ABSTRACT
Prognostic markers are the biomarkers used to measure the disease progression and patient outcome regardless of treatment in coronavirus disease 2019 (COVID-19). This study aimed to analyze laboratory parameters as prognostic markers for the early identification of disease severity. In this study, 165 patients attending Sukraraj Tropical and Infectious Disease Hospital with COVID-19 were enrolled and divided into severe and non-severe groups. The demographic data, underlying co-morbidities, and laboratory findings were analyzed and compared between severe and non-severe cases. The correlation between the disease criticality and laboratory parameters was analyzed. Cut-off values of parameters for severe patients were speculated through the receiver operating characteristics (ROC) curve, and regression analysis was performed to determine the risk factors. Patients with severe COVID-19 infection had significantly higher absolute neutrophil count, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), ferritin, positive carbohydrate reactive protein (CRP), glucose, urea, creatinine, and aspartate aminotransferase, while lower absolute lymphocyte count, absolute eosinophil count (AEC), and red blood cell count in comparison to non-severe infection. ROC analysis gave a cut-off value (sensitivity, specificity) of age, AEC, NLR, PLR, and ferritin as 47.5 years (70.2, 64.7%), 335 cells/mm(3) (74, 67%) 3.3 (68.4, 63.7%), 129 (77.2, 51%), and 241 ng/mL (74.0%, 65.0%) respectively. Risk factor analysis showed higher age, low AEC, high ferritin, and positive CRP as independent risk factors associated with severe COVID-19 infection. Hematological and inflammatory markers, including novel NLR and PLR, should be assessed to aid clinicians in the early identification of severe cases, prioritization of cases, and effective management to decrease the mortality of COVID-19 patients.
ABSTRACT
The novel coronavirus was renamed as coronavirus disease 2019 (COVID-19) by the world health organization, began its spread in December 2019, in the city of Wuhan, China. Global bodies and governments weren't prepared to handle the impact of the virus on society. Nepal's landlocked nation encountered its incident confirmed case of COVID-19 during the first week of January, with the primary host being a student with a travel history from its place of inception. The nation is deficient in its health resources. The country mainly focused on the stringent implementation of washing of hands, wearing masks, restricting general movement, and maintaining social distancing in public. The disease transmission reached to the third stage, which began within three months after the confirmation of the first case of COVID-19. The lack of tropical hospitals, laboratory and diagnostic facilities added to the challenges faced by the country. This paper is a comprehensive review of the overall preparation and steps taken by the federal system of Nepal to combat the virus's effects till the third stage of transmission. It concludes with the practical limitations faced by the governing authorities of the nation while implementing these measures.