Evaluation of Biomarkers and Severity of COVID-19 in A Single Center

Yıl 2022, Cilt: 12 Sayı: 03, 89 - 96, 17.09.2022

Demet Yalçın Seyda Ignak Işılsu Ezgi Uluışık Olida Çeçen Muhammed Mert Sonkaya Ozlem Unay-demirel

https://doi.org/10.5799/jmid.1175432

Öz

Objectives: The clinical course of COVID-19 ranges from mild to severe. The predictability of clinical outcomes gains importance in managing the disease. In this retrospective cohort study, we aimed to investigate the relationship between biomarker levels and the clinical severity of COVID-19.
Methods: COVID-19 patients (n=618) admitted to a tertiary care hospital in Istanbul, Turkey were classified according to their clinical status using a scoring system designed by WHO. Laboratory parameters such as D-dimer, ferritin, and lymphocyte count levels were evaluated. In order to find out the relation between laboratory biomarkers and the severity of COVID-19, univariable and multivariable logistic regression analyses were used.
Results: A positive correlation was found when WHO Score was compared with D-dimer levels (r=.508, p<0.01), and ferritin levels (r=.391, p<0.01), whereas a negative correlation was observed between WHO Score and lymphocyte count levels (r=-.381, p<0.01). The cut-off values for D-dimer and ferritin were found as 0.86 ng/mL (70.9% sensitivity and 87.1% specificity) and 92.74 ng/mL (78.5% sensitivity and 52.2% specificity) respectively. According to the multivariable logistic regression model, lymphocyte count (β=- 0.305, p<0.001) and D-dimer levels (β=1.326, p<0.001) are the statistically significant regressors for hospitalization need.
Conclusion: Patients with higher D-dimer and ferritin levels were likely to have more severe disease, whereas patients with higher lymphocyte counts overcame the disease mildly. Unlike other studies, evaluating D-dimer and lymphocyte count will likely give more detailed information on COVID-19 clinical outcomes. J Microbiol Infect Dis 2022; 12(3):89-96.

Anahtar Kelimeler

COVID-19, ferritin; D-dimer, absolute lymphocyte count, multivariable logistic regression analysis

