COVID-19 outpatients and surviving inpatients exhibit comparable blood test results that are distinct from non-surviving inpatients

Yıl 2021, Cilt: 4 Sayı: 3, 306 - 313, 21.05.2021

Ayse Ulgen , Şirin Çetin , Pervin Balcı Hakan Şıvgın Sevdiye Şıvgın Meryem Çetin , Wentian Li

https://doi.org/10.32322/jhsm.900462

Cited By: 3

Öz

Aim: The decision of admitting COVID-19 patients as inpatients is mostlydetermined by chest X-ray based diagnosis of pneumonia severity. However, prognosis of inpatients may diverge into two groups, onegroup of inpatients did not survive while another group did.
Material and Method: More than 100 COVID-19 outpatients are collected from Tokat, Turkey in three categories: outpatients, surviving inpatients, and deceased inpatients. Their blood test profiles are analyzed and compared bydimension reduction techniques and classic statistical tests.
Results: We observe that surviving inpatients share a common blood test profilewith the outpatients, whereas non-surviving inpatients aredistinctively different. The non-surviving inpatients areon average older. Among patients older than certain age, non-survivinginpatients have higher neutrophil level, lower lymphocyte level(thus higher neutrophil/lymphocyte ratio), lower calcium level,higher C-reactive-protein, sodium, whole blood cell level, andlower hemoglobin level, than the surviving patients (whether these are inpatients or outpatients).
Conclusion: Surviving status is more important than in- and out-patient statusin a patient’s cluster membership based on blood test profile. This result suggests a plan to use both X-ray diagnosis and blood testresults as a criterion to admit COVID-19 inpatients.

