Hematological and inflammatory parameters in hospitalized patients with COVID‐19 infection in Chattogram, Bangladesh

Year 2021, Volume: 25 Issue: 6, 857 - 865, 28.06.2025

Rakibul Hassan Bulbul Giash Uddin Kazi Ishrak Faiyaz Mohammad Rashedul Islam Ashraful Alam Shakeel Ahmed Zakir Hossain Mohammed Lokman Mohammad Safiqul Islam

Abstract

COVID-19 emerged as a pandemic that is persisting with massive casualties around the globe. To ensure clinical management, changes in hematological parameters are routinely monitored and considered essential in patients with coronavirus disease 2019 (COVID-19) to measure the disease prognosis. This study aimed to recognize alterations in patients' hematological and inflammatory parameters with COVID-19. We obtained and analyzed data from 170 COVID-19 positive patients and 78 COVID-19 negative patients confirmed by qRT-PCR. The laboratory data included the hematological and inflammatory parameters of the selected patients. Compared with COVID-19 negative groups, COVID-19 patients had significantly higher levels of hematocrit (HCT) (p <0.01), mean platelets volume (MPV) (p <0.01), neutrophils (p <0.01), erythrocyte sedimentation rate (ESR) (p <0.0001), C-Reactive Protein (CRP) (p <0.0001), and significantly lower levels of Hemoglobin (Hb) (p <0.0001), lymphocytes (p <0.0001), monocytes (p <0.0001), eosinophils (p <0.01), basophils (p <0.05). This study also observed significantly increased levels of Hb, HCT, RBC, MCH, MCHC, monocytes, ferritin, and significantly decreased RDW-CV, platelets count, ESR in the COVID-19 male patients than the COVID-19 female patients. This study suggests that hematological and inflammatory parameters should be considered in the clinical management of COVID-19 patients.

Keywords

COVID-19 , hematological parameters , inflammatory parameters , clinical features , Bangladesh

