Effectiveness of Laboratory Tests in Tracking Severely COVID-19 Infections

Öz

Aim: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a virus that causes COVID-19 (Coronavirus Disease 2019), and poses serious difficulties in terms of healthcare systems and global public health. With the large number of publications on COVID-19, clinicians need a synthesis of evidence to provide guidance when dealing with patients with COVID-19. Emerging studies reveal the existence of numerous demographic, clinical, immunological, biochemical and radiographic data that may be useful for clinicians to predict the severity and mortality of COVID-19. The aim of this study; to determine laboratory parameters that can predict the course and severity of COVID-19 disease in patients, independently of the clinic status of selected patients and based on laboratory findings. Methods: This study is a retrospective cross-sectional study conducted at Karacabey State Hospital between January and April 2022. Among the patients who applied to the COVID-19 outpatient clinic, 469 patients (261 females, 208 males) over the age of 18 and positive for SARS-CoV-2 RT-PCR were included in the study. The patients were divided into groups as outpatients, inpatients and patients in need of intensive care (intensive care unit, ICU). Demographic data (age, gender), COVID-19 RT-PCR results, and simultaneous laboratory parameters of the patients were scanned retrospectively. Results: When CRP, urea, ferritin, LEU, NEU, MONO, RBC, HGB, HCT, MCV, NLR, PLR, CRP-NR, and SII index values were taken into consideration, a statistically significant difference was found between the groups. Creatinine, ALT, AST, LDH, troponin I, mass CK-MB, D dimer, LYM, EOS, PLT, ELR, and PNR values were not significantly different between the groups. Conclusion: Advantages of this study; Comparing the changes in the patient’s other laboratory findings based on a single positive PCR test result and finding meaningful rates in terms of serious covid risk. The disadvantage of this study is that it is a study independent of the patient’s clinic and disease stage. In this study, we found that particularly increased SII was associated with more severe disease progression in patients diagnosed with COVID-19 along with laboratory findings. CRP, urea, ferritin, and indexes such as NLR, PLR, CRP-NR, and SII index values can be used to predict the severity of the disease.

Anahtar Kelimeler

• SARS-CoV-2
• NLR
• CRP-NR
• SII index

Etik Beyan

BURSA ŞEHİR HASTANESİNDEN 2022 YILINDA ALINAN ETİK KURUL ONAYI KARARI (2022-6/3-20.04.2022) EKTE SUNULMUŞTUR.

Şiddetli COVID-19 Enfeksiyonlarının İzlenmesinde Laboratuvar Testlerinin Etkinliği

