Alteration of biomarkers of expired and cured COVID-19 ICU patients in a tertiary care hospital

Abu Hasan; Rummana Rahim; Mizanur Rahman

doi:10.3329/brc.v7i2.54378

Authors

Abu Hasan Molecular Diagnostics Lab, Evercare Hospital Dhaka, Plot- 81, Block- E, Bashundhara R/A, Dhaka-1229, Bangladesh
Rummana Rahim Specialist, Molecular Diagnostics Lab, Evercare Hospital Dhaka, Plot- 81, Block- E, Bashundhara R/A, Dhaka-1229, Bangladesh
Mizanur Rahman Molecular Diagnostics Lab, Evercare Hospital Dhaka, Plot- 81, Block- E, Bashundhara R/A, Dhaka-1229, Bangladesh

DOI:

https://doi.org/10.3329/brc.v7i2.54378

Keywords:

COVID-19, SARS-CoV-2, ICU, D-Dimer, CRP, Ferritin, NLR

Abstract

Coronavirus Disease 2019 (COVID-19) is a respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This is a retrospective observational study aimed to find the alteration of some biochemical and hematological parameters of 121 COVID-19 patients admitted in intensive care unit (ICU) of Evercare Hospital Dhaka during May to December 2020. Methods: Retrospective biochemical, hematological and molecular (COVID-19 RT-PCR Ct value) markers were analyzed on COVID-19 patients in ICU and compared on those who died in the ICU and those cured. Results: Comparison of viral titer assessed by RT-PCR Ct values of target genes of SARS-CoV-2 among cured and expired patients did not show any significant differences. However, biochemical parameters such as CRP, Ferritin and hematological parameters such as WBC, absolute neutrophil, absolute lymphocyte, D-dimer showed significant differences among cured and expired patients. Patients who died in ICU mean CRP, Ferritin, D-dimer, WBC, absolute neutrophil were 10.39, 7694.30, 3196, 16.38, 15.12 respectively, compared to cured patients 0.93, 457.57, 773, 11.24, 8.86 respectively, with 95% confidence interval (95% CI). Platelets and absolute lymphocytes were observed decreased in expired patients compared to cured. Further, elevated level of neutrophil to lymphocyte ratio (NLR) and reduced level of lymphocyte to C-reactive protein ratio (LCR) has significant correlation with disease severity. Conclusion: These findings indicate that biochemical parameters such as CRP, Ferritin and hematological parameters such as CBC, D-Dimer, NLR, LCR can be monitored to identify severity and fatality of COVID-19 patients and thus, may help in improving disease outcome.

References

. Covid map: coronavirus cases, deaths, vaccinations by country. https://www.bbc.com/news/world-51235105

. Countries where COVID-19 has spread- worldometer. https://www.worldometers.info/ coronavirus/countries-where-coronavirus-has-spread/

. Ciaccio M, Agnello L (2020). Biochemical biomarkers alterations in Coronavirus Disease 2019 (COVID-19). Diagnosis (Berl). 7(4):365–72.

. Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G, et al. (2020). Cardiovascular considerations for patients, health care workers, and health systems during the COVID-19 pandemic. J Am Coll Cardiol. 75(18):2352–71.

. Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H (2020). Evidence for gastrointestinal infection of SARS-CoV-2. Gastroenterology. 158(6):1831-1833.e3.

. Medetalibeyoglu A, Catma Y, Senkal N, Ormeci A, Cavus B, Kose M, et al. (2020). The effect of liver test abnormalities on the prognosis of COVID-19. Ann Hepatol. 19(6):614–21.

. Adapa S, Chenna A, Balla M, Merugu GP, Koduri NM, Daggubati SR, et al. (2020). COVID-19 pandemic causing acute kidney injury and impact on patients with chronic kidney disease and renal transplantation. J Clin Med Res. 12(6):352–61.

. Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, et al. (2020). Neurological associations of COVID-19. Lancet Neurol. 19(9):767–83.

. Broxmeyer HE, Parker GC (2020). Impact of COVID-19 and future emerging viruses on hematopoietic cell transplantation and other cellular therapies. Stem Cells Dev. 29(10):625-6.

. Tay MZ, Poh CM, Rénia L, MacAry PA, Ng LFP. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol. 20(6):363–74.

. Lippi G, Plebani M (2020). The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks. Clin Chem Lab Med. 58(7):1063–9

. Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, Hosein Z, Padda I, Mangat J, Altaf M (2020). Comorbidity and its impact on patients with COVID-19. SN Compr Clin Med. Jun 25: 1-8.

. Lippi G, Plebani M (2020). Laboratory abnormalities in patients with COVID-19 infection. Clin Chem Lab Med. 58:1131–4.

. Argyropoulos KV, Serrano A, Hu J, Black M, Feng X, Shen G, Call N et al. (2020). Association of Initial Viral Load in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS COV2) Patients with Outcome and Symptoms. The American Journal of Pathology, Vol. 190, No. 9, September 2020.