References

• [1] Watkins K. Emerging Infectious Diseases: a Review. Curr Emerg Hosp Med Rep. 2018; 6: 86–93.
• [2] Lin L, McCloud RF, Bigman CA, Viswanath K. Tuning in and catching on? Examining the relationship between pandemic communication and awareness and knowledge of MERS in the USA. J Public Heal (United Kingdom). 2017; 39: 282–289. Research Article
• [3] Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020; 382: 727–733.
• [4] Wang L, Wang Y, Ye D, Liu Q. Review of the 2019 novel coronavirus (SARS-CoV-2) based on current evidence. Int J Antimicrob Agents. 2020; 55: 105948.
• [5] Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia. N Engl J Med. 2020; 382: 1199–1207.
• [6]Andersen KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF. The proximal origin of SARS-CoV-2. Nat Med. 2020; 26: 450–452.
• [7] Turk C, Turk S, Malkan UY, Haznedaroglu IC. Three critical clinicobiological phases of the human SARS-associated coronavirus infections. Eur Rev Med Pharmacol Sci. 2020; 24: 8606–8620.
• [8] Li L, Yang Z, Dang Z, Meng C, Huang J, Meng H, et al. Propagation analysis and prediction of the COVID-19. Infect Dis Model. 2020; 5: 282–292.
• [9] 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: 497–506.
• [10] Singhal T. A Review of Coronavirus Disease-2019 (COVID-19). Indian J Pediatr. 2020; 87: 281–6.
• [11] Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. N Engl J Med. 2020; 382: 970–971.
• [12] Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission routes of 2019-nCoV and controls in dental practice. Int J Oral Sci. 2020; 12.
• [13] 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: 1708–1720.
• [14] Bekdas M, Goksugur S, Sarac E, Erkocoglu M, Demircioglu F. Neutrophil/lymphocyte and C-reactive protein/mean platelet volume ratios in differentiating between viral and bacterial pneumonias and diagnosing early complications in children. Saudi Med J. 2014; 35: 442–447.
• [15] Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, et al. Hematological findings and complications of COVID-19. Am J Hematol. 2020; 95: 834–47.
• [16] Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395: 1054–1062.
• [17] Fogarty H, Townsend L, Ni Cheallaigh C, Bergin C, Martin‐Loeches I, Browne P, et al. COVID19 coagulopathy in Caucasian patients. Br J Haematol. 2020; 189: 1044–1049.
• [18] Liao D, Zhou F, Luo L, Xu M, Wang H, Xia J, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study. Lancet Haematol 2020; 7: e671–8.
• [19] Yuan X, Huang W, Ye B, Chen C, Huang R, Wu F, et al. Changes of hematological and immunological parameters in COVID-19 patients. Int J Hematol. 2020; 112: 553–559.
• [20] Elshazli RM, Toraih EA, Elgaml A, El-Mowafy M, El-Mesery M, Amin MN, et al. Diagnostic and prognostic value of hematological and immunological markers in COVID-19 infection: A meta-analysis of 6320 patients. PLoS One. 2020; 15: e0238160.
• [21] Wrapp D, Wang N, Corbett KS, Goldsmith JA, Hsieh C-L, Abiona O, et al. Cryo-EM Structure of the 2019-nCoV Spike in the Prefusion Conformation. Science. 2020; 367.
• [22] Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA - J Am Med Assoc. 2020; 323: 1061–1069.
• [23] Djakpo DK, Wang Z, Zhang R, Chen X, Chen P, Ketisha Antoine MML. Blood routine test in mild and common 2019 coronavirus (COVID-19) patients. Biosci Rep. 2020; 40.
• [24] Algassim AA, Elghazaly AA, Alnahdi AS, Mohammed-Rahim OM, Alanazi AG, Aldhuwayhi NA, et al. Prognostic significance of hemoglobin level and autoimmune hemolytic anemia in SARS-CoV-2 infection. Ann Hematol. 2020: 1–7.
• [25] Bassetti M, Vena A, Giacobbe DR. The novel Chinese coronavirus (2019-nCoV) infections: Challenges for fighting the storm. Eur J Clin Invest. 2020; 50.
• [26] Amgalan A, Othman M. Exploring possible mechanisms for COVID‐19 induced thrombocytopenia: Unanswered questions. J Thromb Haemost. 2020; 18: 1514–1516.
• [27] Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial Version 7). Chin Med J (Engl). 2020; 133: 1087–1095.
• [28] Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest. 2020; 130: 2620–2629.
• [29] Van Der Poll T, Van De Veerdonk FL, Scicluna BP, Netea MG. The immunopathology of sepsis and potential therapeutic targets. Nat Rev Immunol. 2017; 17: 407–420.
• [30] Al-Tawfiq JA, Hinedi K, Abbasi S, Babiker M, Sunji A, Eltigani M. Hematologic, hepatic, and renal function changes in hospitalized patients with Middle East respiratory syndrome coronavirus. Int J Lab Hematol. 2017; 39: 272–278.
• [31] Rabaan Ali A, Al-Ahmed Shamsah H, Haque Shafiul, Sah Ranjit, Tiwari Ruchi, Malik Yashpal Singh, et al. SARS- CoV-2, SARS-CoV, and MERS-COV: A comparative overview. Le Infez Med. 2020; 28: 174–84.
• [32] Panesar NS. What caused lymphopenia in SARS and how reliable is the lymphokine status in glucocorticoid-treated patients? Med Hypotheses. 2008; 71: 298–301.
• [33] He Z, Zhao C, Dong Q, Zhuang H, Song S, Peng G, et al. Effects of severe acute respiratory syndrome (SARS) coronavirus infection on peripheral blood lymphocytes and their subsets. Int J Infect Dis 2005; 9: 323–330.
• [34] Chu H, Zhou J, Wong BHY, Li C, Chan JFW, Cheng ZS, et al. Middle East Respiratory Syndrome Coronavirus Efficiently Infects Human Primary T Lymphocytes and Activates the Extrinsic and Intrinsic Apoptosis Pathways. J Infect Dis 2016; 213: 904–914.
• [35] Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020; 18: 844–547.
• [36] Staubli SM, Schäfer J, Rosenthal R, Zeindler J, Oertli D, Nebiker CA. The role of CRP and Pentraxin 3 in the prediction of systemic inflammatory response syndrome and death in acute pancreatitis. Sci Rep. 2019; 9.
• [37] Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest 2003; 111: 1805–1812.
• [38] Zhao K, Li R, Wu X, Zhao Y, Wang T, Zheng Z, et al. Clinical features in 52 patients with COVID-19 who have increased leukocyte count: a retrospective analysis. Eur J Clin Microbiol Infect Dis. 2020: 1–9.
• [39] Mokart D, Merlin M, Sannini A, Brun JP, Delpero JR, Houvenaeghel G, et al. Procalcitonin, interleukin 6 and systemic inflammatory response syndrome (SIRS): Early markers of postoperative sepsis after major surgery. Br J Anaesth. 2005; 94: 767–773.
• [40] Oda S, Hirasawa H, Shiga H, Nakanishi K, Matsuda KI, Nakamua M. Sequential measurement of IL-6 blood levels in patients with systemic inflammatory response syndrome (SIRS)/sepsis. Cytokine. 2005; 29: 169–175.
• [41] Khalil U, Seliem F, Alnahal A, Awad M, Sadek AE., Fawzy M. Association of serum ferritin with insulin resistance in offsprings of type 2 diabetics. Egypt J Intern Med. 2018; 30: 13.
• [42] IFCC. IFCC information guide on COVID-19 2020.
• [43] Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020; 97: 829–838.
• [44] Naicker S, Yang CW, Hwang SJ, Liu BC, Chen JH, Jha V. The Novel Coronavirus 2019 epidemic and kidneys. Kidney Int. 2020; 97: 824–828.