Role of Potential Biomarkers in Management and Prognosis of CoronaVirus Disease (COVID-19)

ABSTRACT

Aim and background: Coronavirus disease is a global pandemic. A significant majority of patients present with mild symptoms but some of them develop into severe disease. One of the key issues has been the very high volume of patients presenting to health centres or hospitals during the outbreak. It clearly overwhelms the human and mechanistic capacities available, especially the need for critical care support. Therefore, early and effective predictors of clinical outcomes are required for risk stratification. Objective: Identification of biomarkers that can be used as an early and helpful marker to improve the management of COVID-19 patients and as a prognostic marker. Materials and methods: This is an ongoing hospital-based retrospective study on patients who were admitted to COVID wards/ICU at IGGMC. Patients are divided into 3 groups - mild-moderate;severe;and critical based on their clinical presentation on admission. Several biomarkers like WBC, platelets, N/L, CRP, LDH, S. ferritin, d-dimer, CPK-MB, serum creatinine, BUL, SGOT, SGPT, and serum albumin were analysed before and after treatment. Results: 110 patients were enrolled in this study until now. Out of which, 36 were classified into mild-moderate, 56 into severe, and 18 into critical. There was no mortality in the mildmoderate group, 37 deaths in the severe, and 13 deaths in the critical group. As all mild-moderate patients were discharged and the majority of critical patients expired, biomarkers were compared between severe patients who were discharged vs severe patients who died. Out of these various biomarkers, CRP was significantly decreased during the course of treatment in severe patients who were discharged (p = 0.004) in comparison to severe patients who died where CRP was significantly increased (p = 0.001) (p value of difference being 0.00001). There was also significant change in ferritin levels (p = 0.006), while other biomarkers like WBC (p = 0.07), platelets (p = 0.066), N/L (p = 0.3), LDH (p = 0.06), d-dimer (p = 0.1), CPK-MB (p = 0.49), serum creatinine (p = 0.05), urea (p = 0.06), S. albumin (p = 0.3), SGOT (p = 0.07), and SGPT (p = 0.25) did not show promising results. As CRP was most significant in determining the prognosis of patients, various treatment protocols were analysed by comparing CRP before and after treatment. Severe patients were divided into 2 groups, who took injection remdesivir along with antibiotics, LMWH, systemic steroids vs those who did not, and CRP level was compared, but the difference was not significant (p = 0.06). CRP level was also compared in patients receiving steroids for > 10 days vs < 10 days (p = 0.18). Pre- and post-treatment CRP was also compared for injection tocilizumab, tablet fevipiravir, hydroxychloroquine, doxycycline, but none of them were able to decrease CRP significantly (p > 0.05) in the severe or critical group but these drugs were effective in reducing CRP significantly (p < 0.05) when given in mild-moderate group or if the treatment was started early. Conclusion: Increment in CRP and ferritin could effectively predict clinical outcomes and could be used for risk stratification but no available drug is effective in reducing these biomarkers significantly in the severe or critical group.