Main Article Content
Since December 2019 mankind is agonized over the deadly coronavirus disease 2019 (COVID-19) which is due to the novel coronavirus (2019-nCoV) or Severe Acute Respiratory Syndrome Coronavirus-2 (Sars-cov-2).
Methods: In this retrospective study, laboratory findings and demographic features form all confirmed COVID-19 patients who attended the Emergency Department of both branches of our hospital during the first semester of 2021 were collected and analyzed. The working hypothesis was that initial laboratory data at the time the patients seeked medical assistant for the first time, regardless of comorbidities and day of onset of symptoms, can help predict patients’ outcome. Demographic data and laboratory tests were compared between hospitalized and non-hospitalized patients.
Results: Data of 270 patients were collected and analyzed retrospectively. 31 blood measurement parameters performed in both hospital branches were compared between hospitalized and non-hospitalized patients. Of those, WBC count (p=0.016), neutrophil percentage (p<0.001), lymphocyte percentage (p<0.001), platelet count (p=0.041), glucose (p<0.001), urea (p<0.001), creatinine (p<0.001), SGOT (p=0.024), CK (p<0.053), LDH (p<0.001), GGT (p<0.001), sodium (p<0.001), calcium (p<0.001), high sensitivity Troponin I (p<0.001), and ferritin levels (p<0.001), proved statistically significant. Regarding demographic data, age was significantly linked to patients’ survival.
Conclusion: Our data suggest that common initial laboratory findings of COVID-19 patients who seek for the first-time medical assistant regardless of comorbidities and time from onset of symptoms can give clues to the patient outcome. Age is also important for patients’ survival. Especially in a Primary Health Care Setting, common blood parameters like WBC count, neutrophil and lymphocyte percentage, platelet count, glucose, urea, creatinine, SGOT, CK, LDH, GGT, sodium, calcium, high sensitivity Troponin I, and ferritin levels, could be really helpful to predict disease severity.
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
2. COVID-19 pandemic - Greece - A3M Global Monitoring. Available from: https://global-monitoring.com/gm/page/events/epidemic-0001942.ugWbZWZFtsIc.html?lang=en. Last accessed February 3rd, 2022.
3. European Centre for Disease Prevention and Control. Available from: https://vaccinetracker.ecdc.europa.eu/public/extensions/COVID-19/vaccine-tracker.html#uptake-tab. Last accessed February 3rd, 2022.
4. da Rosa Mesquita R, Francelino Silva Junior LC, Santos Santana FM, Farias de Oliveira T, Campos Alcântara R, Monteiro Arnozo G, Rodrigues da Silva Filho E, Galdino Dos Santos AG, Oliveira da Cunha EJ, Salgueiro de Aquino SH, Freire de Souza CD. Clinical manifestations of COVID-19 in the general population: systematic review. Wien Klin Wochenschr. 2021;133(7-8):377-382. doi: 10.1007/s00508-020-01760-4.
5. Basics of COVID-19. Centers for Disease Control and Prevention. Available from: https://www.cdc.gov/coronavirus/2019-ncov/your-health/about-covid-19/basics-covid-19.html. Last assessed January 24, 2022
6. Zhang Y, Zheng L, Liu L, Zhao M, Xiao J, Zhao Q. Liver impairment in COVID-19 patients: A retrospective analysis of 115 cases from a single center in Wuhan city, China. Liver Int. 2020;40(9):2095-2103. doi: 10.1111/liv.14455.
7. Grygiel-Górniak B, Oduah MT. COVID-19: What Should the General Practitioner Know? Clin Interv Aging.2021;16:43-56 https://doi.org/10.2147/CIA.S268607.
8. 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;395:497–506. https://doi.org/10.1016/S0140-6736(20)30183-5.
9. 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;323:1061–1069, https://doi.org/10.1001/jama.2020.1585.
10. SARS-CoV-2 Variant Classifications and Definitions – CDC. Available from: https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-classifications.html. Last access, January 9, 2022.
11. Chen X, Yang Y, Huang M, Liu L, Zhang X, Xu J, Geng S, Han B, Xiao J, Wan Y. Differences between COVID-19 and suspected then confirmed SARS-CoV-2-negative pneumonia: A retrospective study from a single center. J Med Virol. 2020;92(9):1572-1579. doi: 10.1002/jmv.25810. Epub 2020 Jun 12. PMID: 32237148.
12. Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395(10223):507-13. https://doi.org/10.1016/S0140- 6736(20)30211-7.
13. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Mansonet JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020;395(10229):1033-4. https://doi.org/10.1016/ S0140-6736(20)30628-0.
14. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, Xie C, Ma K, Shang K, Wang W, Tian DS. Dysregulation of Immune Response in Patients with Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020;71(15):762-768. doi: 10.1093/cid/ciaa248. PMID: 32161940; PMCID: PMC7108125.
15. Al-Nimer MS, Merza TA, Mohammed YMY, Mohammed A. Blood Cells Indices are Determinants of the COVID-19 Outcome: A Cross-Sectional Study from Kurdistan Region-Iraq. Electron J Gen Med. 2021;18(5):em304. https://doi.org/10.29333/ejgm/11013
16. Zhu B, Feng X, Jiang C, Mi S, Yang L, Zhao Z, Zhang Y, Zhang L. Correlation between white blood cell count at admission and mortality in COVID-19 patients: a retrospective study. BMC Infect Dis. 2021 Jun 14;21(1):574. doi: 10.1186/s12879-021-06277-3. PMID: 34126954; PMCID: PMC8202964.
17. Wong LR, Perlman S. Immune dysregulation and immunopathology induced by SARS-CoV-2 and related coronaviruses - are we our own worst enemy? Nat Rev Immunol. 2022;22(1):47-56. doi: 10.1038/s41577-021-00656-2.
18. Zhou Y, Fu B, Zheng X, et al. Pathogenic T-cells and inflammatory monocytes incite inflammatory storms in severe COVID-19 patients. Natl Sci Rev. 2020;7(6):998-1002. doi:10.1093/nsr/nwaa041.
19. 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. doi:10.1016/j.ijid.2020.04.086
20. Merad M, Martin JC. Pathological inflammation in patients with COVID-19: a key role for monocytes and macrophages. Nat Rev Immunol. 2020;20(6):355-362. https://doi.org/ 10.1038/s41577-020-0331-4.
21. Loperena R, Van Beusecum JP, Itani HA, et al. Hypertension and increased endothelial mechanical stretch promote monocyte differentiation and activation: roles of STAT3, interleukin 6 and hydrogen peroxide. Cardiovasc Res 2018;114(11): 1547-63. https://doi.org/10.1093/cvr/cvy112
22. Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020 Jun 25;58(7):1021-1028. doi: 10.1515/cclm-2020-0369.
23. Qu R, Ling Y, Zhang YH, et al. Platelet-to-lymphocyte ratio is associated with prognosis in patients with coronavirus disease-19. J Med Virol. 2020;92(9):1533-41. https://doi.org /10.1002/jmv.25767.
24. Layla KN, Yeasmin S, Azad AB, Chowdhury MU, Sultana N, Muhammad Shazedur Rahman AFS, Rahman MM, Rafa RL. Red blood cell profile in patients with mild, moderate and severe COVID-19. IMC J Med Sci [Internet]. 2021 Aug. 25 [cited 2022 Feb. 4];15(2):26-31. Available from: https://www.banglajol.info/index.php/IMCJMS/article/view/55811
25. Yuan X, Huang W, Ye B, Chen C, Huang R, Wu F, et al. Changes of hematological and immunological parameters in COVID-19 patients. Intern J Hematol. 2020; 112(4): 553-559.
26. Wang C, Deng R, Gou L, Fu Z, Zhang X, Shao F, et al. Preliminary study to identify severe from moderate cases of COVID-19 using combined hematology parameters. Ann Transl Med. 2020; 8(9): 593.
27. Taneri PE, Gómez-Ochoa SA, Llanaj E, Raguindin PF, Rojas LZ, Roa-Díaz ZM, et al. Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis. Eur J Epidemiol. 2020; 35(8): 763-773.
28. Angileri F, Légaré S, Marino Gammazza A, Conway de Macario E, Macario AJ, Cappello F. Is molecular mimicry the culprit in the autoimmune haemolytic anaemia affecting patients with COVID‐19? Br J Haematol. 2020; 190(2): 92-93.
29. Wynants L, Van Calster B, Collins G S, Riley R D, Heinze G, Schuit E et al. Prediction models for diagnosis and prognosis of covid-19: systematic review and critical appraisal. BMJ 2020; 369:m1328 doi:10.1136/bmj.m1328
30. Komaru Y, Doi K. Does a slight change in serum creatinine matter in coronavirus disease 2019 (COVID-19) patients? Kidney Res Clin Pract. 2021;40(2):177-179. doi: 10.23876/j.krcp.21.108.
31. Post A, Dullaart RPF, Bakker SJL. Sodium status and kidney involvement during COVID-19 infection. Virus Res. 2020; 286:198034. doi: 10.1016/j.virusres.2020.198034.
