ABSTRACT
The COVID-19 disease presents a large range of clinical manifestations and includes asymptomatic, mild, and severe cases. The level of severity is related to parameters associated with immunity, genetics, and biochemistry. Africa shows one of the lowest COVID-19 fatality rates but very few data on the biochemical markers of COVID-19 in patients and the factors associated with disease severity are available for the continent. In Gabon, the COVID-19 fatality rate is only 0.63% but almost no data on biomarkers in COVID-19 patients have been published. Both the number of COVID-19 cases and the mortality rate reported in Africa in general, and in Gabon in particular, are lower than in non-African countries. As such, understanding the factors associated with disease severity in Gabonese patients is a crucial step to better understand the disease in the African context and prepare for future COVID-19 waves and other epidemics of emerging diseases. Here, we compared biochemical and hematological markers among 753 Gabonese COVID-19 patients with asymptomatic (184/753), mild/moderate (420/753), and severe/critical (149/753) forms of the disease using an Analysis of Variance (ANOVA) or a Kruskal-Wallis (KW) test. We modeled these parameters together with comorbidities, age, and sex to predict factors associated with disease severity by using a "binomial generalized linear model" utilizing the "package" stats of R software version 4.0.2. Our results showed that almost all the biochemical and hematological parameters (except creatinine, phosphorus, D-dimers, platelets, and monocytes) varied according to disease severity. However, age and the dysfunction of organs like the kidney, liver, and lung together with the decrease of electrolytes (chloride, potassium, and sodium) are the best predictors of disease severity in Gabonese patients.
Subject(s)
COVID-19 , Humans , Africa , Analysis of Variance , Black People , Retrospective Studies , GabonABSTRACT
Background: Patients with COVID-19 (coronavirus disease 2019) present varying disease severity;with such heterogeneity in clinical presentations, it can be challenging to assess the severity and progression of the disease. In addition, no specific markers have been identified that would indicate the diagnosis or prognosis of the disease. Therefore, this study was aimed to determine whether a panel of hematological and inflammatory biomarkers were indicative of disease severity in the assessment and the prognosis of COVID-19. Methods: The retrospective cross-sectional study was carried out in a university hospital in South India between May 2020 and September 2020. The participants were 997 patients with COVID-19, confirmed by real-time reverse transcriptasepolymerase chain reaction (RT-PCR). Information regarding demographics and laboratory tests was obtained from medical records. Association analysis was conducted using SPSS, version 16, and a P-value <0.05 was considered statistically significant. Results: Inflammatory markers such as C-reactive protein (CRP) and D-dimer, calculated inflammatory ratios, and hemoglobin were significantly increased in cases of severe COVID-19. Leucocytosis with increased absolute neutrophil count and decreased absolute lymphocyte count were observed. Conclusion: Haematological and inflammatory markers may indicate the severity of the disease. The severity of COVID-19 was indicated by elevated total white cells, increased neutrophillymphocyte, and platelet-lymphocyte ratios. Increasing levels of CRP indicated a severe prognosis of the disease. D-dimer elevations may indicate the incidence of thromboembolic episodes. Therefore, hematological indices were considered applicable in assessing the progression of the disease and for the risk stratification of the disease. © 2022 Shriaz University of Medical Sciences
ABSTRACT
INTRODUCTION: Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented mortality and has stretched the health infrastructure thin worldwide, especially in low- and middle-income countries. There is a need to evaluate easily available biomarkers for their clinical relevance for poor outcomes in severe cases of COVID-19. It is also known that comorbidities affect these biomarkers with or without COVID-19. We aimed to unearth the influence of comorbidities on feasible hematological predictive markers for mortality in hospitalized severe COVID-19 patients. MATERIALS AND METHODS: This is a retrospective study done on severe COVID-19 hospitalized patients, diagnosed with RT polymerase chain reaction (n = 205), were investigated. Comorbidities associated with the patients were tracked and scored according to Charlson comorbidity index (CCI). CCI score of zero was grouped in A, those with CCI score 1-4 into group B and those with CCI scores ≥ 5 into group C. Correlation between hematological parameters and CCI scores was analyzed using Pearson correlation coefï¬cient. Optimal cut-off and odds ratio was derived from receiver operating characteristic (ROC) curve analysis. RESULTS: Among the 205 severe COVID-19 patients age, C-reactive protein (CRP), neutrophil lymphocyte ratio (NLR), derived NLR (dNLR), absolute neutrophil count (ANC) and total leukocyte count (TLC) were found to be statistically significant independent risk factors for predicting COVID-19 mortality (p < 0.01). In group A, cut off for CRP was 51.5 mg/L (odds ratio [OR]: 26.7; area under curve [AUC]: 0.867), TLC was 11850 cells/mm³ (OR: 11.7; AUC: 0.731), NLR was 11.76 (OR: 14.3; AUC: 0.756), dNLR was 5.77 (OR: 4.89; AUC: 0.659), ANC was 13110 cells/mm³ (OR: 1.68; AUC: 0.553). In group B, cut off for CRP was 36.5 mg/L (OR: 32.1; AUC: 0.886), TLC was 11077 cells/mm³ (OR: 12.1; AUC: 0.722), NLR was 8.27 (OR: 18.9; AUC: 0.827), dNLR was 3.79 (OR: 9.26; AUC: 0.727), ANC was 11420 cells/mm³ (OR: 2.42; AUC: 0.564). In group C, cut-off for CRP was 23.7 mg/L (OR: 32.7; AUC: 0.904), TLC was 10480 cells/mm³ (OR: 21.2; AUC: 0.651), NLR was 6.29 (OR: 23.5; AUC: 0.647), dNLR was 1.93 (OR: 20.8; AUC: 0.698), ANC was 6650 cells/mm³ (OR: 2.45; AUC: 0.564). CONCLUSIONS: In severe COVID-19 patients, CRP was the most reliable biomarker to predict mortality followed by NLR. Presence, type, and number of co-morbidities influence the levels of the biomarkers and the clinically relevant cut-offs associated with mortality.
ABSTRACT
Background: As Coronavirus disease 2019 (COVID-19) is a global pandemic infectious disease, medical staff all over the world are still struggling with the management of the disease. Biochemical and hematological changes can be considered as prognostic markers. Methods: A total of 65 Egyptian children positive covid-19 were enrolled, between 5-12 years. Results: White blood cell count was significantly low (mean= 4968 +/- 742.6, p<-0.001). Lymphocytopenia was significantly low (mean= 1529.9 +/- 493.9, p<-0.001). N/L showed statistically significantly high (mean= 2.45 +/- 0.72, p<-0.001), platelets showed statistically significantly low (mean= 196.7 +/- 82.58, p<-0.001) both correlated to severity. Plat/Lymph showed a statistically significant difference between groups. CRP increased than normal (mean=12.14 +/- 3.3, p<-0.001), and was negatively correlated with Lymphocyte %. D-dimer slightly increased than normal and showed statistical difference between groups. Conclusion: This study declares that pediatric COVID-19 showed various prognostics as CRP, lymphocyte ratio. As they are easily accessible, the majority of labs not expensive and showed a very good correlation with prognosis.