Öz

Amaç: Şiddetli akut solunum yolu sendromu koronavirüs-2 (SARS-CoV-2), COVID-19’a (Koronavirüs Hastalığı 2019) neden olan bir virüstür ve sağlık sistemleri ve küresel halk sağlığı açısından ciddi zorluklar oluşturmaktadır. COVID-19 ile ilgili çok sayıda yayın olması nedeniyle, klinisyenlerin COVID-19’lu hastalarla ilgilenirken rehberlik sağlamak için bir kanıt sentezine ihtiyaçları vardır. Ortaya çıkan çalışmalar, klinisyenlerin COVID-19’un şiddetini ve mortalitesini tahmin etmelerinde yararlı olabilecek çok sayıda demografik, klinik, immünolojik, biyokimyasal ve radyografik verinin varlığını ortaya koymaktadır. Bu çalışmanın amacı; yalnızca SARS-CoV 2 PCR test pozitifliği tanısı almış hastalarda ve seçilmiş hastaların klinik durumlarından bağımsız olarak ve laboratuvar bulgularına dayanarak COVID-19 hastalığının seyrini ve şiddetini tahmin edebilen laboratuvar parametrelerini belirlemektir. Yöntem: Bu çalışma Ocak-Nisan 2022 tarihleri arasında Karacabey Devlet Hastanesi’nde yürütülen retrospektif kesitsel bir çalışmadır. COVID-19 polikliniğine başvuran hastalar arasından 18 yaş üstü, SARS-CoV-2 RT-PCR pozitif 469 hasta (261 kadın, 208 erkek) çalışmaya dahil edildi. Hastalar ayaktan, yatan ve yoğun bakıma (yoğun bakım ünitesi, yoğun bakım) ihtiyaç duyan hastalar olarak gruplara ayrıldı. Hastaların demografik verileri (yaş, cinsiyet), COVID-19 RT-PCR sonuçları ve eş zamanlı laboratuvar parametreleri retrospektif olarak tarandı. Bulgular: CRP, üre, ferritin, LEU, NEU, MONO, RBC, HGB, HCT, MCV, NLR, PLR, CRP-NR ve SII indeks değerlerine bakıldığında gruplar arasında istatistiksel olarak anlamlı fark bulundu. Kreatinin, ALT, AST, LDH, troponin I, kütle CK-MB, D dimer, LYM, EOS, PLT, ELR ve PNR değerleri gruplar arasında anlamlı farklılık göstermedi. Sonuç: Bu çalışmanın avantajları; tek bir pozitif PCR test sonucuna göre hastanın diğer laboratuvar bulgularındaki değişimleri karşılaştırmak ve ciddi covid riski açısından anlamlı oranlar bulmaktır. Bu çalışmanın dezavantajı ise hastanın kliniğinden ve hastalık evresinden bağımsız bir çalışma olmasıdır. CRP, üre, ferritin ve NLR, PLR, CRP-NR ve SII indeks değerleri gibi indeksler hastalığın şiddetini tahmin etmede kullanılabilir.

Anahtar Kelimeler

• SARS-CoV-2
• NLR
• CRP-NR
• SII index

Kaynakça

1. Zhang ZL, Hou YL, Li DT, Li FZ. Laboratory findings of COVID-19: a systematic review and meta-analysis. Scand J Clin Lab Invest. 2020;80(6):441-7.
2. WHO. COVID-19 Weekly Epidemiological Update. Edition 119 . Available at: fi-le:///C:/Users/105789/Downloads/20221123_Weekly_Epi_Update_119.pdf. Accessed November 29, 2022.
3. 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. 2020;323(11):1061–9.
4. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel corona-virus in Wuhan, China. Lancet. 2020;395(10223):497–506.
5. Hashemieh M. Hematologic Parameters of COVID-19: A Review on Alteration of Hematologic Laboratory Fin-dings. Review Article (Pages:11921-29). Int J Pediatr 2020; 8(9): 11321-929.
6. Thompson S, Bohn M, Mancini N, Loh T, Wang C, Grimmler M, Yuen K, Mueller R, Koch D, Sethi S, Rawlinson W, Clementi M, Erasmus R, Leportier M, Kwon G, Menezes M, Patru M, Gramegna M, Singh K, Najjar O, Fer-rari M, Lippi G, Adeli K, Horvath A, the IFCC Taskforce on COVID-19. IFCC Interim Guidelines on Biochemi-cal/Hematological Monitoring of COVID-19 Patients. Clinical Chemistry and Laboratory Medicine (CCLM). 2020;58(12): 2009-16.
7. Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014 Dec 1;20(23):6212-22.
8. Maxwell D, Ofori K., Rai A. Laboratory Biomarkers in the Management of Patients with COVID-19. Am J Clin Pathol. 2021 Feb 11;155(3):333-342.

