ABSTRACT
Introduction: The association of hematological abnormalities in severe COVID-19 pneumonia is multifactorial. The hemostatic abnormalities in COVID-19 are related with disease progression, severity and mortality. In this study, we aim to investigate the association of routine hematological parameters along with newer CBC parameters in COVID-19 disease Methods: Retrospective study of 164 RT PCR confirmed COVID-19 patients between May' 20 to Dec'20 D-dimer was estimated by immunometric assay with a reference range of 0-0.35ug/L (Instrument -Nephle plus one) and CBC was run on Sysmex 2000 XN. The patients were divided into mild/moderate, severe and the nonsurvivor outcome groups according to the MoHFW India guidelines.Data are expressed as the mean +/- sd for continuous variable and frequency percentage for categorical variable. Comparisons of three groups were performed using Kruskall Wallis test for continuous variables and Chi square test, Fisher's exact test as appropriate for categorical variables. Result(s): RESULTS Of the 164 admitted cases with an age range of 28-90 years, the majority were males(n-117-71.3%) The Receiver operating characteristic curve analysis showed that Neutrophil lymphocyte ratio at discharge had the highest area under curve (0.713) followed by lymphocyte percentage at discharge (0.712).In advanced CBC parameters lymphocyte Y and lymphocyte Z at discharge had the highest area under the curve (Table Presented) Conclusion(s): As the Pandemic draws to an end and Covid 19 becomes an endemic disease ,the routine and advanced CBC parameters can be used -As a Biomarker for severity of disease at admission -For serial monitoring and prognosis of the patients.
ABSTRACT
Introduction: COVID-19 is a global pandemic disease first identified in Wuhan, China in late 2019. As of March 2022, over 450 million cases and 6 million deaths have been reported across the world, with the confirmed numbers probably being a fraction of the real numbers. Red Cell Distribution width (RDW) is a measure of anisocytosis, that is, variation in the circulating red blood cell volume. It is a nonspecific marker of acute illness. Increased RDW is suggestive of dysfunctional erythropoiesis and/or shortened RBC lifespan. Hence, it is a good predictor of clinical outcome in many disorders. Aims & Objectives: AIMS: To prove association of RDW with COVID-19 infection requiring ICU stay in a tertiary care hospital. OBJECTIVE(S): Primary Objective: To assess the predictive value of RDW on admission with requirement of ICU as a marker of severity in COVID-19 patients. Secondary Objectives: To compare RDW to other markers commonly used in COVID-19 infection, such as D-Dimer and CRP. Material(s) and Method(s): Patients over 18 years of age getting admitted at COVID ward or ICU at P.D. Hinduja Hospital, Mumbai were included in the study. RDW, CRP and D-dimer values of Ward group and ICU group patients were noted and compared. Result(s): 234 patients were screened and 190 patients were included in the final study. RDW was found to have significant association with ICU requirement (p = 0.0066). Further, an RDW value of 13 or more is found to be 85% sensitive for predicting ICU requirement. RDW of 16 or more is found to be 80% specific for predicting requirement of ICU stay. Regarding secondary objectives, RDW was found to have significant correlation with D-Dimer (p = 0.0005) but not with CRP (p = 0.12). Conclusion(s): RDW can be a potentially useful marker for risk stratification in COVID-19. A value of RDW more than 16 is associated with a significant risk of ICU requirement in COVID-19 disease. Further studies may be indicated to find a statistically significant correlation between RDW values and mortality in COVID- 19.
ABSTRACT
Introduction: COVID 19 caused by the virus SARS-CoV-2 wasdeclared as a global pandemic by World Health Organization.Alterations in various hematological parameters have been recentlydocumented in the world literature in SARS-Cov-2 infection.As noeffective treatment is known, prediction of disease severity is veryimportant in order to estimate a patients outcome.Aims &Objectives: There is paucity of hematological data in thesepatients. Hence this study is an attempt to evaluate the pattern of thehematological parameters in COVID-19 patients in the Indian population. We present an observational retrospective analysis of D-dimer,neutrophil-lymphocyte ratio and newer CBC parameters in 102Covid-19 patients in a tertiary care hospital and its correlation withdisease severity.Materials &Methods: Records of 102 patients who presented to thehospital between May 2020 to December 2020 with a confirmeddiagnosis of COVID-19 were retrospectively analysed. COVID-19positivity was confirmed based on RT-PCR in all patients. CBC wasrun on the Sysmex XN 2000 and d-dimer was estimated byimmunometric assay with a reference range of 0-0.35 mg/L (Instrument-Nephle plus one).The patients were divided into mild/moderate, severe and the nonsurvivor outcome groups according to the MoHFW, India guidelines.Comparisons of the four groups were performed using Kruskall Qallistest for continuous variables and Chi square test, Fisher's exact test asappropriate for categorical variables.Result: 102 patients were studied retrospectively from May 2020 toDecember 2020.The patients age ranged from 28 to 88 years of which26 female and 75 males. Neutrophil/lymphocyte ratio was found to bestatistically significant at admission and outcome in the severe (median-16.62) and non-survivor group (median-16.52) and correlatedwith the high D-dimer values. The D-dimer values of the 4 groups onadmission and outcome was compared and was significantly higher inpatients belonging to the severe (median-2.81) as compared to themild/moderate (median-0.92) group of patients (P value <0.00001).Conclusions: Hematological parameters appear to be good predictorof severity of the Covid 19 infection and can be used in addition to theclinical findings for monitoring of these patients in our Indianpopulation.
ABSTRACT
Aims & Objectives: The beginning of 2020 shook the world with the onset of a pandemic caused by SARS-coronavirus disease 2019 (COVID-19). As the disease outcome data from various parts of the world unfolded, disturbances in the pathways of coagulation emerged as a major cause of morbidity and mortality and reports of utility of d-dimer as a prognostic marker emerged. We present an observational retrospective analysis of value of d-dimer in 496 Covid-19 patients in a tertiary care hospital and its correlation with disease severity. Patients/Materials & Methods: Records of 496 patients who presented to the hospital between May 2020 to September 2020 with a confirmed diagnosis of COVID-19 were retrospectively analysed. COVID-19 positivity was confirmed based on RT-PCR in all patients and d-dimer was estimated by immunometric assay with a reference range of 0-0.35 mg/L (Instrument -Nephle plus one). The patients were divided into mild/moderate, severe and the non-survivor outcome groups according to the MoHFW, India guidelines. The Kruskal-Wallis one-way ANOVA was used to evaluate the statistical significance of the D-dimer values at admission and outcome in the various groups. ROC curves were derived to estimate cut off value of d-dimer to differentiate between outcome groups. Results: 496 patients were studied retrospectively from May 2020 to September 2020.The patients age ranged from 19 to 91 years of which 157 female and 340 males. The D-dimer values of the 3 groups on admission and outcome was compared and was significantly higher in patients belonging to the severe(2.64 + 3.39) as compared to the mild/moderate (1.05 + 1.68) group of patients (p value<0.00001).The p value for the D-dimer levels at admission and outcome for the non-survivor group were significant by the Wilcoxon signed rank test. ROC curves showed a high accuracy of the D-dimer to discriminate between the survivor and the non-survivor group at outcome (cut off>2.16 D-DU mg/l, Se = 82.05, Sp = 80.42, AUC = 0.88). The ROC curve with a cut off of> 1.31(Se = 58,Sp = 81,AUC = 0.72) at discharge between the mild/moderate and severe group was obtained. Discussion & Conclusion: Elevated D-dimer appears to be good predictor of severity of the Covid 19 infection and in addition can be used for monitoring of these patients.