Anahtar Kelimeler

COVID-19, outpatients, surviving, non-surviving

Kaynakça

• Taubenberger JK and Morens DM. The 1918 influenza pandemic and its legacy. Cold Spring Harb Persp Med 2020; 10: a038695.
• Van Doren TP. The 1918 influenza pandemic has lessons for COVID-19: an anthropology student perspective. Am J Pub Health 2021; 111:79-80.
• Chandra A, Chakraborty U, Pal J, Karmakar P. Silent hypoxia: a frequently overlooked clinical entity in patients with COVID-19. BMJ Case Rep 2020; 13: e237207.
• Wilkerson RG, Adler JD, Shah NG, Brown R. Silent hypoxia: A harbinger of clinical deterioration in patients with COVID-19. Am J Emerg Med 2020; 38: 2243.e5-2234.e6.
• Tenforde MW, Rose EB, Lindsell CJ, et al. Characteristics of adult outpatients and inpatients with COVID-19 -11 Academic Medical Centers, United States, March -May 2020, Morb. Mortal Wkly Rep 2020; 69: 841-6.
• Keshavarz M, Tavakoli A, Zanganeh S, et al. Clinical characteristics of outpatients and inpatients with COVID-19 in Bushehr: a report from the south of Iran. Future Med 2021; 16: 99-106.
• Korkmaz MF, Türe E, Dorum BA, Kiliç ZB. The epidemiological and clinical characteristic of 81children with COVID-19 in a pandemic hospital in Turkey: an observational cohort study. J Korean Med Sci 2020; 35: e236.
• Medetalibeyoglu A, Senkal N, Kose M, et al. Older adults hospitalized with COVID-19: clinical characteristics and early outcomes from a single center in Istanbul, Turkey. J Nutri Health Aging 2020; 24: 928-37.
• Oncel MY, Akın IM, Kanburoglu MK, et al. A multicenter study on epidemiological and clinical characteristics of 125 newborns born to women infected with COVID-19 by Turkish Neonatal Society. Euro J Pediat 2020; 180: 733-42.
• Kocayiğit H, Süner KÖ, Tomak Y, et al. Characteristics and outcomes of critically ill patients with COVID-19 in Sakarya, Turkey: a single center cohort study. Turk J Med Sci 2021; 51: 440-7.
• Altunok ES, Alkan M, Kamat S, et al. Clinical characteristics of adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia. J Infect Chemo 2021; 27: 306-11.
• Satış H, Özger HS, Yildiz PA, et al. Prognostic value of interleukin-18 and its association with other inflammatory markers and disease severity in COVID-19. Cytokine 2021; 137: 155-302.
• Harbalioˇglu H, Genç Ö, Yildirim A. 3 predictors of hospitalization patients with coronavirus (COVID-19): old age, lactate dehydrogenase and neutrophil/lymphocyte ratio. Pamukkale Tip Derg 2021; 14: 57-62.
• Van der Maaten LJ and Hinton GE. Visualizing data using t-SNE. J. Machine Learning Res 2008; 9: 2575-605.
• McInnes L, Healy J, Saul N, Grossberger L. UMAP: uniform manifold approximation and projection. J Open Source Software 2018; 3: 861.
• Colquhoun D. The reproducibility of research and the misinterpretation of p-values. Royal Soc Open Sci 2017; 4: 171085.
• Ioannidis JPA. The proposal to lower P value thresholds to. 005. JAMA 2018; 319: 1429-30.
• Li W, Shih A, Freudenberg-Hua Y, Fury W, Yang Y. Beyond standard pipeline and p<0.05 in pathway enrichment analyses. Comp Biol Chem 2021; 92: 107455.
• Amir ED, Davis KL, Tadmor MD, et al. viSNE enables visualization of high dimensional single-cell data and reveals phenotypic heterogeneity of leukemia. Nature Biotech 2013; 31: 545-52.
• Becht E, McInnes L, Healy J, et al. Dimensionality reduction for visualizing single-cell data using UMAP. Nature Biotech 2019; 37: 38-44.
• Li W, Cerise JE, Yang Y, Han H. Application of t-SNE to human genetic data. J Bioinfo Comp Biol 2017; 15: 1750017.
• Li W, Freudenberg J, Freudenberg J. Alignment-free approaches for predicting novel Nuclear Mitochon-drial Segments (NUMTs) in the human genome. Gene 2019; 691: 141-52.
• Ulgen A, Gürkut Ö, Li W. Potential predictive factors for breast cancer subtypes from a North Cyprus cohort analysis. Cyprus J Med Sci 2020; 5: 339-49.
• Liu J, Liu Y, Xiang P, et al. Neutrophil to lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. J Transl Med 2020; 18: 206.
• Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progression. Crit Rev Clin Lab Sci 2020; 57: 389-99.
• Ye W, Chen G, Li X, et al. Dynamic changes of D-dimer and neutrophil-lymphocyte count ratio as prognostic biomarkers in COVID-19. Resp Res 2020; 21: 169.