32. Aziz M, Fatima R, Lee-Smith W, Assaly R. The association of low serum albumin level with severe COVID-19: a systematic review and meta-analysis. Crit Care. 2020;24(1):255. doi: 10.1186/s13054-020-02995-3.
33. Akbar MR, Pranata R, Wibowo A, Lim MA, Sihite TA, Martha JW. The prognostic value of elevated creatine kinase to predict poor outcome in patients with COVID-19 - A systematic review and meta-analysis. Diabetes Metab Syndr. 2021;15(2):529-534. doi:10.1016/j.dsx.2021.02.012.
34. De Rosa A, Verrengia EP, Merlo I, et al. Muscle manifestations and CK levels in COVID infection: results of a large cohort of patients inside a Pandemic COVID-19 Area. Acta Myol. 2021;40(1):1-7. Published 2021 Mar 31. doi:10.36185/2532-1900-040.
35. Al Abbasi B, Torres P, Ramos-Tuarez F, Dewaswala N, Abdallah A, Chen K, et al. Cardiac Troponin-I and COVID-19: A Prognostic Tool for In-Hospital Mortality. Cardiol Res. 2020 Dec;11(6):398-404. doi: 10.14740/cr1159.
36. Dimopoulos G, Sakelliou A, Flevari A, Tzannis K, Giamarellos - Bourboulis J. Ferritin levels in critically ill patients with COVID-19: A marker of outcome? Pneumon. 2021;34(2):5. doi:10.18332/pne/135958.
37. M Hussein A, Taha ZB, Gailan Malek A, Akram Rasul K, Hazim Kasim D, Jalal Ahmed R, Badraden Mohamed U. D-Dimer and Serum ferritin as an Independent Risk Factor for Severity in COVID-19 Patients. Mater Today Proc. 2021 Apr 13. doi: 10.1016/j.matpr.2021.04.009.
38. Hu W, Lv X, Li C, Xu Y, Qi Y, Zhang Z, Li M, Cai F, Liu D, Yue J, Ye M, Chen Q, Shi K. Disorders of sodium balance and its clinical implications in COVID-19 patients: a multicenter retrospective study. Intern Emerg Med. 2021 Jun;16(4):853-862. doi: 10.1007/s11739-020-02515-9.
39. Osman W, Al Fahdi F, Al Salmi I, Al Khalili H, Gokhale A, Khamis F. Serum Calcium and Vitamin D levels: Correlation with severity of COVID-19 in hospitalized patients in Royal Hospital, Oman. Int J Infect Dis. 2021; 107:153-163. doi: 10.1016/j.ijid.2021.04.050.
40. Zhou X, Chen D, Wang L, et al. Low serum calcium: a new, important indicator of COVID-19 patients from mild/moderate to severe/critical [published online ahead of print, 2020 Nov 30]. Biosci Rep. 2020;40(12):BSR20202690. doi:10.1042/BSR20202690.
41. Noori M, Nejadghaderi SA, Sullman MJM, Carson-Chahhoud K, Ardalan M, Kolahi AA, Safiri S. How SARS-CoV-2 might affect potassium balance via impairing epithelial sodium channels? Mol Biol Rep. 2021 Sep;48(9):6655-6661. doi: 10.1007/s11033-021-06642-0. Epub 2021 Aug 15. PMID: 34392451; PMCID: PMC8364628.
42. Bruns JB, Carattino MD, Sheng S, Maarouf AB, Weisz OA, Pilewski JM, Hughey RP, Kleyman TR. Epithelial Na+ channels are fully activated by furin- and prostasin-dependent release of an inhibitory peptide from the gamma-subunit. J Biol Chem. 2007 Mar 2;282(9):6153-60. doi: 10.1074/jbc.M610636200. Epub 2007 Jan 1. PMID: 17199078.
43. Centers for Disease Control and Prevention, available from: https://www.cdc.gov/nchs/covid19/mortality-overview.htm. Last accessed February 5th, 2022.
44. Faes C, Abrams S, Van Beckhoven D, et al. Time between Symptom Onset, Hospitalisation and Recovery or Death: Statistical Analysis of Belgian COVID-19 Patients. Int J Environ Res Public Health. 2020;17(20):7560. Published 2020 Oct 17. doi:10.3390/ijerph17207560.
45. Centers for Disease Control and Prevention. Available from: https://www.cdc.gov/coronavirus/2019-ncov/covid-data/investigations-discovery/hospitalization-death-by-age.html. Last accessed February 2nd, 2022.