CRP and LDH Levels Can Be Used for Support the COVID-19 Diagnose in Intensive Care Unit Patients

Öz

Aim: The coronavirus disease (COVID-19) has been a public health problem that causes severe acute respiratory syndrome affected all over the word since 2019. The most commonly used parameters as inflammatory response in the clinic are leukocytes, neutrophils, erythrocyte amount and serum C-reactive protein (CRP). In recent years, it has been reported that serum PCT (procalcitonin) level may be useful in the diagnosis of bacterial and viral infections. The aim of our study is to compare blood parameters that may play a supportive role to diagnose of COVID-19 in healthy control and critically COVID-19 patient groups.
Material and Methods: This retrospective research was carried out in Malatya Turgut Ozal University Training and Research Hospital, Malatya, Türkiye. Total 88 critically ill patients and 90 healthy people accepted to the study and electronic medical records of patients and control group has been collected from hospital information system (HIS). COVID-19 diagnose has been confirmed by real-time polymerase chain reaction (RT-PCR) results.
Results: No statistically significant difference was found between the patient and control groups according to gender in the participants included in the study. A statistically significant increase was observed in CRP, LDH, PCT, D-dimer, urea, sediment, lympocyte and neutrophil levels in COVID-19 patients. According to logistic regression analysis CRP, LDH and sediment values were found to be statistically effective in estimating the COVID-19 infection. These results also supported by ROC analysis, CRP, neutrophil, LDH, PCT and D-dimer results were determined to be distinguishing parameters for COVID-19 patients.
Conclusion: We found that CRP, PCT and LDH levels higher in the COVID-19 patients and these parameters can be used to diagnose and estimate the prognose of COVID-19 infection in intensive care patients.

Anahtar Kelimeler

• COVID-19
• CRP
• LDH
• İntensive care

Kaynakça

1. 1. Otlu Ö, Erdem M, Korkmaz K, et al. Effect of altered iron metabolism on hyperinflammation and coagulopathy in patients with critical COVID-19: A Retrospective Study. Int J Acad Med Pharm. 2022;4:60-4.
2. 2. Chorba T. The Concept of the Crown and Its Potential Role in the Downfall of Coronavirus. Emerging Infectious Diseases, 2022;26:2302.
3. 3. European Centre for Disease Prevention and Control. Rapid Risk Assessment: Outbreak of acute respiratory syndrome associated with a novel coronavirus, Wuhan, China; first update – 22 January 2020. ECDC: Stockholm; 2020.
4. 4. Coronavirus disease (COVID-19). https://www.who.int/health-topics/coronavirus#tab=tab_1 access date 13.09.2022
5. 5. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmunity, 2020;109:102433.
6. 6. Batırel A. Specific treatment of COVID-19. Southern Clinics of Istanbul Eurasia. 2020;31(Suppl):31-41.
7. 7. Carriazo S, Kanbay M, Ortiz A. Kidney disease and electrolytes in COVID-19: more than meets the eye. Clin Kidney J. 2020 Jul 16;13:274-80.
8. 8. Bozkurt İ, Keleş GT. Laboratory Tests Used in the Diagnosis and Treatment of COVID-19 Disease. CBU-SBED. 2021;8: 380-7.