9. Chen Z, Xu W, Ma W, Shi X, Li S, Hao M, et al. Clinical laboratory evaluation of COVID-19. Clin Chim Acta. 2021 Aug;519:172-182.
10. Gallo Marin B, Aghagoli G, Lavine K, Yang L, Siff EJ, Chiang SS, et al. Predictors of COVID-19 severity: A litera-ture review. Rev Med Virol. 2021 Jan;31(1):1-10.
11. Ferrari D, Motta A, Strollo M, Banfi G, Locatelli M. Routine blood tests as a potential diagnostic tool for COVID-19. Clin Chem Lab Med. 2020 Jun 25;58(7):1095-1099.
12. C. Castro-Castro MJ, García-Tejada L, Arbiol-Roca A, Sánchez-Navarro L, Rapún-Mas L, Cachon-Suárez I, et al. Dynamic profiles and predictive values of some biochemical and haematological quantities in COVID-19 inpatients. Biochem Med (Zagreb). 2022;32:010706
13. Aloisio E, Chibireva M, Serafini L, Pasqualetti S, Falvella FS, Dolci A, et al. A Comprehensive Appraisal of La-boratory Biochemistry Tests as Major Predictors of COVID-19 Severity. Arch Pathol Lab Med. 2020 Dec 1;144(12):1457-1464.
14. Singh K, Mittal S, Gollapudi S, Butzmann A, Kumar J, Ohgami RS. A meta-analysis of SARS-CoV-2 patients identifies the combinatorial significance of D-dimer, C-reactive protein, lymphocyte, and neutrophil values as a predictor of disease severity. Int J Lab Hematol. 2020;00:1–5.
15. W.J. Guan, Z.Y. Ni, Y. Hu, W.H. Liang, C.Q. Ou, J.X. He, et al. China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China, N Engl J Med 2020;382:1708–20.
16. G. Chen, D. Wu, W. Guo, Y. Cao, D. Huang, H. Wang, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019, J Clin Invest 2020;130(5):2620-29.
17. Y. Shi, J. Ou, X. Chen, M. Tan, F. Li, Y. Liu, Expressions of multiple inflammation markers in the patients with COVID-19 and their clinical values, Chinese Journal of Laboratory Medicine 2020;43:346–351.
18. F. Zhou, T. Yu, R. Du, G. Fan, Y. Liu, Z. Liu, 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(10229):1054–62.
19. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–69.
20. Avcioglu G, Otal Y, Haydar F. The importance of LDH/Albumin, LDH/Lymphocyte, and LDH/Platelet ratios in the evaluation of COVID-19 B.1.1.7 variant. Turkish Journal of Biochemistry. 2022;47(5): 656-664.
21. G. Georgakopoulou VE, Garmpis N, Damaskos C, Valsami S, Dimitroulis D, Diamantis E, et al. The Impact of Peripheral Eosinophil Counts and Eosinophil to Lymphocyte Ratio (ELR) in the Clinical Course of COVID-19 Patients: A Retrospective Study. In Vivo. 2021 Jan-Feb;35(1):641-648.
22. X.H. Yao, T.Y. Li, Z.C. He, Y.F. Ping, H.W. Liu, S.C. Yu,et al. A pathological report of three COVID-19 cases by minimal invasive autopsies, Zhonghua Bing Li Xue Za Zhi 2020;49:411–417.
23. F.A. Klok, M. Kruip, N.J.M. van der Meer, M.S. Arbous, D. Gommers, K.M. Kant, F. et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An upda-ted analysis, Thromb Res 2020;191:148–150.
24. Cai Q, Huang D, Ou P, Yu H, Zhu Z, Xia Z, et al. COVID-19 in a designated infectious diseases hospital outside Hubei Province, China. Allergy 2020; 75(7): 1742-52.
25. Salman E, Çelikbilek N, Aydoğan S, Özdem B, Gökay S, Kırca F, et al. COVID-19 Tanılı Hastalarda Sistemik İm-mün-Enflamasyon İndeksi, C-Reaktif Protein ve İnterlökin-6’nın Viral Dinamik ile İlişkisinin Araştırılması (In-vestigation of the Relationship of Systemic Immune-Inflammation Index, C-Reactive Protein and Interleukin-6 with Viral Dynamics in Patients with COVID-19). Mikrobiyol Bul. 2021 Oct;55(4):539-552.
26. Qu R, Ling Y, Zhang YHZ, 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): 1533-41.
27. 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. 2022 Feb;23(1):20–6.