ABSTRACT
The interrelationship between matrix degradation, oxidative stress, inflammation and trace elements can be speculated in COVID-19. The objective of the study was to evaluate the oxidative stress, inflammation and matrix degradation markers and trace elements in COVID-19 positive patients. A group of confirmed severe COVID-19 positive patients (n = 30) along with COVID-19 negative patients (n = 30) with similar symptoms were included. Both group of patients were assessed for oxidative stress markers, inflammatory cytokines, matrix metalloproteinase (MMP)s and their inhibitors along with trace elements in blood. All the data were subjected to univariate as well as multivariate analysis including PCA, PLS-DA, OPLS-DA. Diagnostic accuracy was tested by ROC curve analysis. Further relationship with Neutrophil/ lymphocyte (N/L) ratio was established if any. Increased oxidative stress, inflammation and matrix degradation is evidenced by significant rise in oxidative markers, inflammatory cytokines and MMP9/TIMP-1 ratio. Decreased Cu/Zn ratio is also observed in COVID-19 positive patients. Multivariate analysis identified SOD, Cu/Zn ratio, IL-6 and TOS, as effective discriminant among the two groups of patients. Further, accuracy was confirmed by ROC curves. Neutrophil/ lymphocyte (N/L) ratio, shows significant negative association with SOD (r= -0.75, p < 0.005) and Cu/Zn ratio (r = -0.88, p < 0.005). These data suggest the attributes of these biomarkers in disease severity. The potential use of these blood-based laboratory markers in disease prognosis seems promising and warrants further attention. Given by the symptoms and severity of the disease, it will be promising to monitor Cu/Zn ratio along with other prognostic indicators.
ABSTRACT
Introduction: Worldwide pandemic spread of the novel coronavirus disease-2019 (COVID-19) has led to people being afflicted by COVID-19 with an ever-rising mortality leading to 1,079,029 deaths as on October 13, 2020 (covid19.who.int). Due to the rising incidence and mortality associated with COVID 19 in India with 7,175,880 confirmed cases and 109,856 deaths reported till October 13, 2020, it was imperative to have an early and effective predictor of clinical outcome to augment the present management of COVID 19 patients. Objective: The aim of the present retrospective study was to evaluate whether elevated D-dimer levels at admission in a reverse transcription-polymerase chain reaction (RT-PCR) confirmed COVID-19 patients could predict the severity of disease and outcome. Methods: D-dimer levels of patients with RT-PCR confirmed COVID-19 were retrospectively evaluated for patients admitted at this tertiary care hospital in India from March 28, 2020 to June 2, 2020. D-dimer levels on admission along with the clinicopathological profile of the patients were retrieved from the records held and intensive care unit (ICU) as well as death events were collected to calculate the optimum cutoff using the receiver operating characteristic curve. The subjects were divided into two groups and D-dimer levels between uncomplicated cases and those requiring ICU admission or died during the course of disease compared to assess the predictive value of D-dimer. Results: A total of 70 patients were included in this study admitted in this tertiary care hospital whose complete D-dimer records were available and retrieved retrospectively. Ten deaths occurred during hospitalization in the study period. Patients with mean D-dimer levels >= 4026.56 mu g/ml (fibrinogen equivalent units [FEU]) had a higher incidence of morbidity and mortality as compared to those who with lower mean D-dimer levels of 1268.66 mu g/dl (FEU) with P < 0.001. The optimum cutoff value of D-dimer to predict in-hospital ICU admission or mortality at our hospital was 857.9 mu g/L (FEU) with a sensitivity of 93.3% and a specificity of 69.09% and a negative predictive value of 97.44%. Conclusion: A D-dimer level > 857.9 mu g/L (FEU) at admission portends a worse outcome for COVID-19 patients.