ABSTRACT
Whole world experienced COVID-19 pandemic with more than 155 million cases and >3.4 million deaths. Vasculitis and immune system activation plays a critical role in pathogenesis, especially in severely ill and non-survivors COVID-19 patients. Aims and Objectives: The aim of the study was to establish the role of hematological indices and inflammatory biomarker as predictors of mortality among non-survivor and survivor COVID-19 cases at the time of admission. Materials and Methods: The cross-sectional study was conducted at a dedicated COVID-19 referral hospital from July 2020 to August 2020, among 300 real time-polymerase chain reaction confirmed COVID-19 cases. Demographic, clinical, comorbidity, laboratory investigation, and outcome data were collected from patient's medical record. Outcome variables -- discharged (survived) or death (non-survived) were considered for comparison of various hematological indices and inflammatory biomarkers. Data are represented as median, IQR (Q1-Q3) and difference between median and proportions were calculated by Mann--Whitney U-test and χ² test. A predictive power of laboratory parameters between survivors and non-survivors was evaluated using receiver operant curve (ROC) analysis and area under the ROC curve (AUC). Results: The median age of non-survivors was significantly higher than survivors. Hypertension was significantly associated with non-survivors. Hematological parameters such as total leukocyte count, absolute neutrophil count, Neutrophil: Lymphocyte ratio were significantly increased with lymphocytopenia (P=0.001), and Inflammatory biomarkers such as C-reactive protein (CRP), lactate dehydrogenase, D-dimer, ferritin, procalcitonin, and NT-Pro BNP, all were significantly increased in non-survivors patients (P=0.001). CRP and neutrophil lymphocyte ratio (NLR) showed "Good" predictive value for mortality with cutoff value of 74.0 mg/l (AUC=0.841, Sensitivity=80.4%, Specificity=73.0%) and 5.65 (AUC=0.805, Sensitivity=76.1%, Specificity=73.0%), respectively. Pro-BNP showed "Fair" predictive value for mortality with cutoff value of 330.5 pg/ml (AUC=0.726, Sensitivity=73.9%, Specificity=58.2%). Conclusion: We suggest that CRP, NLR, and Pro-BNP can be used as a screening tool to predict mortality in COVID-19 patients for timely intervention to save valuable life, especially when sensitivity toward severity of COVID-19 among medical health professionals and general public is on decline. [ABSTRACT FROM AUTHOR] Copyright of Asian Journal of Medical Sciences is the property of Manipal Colleges of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
ABSTRACT
BACKGROUND: COVID-19 is a pandemic viral disease that has affected the Indian population very badly with more than 8.46 million cases and > 0.125 million deaths. AIM: Primary objective of the study is to establish the role of hematological, coagulation and inflammatory biomarkers in early identification of clinically severe covid-19 cases. MATERIALS AND METHODS: This study was conducted from July 2020 to August 2020 at a dedicated COVID-19 referral hospital in central India. Only RT-PCR confirmed COVID-19 positive 300 cases admitted in the hospital were included in this study. Based on the clinical assessment, patients were categorised as mild, moderate, and severe groups as per ICMR guidelines. Blood samples of all cases were tested for haematological, coagulation and inflammatory biomarkers and mean values were compared among the three groups of patients. RESULTS: 46% patients belonged to >60 years of age group. Hematological parameters like total leukocyte count, absolute neutrophil count, Neutrophil: Lymphocyte ratio, Platelet: Lymphocyte ratio significantly increased with lymphocytopenia (P=0.001). Coagulation profile(D-dimer and PT) and inflammatory biomarkers like CRP, LDH, ferritin, procalcitonin and NT- Pro BNP, all were significantly increased with severity of patients(p=0.001). ROC plotted for all the parameters between severe v/s non-severe cases showed that CRP, LDH and D-dimer had a good discriminative precision with AUC >0.8. CONCLUSION: We suggest that biochemical markers like CRP, LDH and D-dimer can be used as a screening tool to differentiate severe patients from non-severe patients of Covid-19 disease in order to identify severe disease at early stage for optimal utilization of resources & reducing further morbidity & mortality.