• Moradi EV, Teimouri A, Rezaee R, et al. Increased age, neutrophil-to-lymphocyte ratio (NLR) and white blood cells count are associated with higher COVID-19 mortality. Am J Emerg Med 2021; 40: 11-4.
• Sun JK, Zhang WH, Zou L, et al. Serum calcium as a biomarker of clinical severity and prognosis in patients with coronavirus disease 2019. Aging 2020; 12: 11287-95.
• Lim JP, Low KYH, Lin NJJ, et al. Predictors for development of critical illness amongst older adults with COVID-19: Beyond age to age-associated factors. Archives Gerontology and Geriatrics 2021; 94: 104331.
• Sahu BR, Kampa RK, Padhi A, Panda AK. C-reactive protein: a promising biomarker for poor prognosis in COVID-19 infection. Clinica Chimica Acta 2020; 509: 91-4.
• Tezcan ME, Gokce GD, Sen N, Kaymak NZ, Ozer RS. Baseline electrolyte abnormalities would be related to poor prognosis in hospitalized coronavirus disease 2019 patients. New Microb New Infect 2020; 37: 100753.
• Naoum FA, Zucareli Ruiz AL, de Oliveira Martin FH, Gomes Brito TH, Hassem V, de Lucca Oliveira MG. Diagnostic and prognostic utility of WBC counts and cell population data in patients with COVID19. Int J Lab Hematol 2021. Doi: 10.1111/ijlh.13395.
• Algassim AA, Elghazaly AA, Alnahdi AS, et al. Prognostic significance of hemoglobin level and autoimmune hemolytic anemia in SARS-CoV-2 infection. Ann Hematol 2021; 100: 37-43.
• Sharifpour M, Rangaraju S, Liu M, et al. C-Reactive protein as a prognostic indicator in hospitalized patients with COVID-19. PLoS One 2020; 15: e0242400.
• Nemer DM, Wilner BR, Burkle A, et al. Clinical characteristics and outcomes of Non-ICU hospitalization for COVID-19 in a nonepicenter, centrally monitored healthcare system, J Hosp Med 2021; 16: 7-14.
• Bergamaschi G, de Andreis FB, Aronico N, et al. Anemia in patients with COVID-19: pathogenesis and clinical significance, Clin Exp Med 2021. Doi: 10.1007/s10238-020-00679-4.
• Lippi G and Mattiuzzi C. Hemoglobin value may be decreased in patients with severe coronavirus disease 2019. Hematol Transfus Cell Ther 2020; 42: 116-7.
• Zhang L, Yan X, Fan Q, et al. D-dimer levels on admission to predict in-hospital mortality in patients with COVID-19. J Thromb Haemost 2020; 18: 1324-9.
• Hachim MY, Hachim IY, Naeem KB, Hannawi H, Al Salmi I, Hannawi S. D-dimer, troponin, and urea level at presentation with COVID-19 can predict ICU admission: a single centered study. Front Med 2020; 7: 949.
• Ceriello A. Hyperglycemia and COVID-19: What was known and what is really new? Diabetes Res Clin Pract 2020; 167: 108383.
• Di Filippo L, Formenti AM, Rovere-Querini P, et al. Hypocalcemia is highly prevalent and predicts hospitalization in patients with COVID-19. Endocrine 2020; 68: 475-8.
• Benedetti C, Waldman M, Zaza G, Riella LV, Cravedi P. COVID-19 and the kidneys: an update. Front Med 2020; 7: 423.
• Chen D, Li X, Song Q, et al. Assessment of hypokalemia and clinical characteristics in patients with coronavirus disease 2019 in Wenzhou, China, JAMA Netw Open 2020; 3: e2011122.
• Tzoulis P, Waung JA, Bagkeris E, et al. Dysnatremia is a predictor for morbidity and mortality in hospitalized patients with COVID-19. J Clin Endo Metab 2021. Doi: 10.1210/clinem/dgab107
• Anurag A, Jha PK, Kumar A. Differential white blood cell count in the COVID-19: A cross-sectional study of 148 patients. Diabetes Metab Syndr 2020; 14: 2099-102.
• Aschenbrenner AC, Mouktaroudi M, Krmer B, et al. German COVID-19 Omics Initiative (DeCOI). Disease severity-specific neutrophil signatures in blood transcriptomes stratify COVID-19 patients. Genome Biol 2020; 13: 1-25.
• Huang I and Pranata R. Lymphopenia in severe coronavirus disease-2019 (COVID-19): systematic review and meta-analysis. J Intensive Care 2020; 8: 1-10.
• Liu J, Li H, Luo M, et al. Lymphopenia predicted illness severity and recovery in patients with COVID-19: a single-center, retrospective study, PLoS ONE 2020; 15: e0241659.
• Li X, Liu C, Mao Z, Xiao M, Wang L, Qi S. Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis. Crit Care 2020; 24: 1-10.
• Simadibrata DM, Pandhita BAW, Ananta ME, Tango T. Platelet-to-lymphocyte ratio, a novel biomarker to predict the severity of COVID-19 patients: A systematic review and meta-analysis. J Intensive Care Soc 2020; 1751143720969587.