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Introduction: Effective triage of COVID-19 patients, especially in resource-limited settings, requires cost-effective and readily available markers. The present study looks at the prognostic role of three such laboratory parameters, absolute lymphocyte count (ALC), absolute neutrophil count (ANC), and neutrophil-to-lymphocyte ratio (NLR). Methodology: A retrospective cohort study was done including 328 COVID-19 reverse transcriptase-polymerase chain reaction-confirmed hospitalized patients aged 18 and above in a tertiary center in northern India. Baseline demographic, clinical, and laboratory parameters were collected on the day of admission. Statistical analysis included descriptive statistics, sensitivity-specificity analysis for optimum cutoffs, multiple logistic regression, and Cox proportional hazards regression. Results: The median age of the patients was 45 with 266 (81.1%) males and 62 (18.9%) females. A total of 109 (33.2%) patients were affected with moderate to severe disease. Forty-nine (14.9%) patients had fatal outcomes. Median ALC was lower in patients with moderate to severe disease compared to mild disease (895 vs. 1554.2) and in nonsurvivors compared to survivors (732.0 vs. 1423.9). Median ANC (5182.8 vs. 3057.6) and NLR (5.38 vs. 2.03) were significantly raised in patients with moderate to severe disease as against mild disease and in nonsurvivors(ANC 7040.25 vs. 3448.5, NLR 10.05 vs. 2.35). ALC <1273, ANC >3907, and NLR >2.74 showed considerable sensitivity and specificity for disease severity at admission. ALC and ANC were significantly associated with the odds of moderate to severe disease at admission in the multivariable logistic regression analysis. ALC <1183, ANC >4612, and NLR >3.76 had good sensitivity and specificity as predictors of mortality and emerged as independent risk factors for mortality in the multivariable Cox proportional hazards regression. Conclusion: ALC, ANC, and NLR are relatively cost-effective and readily available routine investigations obtained as a part of complete blood count. These indices show good prognostic significance. Their utility in clinical algorithms can better guide management of patients.
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INTRODUCTION: Infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have multisystemic involvement with hyperinflammation being a cardinal feature and deranged iron metabolism having a possible role. In this premise, we studied the prognostic value of two markers of iron metabolism ferritin and hemoglobin. METHODOLOGY: A retrospective-cohort study was carried out in a tertiary hospital in northern India involving 210 hospitalized COVID-19 patients aged 15-and above. Analysis was done for clinical profile, comorbidities and basic laboratory indices including ferritin-hemoglobin ratio (FHR) with primary end-point being in-hospital all-cause mortality. RESULTS: Median serum ferritin levels (640.00ng/mL vs 220.00ng/mL) were significantly higher among non-survivors as against survivors while median hemoglobin levels were significantly lower (12.12g/dL vs 13.73g/dL). Serum ferritin levels >400ng/mL (Sn 80%, Sp 70%) predicted mortality with high sensitivity and specificity. Notably, serum ferritin levels >400ng/mL (HR 11.075 [1.481-82.801]) and anemia, defined as a hemoglobin of <12g/dL for females and <13g/dL for males and were significantly associated with the risk of mortality in a univariable Cox-proportional hazards regression. The median FHR was significantly higher among non-survivors compared to survivors (56.98 vs 17.17). FHR>31 (Sn 85% Sp 71.6%) was highly sensitive and specific for predicting mortality. The multivariable analysis indicated that FHR >31 remained an independent risk factor for mortality (HR 12.293 [3.147-48.028]). CONCLUSION: Ferritin-hemoglobin ratio (FHR), which encompasses into a single index, the effects of both elevated levels of ferritin and the severity of anemia, seems to perform particularly well as a prognostic marker and emerged as an independent risk factor for mortality in COVID-19 patients. Hyperferritinemia and anemia, both, are inexorably interlinked in addition to having a role, directly or indirectly in the disease pathophysiology. Ferritin and hemoglobin, hence should be seen as two sides of the same coin rather than as two discrete entities. © Journal of the Association of Physicians of India 2011.
ABSTRACT
Introduction: Infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have multisystemic involvement with hyperinflammation being a cardinal feature and deranged iron metabolism having a possible role. In this premise, we studied the prognostic value of two markers of iron metabolismferritin and hemoglobin. Methodology: A retrospective-cohort study was carried out in a tertiary hospital in northern India involving 210 hospitalized COVID-19 patients aged 15-andabove. Analysis was done for clinical profile, comorbidities and basic laboratory indices including ferritin-hemoglobin ratio (FHR) with primary end-point being in-hospital all-cause mortality. Results: Median serum ferritin levels (640.00ng/mL vs 220.00ng/mL) were significantly higher among non-survivors as against survivors while median hemoglobin levels were significantly lower (12.12g/dL vs 13.73g/dL). Serum ferritin levels >400ng/mL (Sn 80%, Sp 70%) predicted mortality with high sensitivity and specificity. Notably, serum ferritin levels >400ng/mL (HR 11.075 [1.481-82.801]) and anemia, defined as a hemoglobin of <12g/dL for females and < 13g/dL for males and were significantly associated with the risk of mortality in a univariable Cox-proportional hazards regression. The median FHR was significantly higher among non-survivors compared to survivors (56.98 vs 17.17). FHR>31 (Sn 85% Sp 71.6%) was highly sensitive and specific for predicting mortality. The multivariable analysis indicated that FHR >31 remained an independent risk factor for mortality (HR 12.293 [3.147-48.028]). Conclusion: Ferritin-hemoglobin ratio (FHR), which encompasses into a single index, the effects of both elevated levels of ferritin and the severity of anemia, seems to perform particularly well as a prognostic marker and emerged as an independent risk factor for mortality in COVID-19 patients. Hyperferritinemia and anemia, both, are inexorably interlinked in addition to having a role, directly or indirectly in the disease pathophysiology. Ferritin and hemoglobin, hence should be seen as two sides of the same coin rather than as two discrete entities. © 2021 Journal of Association of Physicians of India. All rights reserved.
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Diabetes mellitus (DM) was noted as the commonest comorbidity in the coronavirus disease 2019 (COVID-19) which contributed to worse prognosis in these patients. In some cases, we also noted new-onset DM detected during hospitalization for symptomatic COVID disease. We describe three such cases, where the patients presented with severe symptomatic hyperglycemia and ketoacidosis in two and hyperosmolality in one of them. Antibody to GAD-65 was negative and varying degrees of C-peptide secretion was noted after recovery in them. There was no clinical or biochemical evidence of exocrine pancreatic involvement noted during acute presentation or after the recovery. This interesting phenomenon of coexisting DM in symptomatic COVID-19 requires further studies to differentiate between coincidence or causation.