laboratory Medicine 2020;44:357-9.
Han Y, Zhang H, Mu S, Wei W, Jin C, Tong C, et al. Lactate dehydrogenase, an independent risk factor of severe COVID-19 patients: a retrospective and observational study. Aging. 2020;12:11245-58.
Shi J, Li Y, Zhou X, Zhang Q, Ye X, Wu Z, et al. Lactate dehydrogenase and susceptibility to deterioration of mild COVID-19 patients: a multicenter nested case-control study. BMC med. 2020;18:168.
Rivas-Garcia S, Bernal J, Bachiller-Corral J. Rhabdomyolysis as the main manifestation of coronavirus disease 2019.Rheumatology (Oxford). 2020;59(8):2174-6.
Li Y, Hu Y, Yu J, Ma T. Retrospective analysis of laboratory testing in 54 patients with severe or critical-type 2019 novel coronavirus pneumonia. Lab Invest. 2020;100:794-800.
Kernan KF, Carcillo JA. Hyperferritinemia and inflammation. Int Immunol. 2017;29:401-9.
Cheng L, Li H, Li L, Liu C, Yan S, Chen H| , et al. Ferritin in the coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. J clin lab Anal 2020;34:e23618.
Gao L, Jiang D, Wen XS, Cheng XC, Sun M, He B, et al. Prognostic value of NT-proBNP in patients with severe COVID-19. Respir Res. 2020;21:83.
Zhang F, Yang D, Li J, Gao P, Chen T, Cheng Z, et al. Myocardial injury is associated with in-hospital mortality of confrmed or suspected COVID19 in Wuhan, China: a single center retrospective cohort study. med Rxiv. 2020;
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323:1061–9.
Chen C, Chen C, Yan JT, Zhou N, Zhao JP, Wang DW. Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19. Zhonghua Xin Xue Guan Bing Za Zhi. 2020;48:567-71.
Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 2020;395:514-23.
Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy 2020; 75: 1730-41.
Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020;395:565–74.
Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chim Acta 2020;505:190–1. doi: 10. 1016/j.cca.2020.03.004 .
Hu R, Han C, Pei S, Yin M, Chen X. Procalcitonin levels in COVID-19 patients. Int J Antimicrob Agents 2020 ;56:106051.
Lipworth B, Chan R, Lipworth S, Kuo CR. Weathering the cytokine storm n susceptible patients with severe SARS-CoV-2 infection. J Allergy Clin Immunol Pract 2020;8:1798-1801.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Rajeshwari B, Salapathi Shanmugam, Anila Mathan, Dhananjayan R, Isabella Princess B, Selvan K, Mitra Ghosh
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).