9. 9. Doruk ÖG, Örmen M, Tuncel P. Bıochemıcal And Hematologıcal Parameters In Covıd-19, Deu Tıp Derg. 2021;35:71-80.
10. 10. Alpar R. Kuramsal Dağılımlar. In: Spor Sağlık ve Eğitim Bilimlerinden Örneklerle Uygulamalı İstatistik ve Geçerlik-Güvenilirlik. 6. Baskı. Detay Yayıncılık, Ankara, 2020;165-218.
11. 11. Dirican A. Evaluation of the diagnostic test’s performance and their comparisons. Cerrahpaşa J Med. 2001;32:25-30.
12. 12. Ertuğrul Ö, Ertuğrul MB. Prokalsitonin ve Enfeksiyon, Klimik Dergisi. 2005;18:59-62.
13. 13. Sitter T, Schmidt M, Schneider S, Schiffl H. Differential diagnosis of bacterial infection and inflammatory response in kidney diseases using procalcitonin. J of Nephrol 2001;15:297-301.
14. 14. Gianotti L, D’Agnano S, Pettiti G, et al. Persistence of elevated procalcitonin in a patient with coronavirus disease 2019 uncovered a diagnosis of medullary thyroid carcinoma. AACE Clinical Case Rep. 2021;7:288-92.
15. 15. Meier-Ewert HK, Ridker PM, Rifai N, et al. Absence of diurnal variation of C-reactive protein concentrations in healthy human subjects. Clin Chem. 2001;47:426-30.
16. 16. Hutchinson WL, Koenig W, Frohlich M. Immunoradiometric assay of circulating C-reactive protein: Age-related values in the adult general population. Clin Chem. 2000;46:934-8.
17. 17. Dubey DB, Mishra S, Reddy HD, et al. Hematological and serum biochemistry parameters as a prognostic indicator of severally ill versus mild Covid-19 patients: A study from tertiary hospital in North India. Clin Epidemiol Glob Health. 2021;12:100806.
18. 18. Stenvinkel P, Chung SH, Heimbürger O, Lindholm B. Malnutrition, inflammation, anda therosclerosis in peritoneal dialysis patients. Perit Dial Int. 2001;21:157–62.
19. 19. Alba-Patiño A, Vaquer A, Barón E, et al. Micro-and nanosensors for detecting blood pathogens and biomarkers at different points of sepsis care. Microchimica Acta. 2022; 189:1-26.
20. 20. Doğan Ö, Devrim E. Tanı ve İzlemde Laboratuvar Testleri. In: COVID-19. Ankara Üniversitesi Basımevi, Ankara, 2020;29-33.
21. 21. Liu J, Han P, Wu J, et al. Prevalence and predictive value of hypocalcemia in severe COVID-19 patients, J Infect Public Health. 2020;13:1224–8.
22. 22. Schutte T., Thijs A., Smulders Y.M. Never ignore extremely elevated D-dimer levels: they are specific for serious illness. Neth J Med. 2016;74:443-8.
23. 23. Şit D, Kayabaşı H. Acute kidney injury associated with SARS-CoV-2 Dicle Med J. 2020;47:498-507. 24. Li Z, Wu M, Yao J, et al. Caution on kidney dysfunctions of COVID-19 patients. MedRxiv. 2020;27.
24. 25. Lotfi B, Farshid S, Dadashzadeh N, et al. Is Coronavirus Disease 2019 (COVID-19) Associated with Renal Involvement? A Review of Century Infection, Jundishapur J Microbiol. 2020;13:e102899.
25. 26. Mohamed MM, Lukitsch I, Torres-Ortiz AE, et al. Acute kidney injury associated with coronavirus disease 2019 in urban New Orleans. Kidney360. 2020;1:614-22.
26. 27. Nahkuri S, Becker T, Schueller V, et al. Prior fluidand electrolyte imbalance is associated with COVID-19 mortality. Commun Med. 2021;1:51.
27. 28. Lippi G, South AM, Henry BM. Electrolyte Imbalances in Patients with Severe Coronavirus Disease 2019 (COVID-19). Ann Clin Biochem. 2020;57:262–5.
28. 29. Filippo L, Doga M, Frara S, Giustina A. Hypocalcemia in COVID 19: Prevalence, clinical significance and therapeutic implications. Rev Endocr Metab Disord. 2022;23:299–308.
29. 30. Carrick JB, Begg AP. Peripheral blood leukocytes. Veterinary Clinics of North America: Equine Practice. 2008;24:239-59.
30. 31. Witko-Sarsat V, Rieu P, Descamps-Latscha B, et al. Neutrophils: molecules, functions and pathophysiological aspects. Lab Invest. 2000;80:617-53.
31. 32. Flad HD, Brandt E. Platelet-derived chemokines: Pathophysiology and therapeutic aspects. Cell Mol Life Sci. 2010;67:2363-86.
32. 33. Tan L, Wang Q, Zhang D, et al. Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Signal Transduct Target Ther. 2020;5:33.