Kaynakça

• 1. Coronaviridae Study Group of the International Committee on Taxonomy of Viruses. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol 2020;5(4):536-544.
• 2. Republic of Turkey Ministry of Health. COVID-19 adult treatment algorithm. Available from: https://covid19bilgi.saglik.gov.tr/depo/algoritmalar/COVID19-plkacilhastayonetimi.pdf.
• 3. World Health Organization. (‎2021)‎. COVID-19 clinical management: living guidance, January 25 2021. World Health Organization. Available from: https://apps.who.int/iris/handle/10665/338882
• 4. Palich R, Wakim Y, Itani O, et al. Clinical, biological and radiological features, 4-week outcomes and prognostic factors in COVID-19 elderly inpatients. Infect Dis Now 2021;51(4):368-373.
• 5. Bayle C, Cantin D, Vidal J-S, et al. Asymptomatic SARS COV-2 carriers among nursing home staff: A source of contamination for residents? Infect Dis Now 2021; 51(2):197-200.
• 6. Bats M-L, Rucheton B, Fleur T, et al. Covichem: A biochemical severity risk score of COVID-19 upon hospital admission. PLoS One 2021;16(5): e0250956.
• 7. Pourbagheri-Sigaroodi A, Bashash D, Fateh F, Abolghasemi H. Laboratory findings in COVID-19 diagnosis and prognosis. Clin Chim Acta 2020;510: 475-482.
• 8. Nizami DJ, Raman V, Paulose L, Hazari KS, Mallick AK. Role of laboratory biomarkers in assessing the severity of COVID-19 disease. A cross-sectional study, J Family Med Prim Care 2021;10(6):2209-2215.
• 9. World Health Organization. (‎2020)‎. WHO R&D Blueprint: novel Coronavirus: outline of trial designs for experimental therapeutics, February 18, 2020, Geneva, Switzerland. World Health Organization. Available from: https://apps.who.int/iris/handle/10665/330694
• 10. Zhou C, Chen Y, Ji Y, He X, Xue D. Increased serum levels of hepcidin and ferritin are associated with severity of COVID-19. Med Sci Monit 2020; 26: e926178.
• 11. Taneri PE, Gómez-Ochoa SA, Llanaj E, et al. Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis. Eur J Epidemiol 2020; 35(8):763-773.
• 12. Weitz JI, Fredenburgh JC, Eikelboom JW. A test in context: D-dimer. J Am Coll Cardiol 2017; 70(19):2411-20.
• 13. Gungor B, Atici A, Baycan OF, et al. Elevated D-dimer levels on admission are associated with severity and increased risk of mortality in COVID-19: A systematic review and meta-analysis. Am J Emerg Med 2021; 39: 173-179.
• 14. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395(10223): 497-506.
• 15. He, X., Yao, F., Chen, J. et al. The poor prognosis and influencing factors of high D-dimer levels for COVID-19 patients. Sci Rep 2021; 11: 1830.
• 16. The study on Anticytokine-Antiinflammatory treatments, and coagulopathy management from the Advisory Committee of COVID-19 of the Turkish Ministry of Health. https://covid19.saglik.gov.tr/Eklenti/39296/0/covid-19rehberiantisitokin-antiinflamatuartedavilerkoagulopatiyonetimipdf.pdf
• 17. 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: 1324-1329.
• 18. Rostami M, Mansouritorghabeh H. D-dimer level in COVID-19 infection: a systematic review. Expert review of hematology. 2020;13(11):1265-1275.
• 19. 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(4):844-7.
• 20. Bozkurt FT, Tercan M, Patmano G, Bingol Tanrıverdi T, Demir HA, Yurekli UF. Can ferritin levels predict the severity of illness in patients with COVID-19? Cureus 2021; 13:e12832.
• 21. Qeadan F, Tingey B, Gu LY, Packard AH, Erdei E, Saeed AI. Prognostic values of serum ferritin and D-dimer trajectory in patients with COVID-19. Viruses 2021; 13(3):419.
• 22. Lino K, Guimarães GMC, Alves LS, et al. Serum ferritin at admission in hospitalized COVID-19 patients as a predictor of mortality. Braz J Infect Dis. 2021; 25(2):101569.
• 23. Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis 2020;71(15):762-768.
• 24. Laguna-Goya R, Utrero-Rico A, Talayero P, et al. IL-6-based mortality risk model for hospitalized patients with COVID-19. J Allergy Clin Immunol 2020; 146:799-807.e9.
• 25. Önal U, Güçlü ÖA, Akalın et al. Prognostic factors for COVID-19 patients. J Infect Dev Ctries 2022; 16, 409-417.
• 26. Wagner J, DuPont A, Larson S, Cash B, Farooq A. Absolute lymphocyte count is a prognostic marker in COVID-19: A retrospective cohort review. Int J Lab Hematol 2020; 42:761-765.
• 27. Waris A, Din M, Khalid A, et al. Evaluation of hematological parameters as an indicator of disease severity in COVID-19 patients: Pakistan’s experience. J Clin Lab Anal 2021; 35: e23809.
• 28. Zhao Q, Meng M, Kumar R, et al. Lymphopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A systemic review and meta-analysis. Int J Infect Dis 2020; 96: 131-135.
• 29. Illg Z, Muller G, Mueller M, Nippert J, Allen B. Analysis of absolute lymphocyte count in patients with COVID-19. Am J Emerg Med 2021; 46:16-19.
• 30. Biolè C, Bianco M, Núñez-Gil IJ, et al. Gender Differences in the Presentation and Outcomes of Hospitalized Patients With COVID-19. J Hosp Med 2021; 16:349-352.