Cytopenias in Hospitalized Patients of Covid-19 during First and Other Waves

ABSTRACT

Introduction: COVID -19 emerged in December 2019 in china and till date this virus has mutated into different strains which are somewhat different in their presentation and severity. Pakistan has faced five waves of COVID-19 till date. This study was aimed to compare Haematological parameters and outcomes of hospitalized patients during First and other waves (second and third) of COVID-19. Method(s) Demographic, Clinical and laboratory data as well as outcome of total 202 COVID-19 PCR positive patients admitted in Fatima memorial Hospital, Lahore, Pakistan was collected during first and other waves. Data of First wave is from May 2020 to July 2020, second wave from early November to Mid December 2020 and third wave from Mid march to June 2021. We compared the data on basis of SII as well hematological parameters of First Wave were compared with other waves (second & third) of COVID-19. Result(s) There were 54(26.7%) patients with SII< 600 and 148(73.2%) patients with SII>600. Neutrophilia (p-< 0.001), leukocytosis (p-< 0.001), lymphocytopenia(p-< 0.001), Raised NLR(p-< 0.001), PLR(p-< 0.001) and MLR(p-< 0.001) had direct association with SII. Raised SII was directly related to increased requirement of ventilator support (p-0.2) and Mortality (p-0.001). There were total 90(44.5%) patients in first wave and 112(55.4%) patients in other waves of COVID-19. More Females (33.3% Vs 57.1%) than Males (66.7% Vs 42.9%) were infected during other waves (p- 0.001). Anemia (27.8% vs 37.5%) (p-0.09), leucopenia (1.1% vs 8.9%) (p-< 0.001), Lymphocytopenia (20% Vs 39.3%) (p-0.003) and thrombocytopenia (3.3% Vs 25%) (p-< 0.001) were more prevalent in other waves of COVID-19 when compared to first wave. Requirement of Ventilator Support (7.7% vs 22%) and mortality (10% vs 33.9%) were also increased in other waves of COVID-19 Conclusion(s) Systemic immune Inflammation Index (SII) is a good predicting tool in COVID -19 patients for prognosis and is directly associated with severity of disease as well as outcome. Patients with cytopenias like anemia, leucopenia, lymphocytopenia thrombocytopenia, requirement of Ventilator Support and mortality were noted to be more in other waves of COVID-19. Haematological parameters like ANC, AMC NLR, PLR, MLR and SII show no significant difference between first and subsequent waves of COVID-19.