Evaluation of biochemical parameters ın COVID-19 patients in early stage

Öz

Purpose: COVID-19 is the result of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus infection, which was first isolated and identified in a patient in Wuhan. Although viral pathogenesis is not yet fully known, viral infection is thought to be cytopathic to airway epithelial cells and alveolar cells. In addition, similar to SARS-COV, immune-mediated damage is thought to play a critical role in the pathogenesis of COVID-19. In most patients, the disease progresses with mild to moderate symptoms. The most common findings; symptoms of upper respiratory tract infection including fever, dry cough, malaise, headache, sore throat and myalgia. 20% of the patients show signs of severe lung damage. In the diagnosis of COVID-19, Polymerase Chain Reaction (PCR), serological examination, imaging methods and routine laboratory tests are used. It is thought that determination of laboratory parameters for the diagnosis of COVID-19 will help in the diagnosis, early isolation and early treatment of suspicious cases. Therefore, it was aimed to evaluate complete blood count and biochemical parameters in patient and healthy control groups. Materials and Methods: Fifty patients who applied to the COVID-19 outpatient clinic with early-stage complaints and had a positive PCR test and 50 healthy individuals were included in the study. Biochemical parameters were evaluated retrospectively. 17th edition of SPSS Statistics (IBM Corporation, Somers, NY) software was used for the statistical analysis. Results: A significant difference was found between the patient and control groups in terms of lymphocyte count, monocyte count and CRP parameters. While the lymphocyte count was lower in the patient group, the monocyte count and CRP levels were found to be higher. Conclusion: In line with the data we have obtained; It is considered that especially lymphocyte and monocyte count, CRP values can provide support in terms of diagnosis and follow-up of patients presenting with mild symptoms.

Anahtar Kelimeler

• COVID-19
• Lymphocyte
• Monocyte
• CRP
• Biochemical parameter
• Laboratory
• RT-PCR

Erken evre COVİD-19 hastalarında biyokimyasal parametrelerin değerlendirilmesi

Öz

Amaç: COVİD- 19 ilk kez Wuhan’da bir hastada izole edilen ve tanımlanan Şiddetli Akut Solunum Sendromu Coronavirus 2 (SARS-CoV-2) virüs enfeksiyonun sonucudur. Viral patogenez henüz tam olarak bilinmiyor olmakla birlikte, viral enfeksiyonun hava yolu epitel hücrelerine ve alveoler hücrelere sitopatik olduğu düşünülmektedir. Ayrıca SARS-COV’a benzer şekilde immün aracılı hasar da COVİD- 19’un patogenezinde kritik rol oynadığı düşünülmektedir. Çoğu hastada hastalık hafif–orta düzeyde semptomlarla seyreder. En sık bulgular; ateş, kuru öksürük, kırgınlık, baş ağrısı, boğaz ağrısı ve miyaljiyi içeren üst solunum yolu enfeksiyonu bulgularıdır. Hastaların %20’si ağır akciğer hasarı bulguları gösterir. COVİD- 19’da tanıda Polimeraz Zincir Reaksiyonu (PCR), serolojik inceleme, görüntüleme metodları ve rutin laboratuvar tetkikleri kullanılır. COVİD-19 tanısına yönelik laboratuvar parametrelerinin belirlenmesinin şüpheli vakaların tanınması, erken izolasyonu ve erken tedavisine yardımcı olacağı düşünülmektedir. Bu nedenle, hasta ve sağlıklı kontrol gruplarında tam kan sayımı ve biyokimyasal parametreler değerlendirilmesi amaçlandı. Materyal ve Metot: Çalışmaya COVİD-19 polikliniğine erken evre şikayetlerle başvuran, PCR testi pozitif olan 50 hasta ve 50 sağlıklı birey dahil edildi. Biyokimyasal parametreler retrospektif olarak değerlendirildi. İstatistik analiz; SPSS Statistics (IBM Corporation, Somers, NY) yazılımının 17. sürülümü ile yapıldı. Bulgular: Lenfosit sayısı, monosit sayısı ve CRP parametreleri açısından hasta ve kontrol grubu arasında anlamlı farklılık bulundu. Lenfosit sayısı hasta grubunda daha düşük seyrederken, monosit sayısı ve CRP düzeylerinin daha yüksek olduğu belirlendi. Sonuç: Elde ettiğimiz veriler doğrultusunda; hafif semptomlarla başvuran hastalarda özellikle lenfosit ve monosit sayısı, CRP değerlerinin tanı ve hastaların takibi açısından destek sağlayabileceği değerlendirilmektedir.

Anahtar Kelimeler

• COVİD-19
• Lenfosit
• Monosit
• CRP
• Biyokimyasal parametre
• Laboratuvar
• RT-PCR

