Document Type : Original Article

Authors

1 Department of General Medicine, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India

2 Department of Human Genetics, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India

3 Department of Physiology and Biochemistry, Government Yoga and Naturopathy Medical College and Hospital, Chennai, Tamil Nadu, India

4 Department of Biochemistry, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India

Abstract

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.

Keywords

  1. Mattiuzzi C, Lippi G. Which lessons shall we learn from the 2019 novel coronavirus outbreak?. Ann Transl Med. 2020;8(3):48.
  2. Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci 2020;12:8.
  3. Ksiazek TG, Erdman D, Goldsmith CS, Zaki SR, Peret T, Emery S, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med 2003;348(20):1953–66.
  4. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) [Internet]. [cited 2020 Apr 30].
  5. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult in patients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet.2020;395:1054–1062.
  6. Kantri A, Ziati J, Khalis M, Haoudar A, El Aidaoui K, Daoudi Y, et al. (2021) Hematological and biochemical abnormalities associated with severe forms of COVID-19: A retrospective singlecenter study from Morocco. PLoS ONE 16(2): e0246295
  7. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutierrez-Ocampo E, Villamizar-Peña R, Holguin-Rivera Y, Escalera-Antezana JP, et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis. 2020;34:101623.
  8. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet.2020;395:507–513.
  9. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020 Jul 1;180(7):934-943. Erratum in: JAMA Intern Med. 2020;180(7):1031.
  10. Javanian M, Bayani M, Shokri M, Sadeghi-Haddad-Zavareh M, Babazadeh A, Yeganeh B, et al. Clinical and laboratory findings from patients with COVID-19 pneumonia in Babol North of Iran: a retrospective cohort study. Rom J Intern Med. 2020 Sep 1;58(3):161-167.
  11. Guan W, Ni Z, Hu Y, Liang W, Ou C, He J, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708–1720.
  12. Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020 Jun 25;58(7):1021-1028. 
  13. Rodríguez-Morales AJ, MacGregor K, Kanagarajah S, Patel D, Schlagenhauf P. Going global - Travel and the 2019 novel coronavirus. Travel Med Infect Dis. 2020;33:101578.
  14. Waris A, Din M, Khalid A, Lail RA, Shaheen A, Khan N, et al. Evaluation of hematological parameters as an indicator of disease severity in Covid-19 patients: Pakistan's experience. J Clin Lab Anal. 2021 Jun;35(6):e23809. 
  15. Fan BE, Chong VCL, Chan SSW, Lim GH, Lim KGE, Tan GB, et al. Hematologic parameters in patients with COVID-19 infection. Am J Hematol. 2020 Jun;95(6):E131-E134. Erratum in: Am J Hematol. 2020 Nov;95(11):1442.
  16. Chowdhury ATMM, Karim MR, Mehedi HH, Shahbaz M, Chowdhury MW, Dan G, et al. Analysis of the primary presenting symptoms and hematological findings of COVID-19 patients in Bangladesh. The Journal of Infection in Developing Countries 2021;15(2):214-223.
  17. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta. 2020;506:145–148.
  18. Rahman A, Niloofa R, Jayarajah U, De Mel S, Abeysuriya V, Seneviratne SL. Hematological Abnormalities in COVID-19: A Narrative Review. Am J Trop Med Hyg 2021;104(4):1188–1201.
  19. Lim AYH, Goh JL, Chua MCW, Heng BH, Abisheganaden JA, George PP. Temporal changes of haematological and radiological findings of the COVID-19 infection-a review of literature. BMC Pulm Med. 2021 Jan 22;21(1):37. 
  20. Khandait H, Gandotra G, Sachdeva S, Kramer CA, Nye D, Golamari R, et al. COVID-19 and Hematology-What Do We Know So Far?. SN Compr Clin Med. 2020;2(12):2631-2636.
  21. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis. 2020;71(15): 762–768.
  22. Qu R, Ling Y, Zhang YH, Wei LY, Chen X, Li XM, et al. Platelet-to-lymphocyte ratio is associated with prognosis in patients with coronavirus disease-19. J Med Virol. 2020;92(9):1533–1541.
  23. Agrawal A, Tyagi P, Mahavar S, Banerjee S, Sharma R, Bhandari S, et al. Study of hematological and biochemical parameters in a cohort of Indian COVID-19 patients admitted in a tertiary care centre. Int J Adv Med. 2020;7(12):1840-1845.
  24. Cheung CKM, Law MF, Lui GCY, Wong SH, Wong RSM. Coronavirus Disease 2019 (COVID-19): A Haematologist's Perspective. Acta Haematol. 2021;144(1):10-23. Coronavirus Disease 2019 (COVID-19):
  25. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
  26. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalised patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAM. 2020;323(11):1061-1069. Erratum in: JAMA. 2021 Mar 16;325(11):1113. 
  27. Kumar A, Sepolia S, Shilpa RH, Rezayani G, Kumari S, Aastha, et al. Role of Hematological and Immunological Parameters in COVID-19 Patients. J Pharm Bioallied Sci. 2021;13(2): 238–243.
  28. Behzad Saberi. Surgical Resection Technique for Convexity Meningiomas. Canc Therapy & Oncol Int J. 2020; 17(2): 555958.
  29. Bellan M, Azzolina D, Hayden E, Gaidano G, Pirisi M, Acquaviva A, et al. Simple Parameters from Complete Blood Count Predict In-Hospital Mortality in COVID-19. Dis Markers. 2021 May 13;2021:8863053.