. Zhang J-J, Cao Y-Y, Dong X, Wang B-C, Liao M-Y, Lin J, et al. (2020). Distinct characteristics of COVID-19 patients with initial rRT-PCR-positive and rRT-PCR-negative results for SARS-CoV-2. Allergy. 75(7):1809–12

. Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. (2020). 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. 58(7):1021–8

. Shang Y, Pan C, Yang X, Zhong M, Shang X, Wu Z, Yu Z, Zhang W, Zhong Q, Zheng X, Sang L, Jiang L, Zhang J, Xiong W, Liu J, and Chen D (2020). Management of critically ill patients with COVID-19 in ICU: statement from front-line intensive care experts in Wuhan, China. Ann Intensive Care. 10: 73.

Fa´ıco-Filho KS, Passarelli VC et al. (2020). Is Higher Viral Load in SARS-CoV-2 Associated with Death? Am. J. Trop. Med. Hyg., 103(5)pp

. Lee JS, Kim NY, Na SH, et al. (2018). Reference value of neutrophil-lymphocyte ratio, lymphocyte-monocyte ratio, platelet-lymphocyte ratio, and mean platelet volume in healthy adults in South Korea. Medicine (Baltimore). 97:26.

. Sato H, Tsubosa Y, Kawano T (2012). Correlation between the pretherapeutic neutrophil to lymphocyte ratio and the pathologic response to neoadjuvant chemotherapy in patients with advanced esophageal cancer. World J Surg. 36(3):617–622. PMID 22223293

. Chen Z, Fan H, Cai J, Li Y, Wu B, Hou Y, Xu S, Zhou F, Liu Y, Xuan W, Hu H (2020). High- resolution computed tomography manifestations of COVID-19 infections in patients of different ages. European journal of radiology. May 1;126: 108972.

. Asghar MS, Khan NA, Kazmi SJH, Ahmed A, Hassan M, Jawed R, Akram M, Rasheed U, Memon GM, Ahmed MU, Tahniyat U & Tirmizi SB (2020). Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comparative analysis

Journal Of Community Hospital Internal Medicine Perspectives. VOL. 10, NO. 6, 514–520; https://doi.org/10.1080/20009666.2020.1816276

. Siddiqi HK, Mehra MR (2020). COVID-19 illness in native and immunosuppressed states: a clinical-therapeutic staging proposal. J Heart Lung Transplant. https://doi.org/10.1016/j.healun. 2020.03.012.

. Ciaccio M and Agnello L (2020). Biochemical biomarkers alterations in Coronavirus Disease 2019 (COVID-19). Diagnosis. 7(4): 365–372. https://doi.org/10.1515/dx-2020-0057

. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al.(2020). Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 8:420–2.

. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. (2020). Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. https://doi.org/10.1056/NEJMoa 2002032.

. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 395:507–13.

. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y. et al. (2020). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 395:497–506.

. Liao YC, Liang WG, Chen FW, Hsu JH, Yang JJ, Chang MS (2002). IL-19 induces production of IL-6 and TNF-alpha and results in cell apoptosis through TNF-alpha. J Immunol. 169:4288–97.

. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, et al. (2020). Neutrophil-tolymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. https://doi.org/10.1016/j.jinf.2020.04.002.

. Pilaczyńska-Cemel M, Gołda R, Dąbrowska A, Przybylski G (2019). Analysis of the level of selected parameters of inflammation, circulating immune complexes, and related indicators

(neutrophil/lymphocyte, platelet/lymphocyte, CRP/CIC) in patients with obstructive diseases. Cent Eur J Immunol. 44:292–8.

. Shinya K, Gao Y, Cilloniz C, Suzuki Y, Fujie M, Deng G et al. (2012). Integrated clinical, pathologic, virologic, and transcriptomic analysis of H5N1 influenza virus-induced viral pneumonia in the rhesus macaque. J Virol. 86:6055–66.

. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 395: 1054–62.

. Tang N, Bai H, Chen X, Gong J, Li D, Sun Z (2020). Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. https://doi.org/10.1111/jth.14817

. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S (2020). Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. https://doi.org/10.1001/jamainternmed.2020. 0994

. Akizawa T, Gejyo F, Nishi S, Iino Y, Watanabe Y, Suzuki M, Saito A, Akiba T, Hirakata H, Fukuhara S, Morita S (2011). Positive outcomes of high hemoglobin target in patients with chronic kidney disease not on dialysis: a randomized controlled study. Therapeutic Apheresis and Dialysis. Oct;15(5):431-40.

. Yang W, Cao Q, Qin L, Wang X, Cheng Z, Pan A, et al. (2020). Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): a multi-center study in Wenzhou city, Zhejiang, China. J Infect. 80: 388–93.

. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. (2020). Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. J Am Med Assoc. 323: 1061–69. https://doi.org/10.1001/jama.2020. 1585

. Matsumoto H, Kasai T, Sato A, Ishiwata S, Yatsu S, Shitara J, et al. (2019). Association between C-reactive protein levels at hospital admission and long-term mortality in patients with acute decompensated heart failure. Heart Ves.34: 1961–8.

. Tan C, Huang Y, Shi F, Tan K,MaQ, Chen Y, et al. (2020). C-reactive protein correlates with CT findings and predicts severe COVID-19 early. 370 Ciaccio and Agnello: Biomarkers in COVID-19 J Med Virol.

https://doi.org/10.1002/jmv.25871

. Lippi G, South AM, Henry BM (2020). Annals express: electrolyte imbalances in patients with severe coronavirus disease 2019 (COVID-19). Ann Clin Biochem. https://doi.org/10.1177/ 0004563220922255