Kaynakça

1. 1. 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; 382:727-33. doi: 10.1056/NEJMoa2001017
2. 2. Shi Y, Wang G, Cai X, Deng J, Zheng L, Zhu H et al. An overview of COVID-19. J Zhejiang Univ Sci B. 2020;21(5):343-60. doi: 10.1631/jzus.B2000083
3. 3. King AM, Lefkowitz E, Adams MJ, & Carstens, E. B. (Eds.). Virus taxonomy: ninth report of the International Committee on Taxonomy of Viruses (Vol. 9). Elsevier. 2011.
4. 4. Zhou P, Yang XL, Wang XG,Hu B, Zhang L,Zhang W et al. Discovery of a novel coronavirus associated with the recent pneumonia outbreak in humans and its potential bat origin. BioRxiv. 2020. doi: 10.1038/s41586-020-2012-7
5. 5. Chan JFW, Kok KH, Zhu Z,Chu H,To KKW, Yuan S et al. Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan. Emerg Microbes Infect. 2020;28;9(1):221-36. doi:10.1080/22221751.2020.1719902
6. 6. Razzaque MS, Taguchi T. Pulmonary fibrosis: cellular and molecular events. Pathol Int. 2003;53(3):133-45. doi: 10.1046/j.1440-1827.2003.01446.x
7. 7. Li CKF, Xu XN. Host immune responses to SARS coronavirus in humans. In Molecular Biology of the SARS-Coronavirus (Ed Lal SK) Springer, Berlin, Heidelberg, 2010 p. 259-78. doi: 10.1007/978-3-642-03683-5_16
8. 8. Xu Z, Shi L, Wang YJ,Zhang j, Huangl L,Zhang j et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8:420-2. doi: 10.1016/S2213-2600(20)30076-X.

9. 9. Frater JL, Zini G, d’Onofrio G, Rogers HJ. COVID-19 and the clinical hematology laboratory. Int J Lab Hematol. 2020;42(Suppl. 1):11–8. doi: 10.1111/ijlh.13229
10. 10. 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(10223):497-506. doi:https://doi.org/10.1016/S0140-6736(20)30183-5
11. 11. Fan BE, Chong VCL, Chan SSW, Lim GH, Lim KGE,Tab GB et al. Hematologic parameters in patients with COVID-19 infection. Am J Hematol. 2020;95(6):E131-4. doi: 10.1002/ajh.25774.
12. 12. Ghweil A,Hassan MH, Khodeary A, Mohamed AO, Mohammed HG, Abdelazez AA et al. Characteristics, Outcomes and Indicators of Severity for COVID-19 Among Sample of ESNA Quarantine Hospital’s Patients, Egypt: A Retrospective Study. Infection and Drug Resistance. 2020;13:2375–83. doi: 10.2147/IDR.S263489
13. 13. Ciaccio M, Agnello L. Biochemical biomarkers alterations in Coronavirus Disease 2019 (COVID-19). Diagnosis. 2020; 7(4): 365–72. doi: 10.1515/dx-2020-0057.
14. 14. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43. doi: 10.1001/jamainternmed.2020.0994.
15. 15. Deng Y, Liu W, Liu K, Yuan FY, Jin S, Ling Zet al. Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 (COVID-19) in Wuhan, China: a retrospective study. Chin Med J (Engl). 133-11;1261-1267. doi: 10.1097/CM9.0000000000000824.
16. 16. Liu Y, Du X, Chen J, Jin Y, Peng L, Wang HHX, et al. Neutrophil-tolymphocyte ratio as an independent risk factor for mortality in hospitalized patients with COVID-19. J Infect. 2020;81(1):e6-12. Doi: 10.1016/j.jinf.2020.04.002.
17. 17. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382:1708-20. doi: 10.1056/NEJMoa2002032
18. 18. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta. 2020;506:145-8. doi:10.1016/j.cca.2020.03.022
19. 19. Lippi G, Plebani M. The critical role of laboratory medicine during coronavirus disease 2019 (COVID19) and other viral outbreaks. Clin Chem Lab Med. 2020; 58(7): 1063–9. doi: 10.1515/cclm-2020-0240.
20. 20. Eickmann M, Gravemann U, Handke W, Tolksdorf F, Reichenberg S, Müller TH, et al. Inactivation of three emerging viruses – severe acute respiratory syndrome coronavirus, Crimean-Congo haemorrhagic fever virus and Nipah virus – in platelet concentrates by ultraviolet C light and in plasma by methylene blue plus visible light. Vox Sang. 2020;115:146–51. doi: 10.1111/vox.12888.
21. 21. Pilaczyńska-Cemel M, Gołda R, Dąbrowska A, Przybylski G. Analysis of the level of selected parameters of inflammation, circulating immune complexes, and related indicators (neutrophil/lymphocyte, platelet/lymphocyte, CRP/CIC) in patients with obstructive diseases. Cent Eur J Immunol. 2019;44: 292–8. doi: 10.5114/ceji.2019.87498.
22. 22. Qin S, Jiang Y, Wei X, Liu X, Guan J, Chen Y et al. Dynamic changes in monocytes subsets in COVID-19 patients. Hum immunol 2021; 82(3):170-6. doi: 10.1016/j.humimm.2020.12.010
23. 23. Lippi G, Plebani M. Laboratory abnormalities in patients with COVID-2019 infection. Clin Chem Lab Med. 2020; 58(7): 1131–1134. doi: 10.1515/cclm-2020-0198.
24. 24. Tan C, Huang Y, Shi F, Tan K, MaQ, Chen Y, et al. C-reactive protein correlates with CT findings and predicts severe COVID-19 early. J Med Virol. 2020; 1-7. doi: 10.1002/jmv.25871.
25. 25. Deng X, Liu B, Li J, Zhang J, Zhao Y, Xu K et al. Blood biochemical characteristics of patients with coronavirus disease 2019 (COVID-19): a systemic review and meta-analysis. Clin Chem Lab Med. 2020; 58(8): 1172–81. doi: 10.1515/cclm-2020-0338.