EVALUATION OF THE PROGNOSTIC ROLE AND CLINICAL RELEVANCE OF LABORATORY BIOMARKERS IN HOSPITALIZED PATIENTS WITH COVID-19
Keywords:
COVID-19, serum ferritin, C-reactive protein, lactate dehydrogenaseAbstract
Coronavirus disease-2019 (COVID-19), which started from Wuhan, China, very quickly became
pandemic and spread all over the world. It is a new infection that has been declared a global public health
emergency by the World Health Organization. The initial clinical characteristics of COVID-19 are non-specific, and
the clinical spectrum varies widely from asymptomatic, mild influenza-like symptoms and pneumonia to acute respiratory
distress syndrome, multi-organ failure and even death. It is still not well understood why some individuals
become critically ill, while others do not. Scientists face challenges related to the management, prognosis and
treatment of the infection and try to identify laboratory predictors for progression towards severe and fatal forms of
this disease. Laboratory parameter abnormalities are commonly observed in COVID-19 patients; however, their
clinical significance remains controversial. We assessed the prevalence, characteristics, and clinical impact of some
laboratory parameters in hospitalized COVID-19 patients and looked for their possible association with systemic
inflammation and disease severity. We evaluated on admission hematologic (hemoglobin, white blood cell count,
neutrophils%, lymphocytes%, and platelet count), coagulation (prothrombin time, activated partial thromboplastin
time, fibrinogen and D-dimers), biochemical (albumin, total protein, aspartate aminotransferase, alanine
aminotransferase, lactate dehydrogenase, creatinine, and electrolytes), inflammatory (C-reactive protein, ESR,
ferritin, procalcitonin and serum amyloid A), cardiac (creatinine kinase MB isoenzyme and troponin I) parameters.
The most common laboratory findings in patients with COVID-19 are significantly increased leukocyte count,
neutrophilia, and lymphocytopenia in peripheral blood. There is evidence that the neutrophil/lymphocyte ratio
(NLR) is significantly elevated in patients with more severe infection and death. Coagulation parameters are also
elevated and reported more frequently in older (≥65 years) compared to young and middle-aged patients with
COVID-19. Inflammatory markers such as C-reactive protein, ESR, ferritin, procalcitonin and serum amyloid A are
elevated in most patients. A study of patients with COVID-19-induced acute respiratory distress syndrome found
that elevations in serum ferritin, lactate dehydrogenase, and procalcitonin could be a sign of potential adverse
progression. Hypoalbuminemia and hypoproteinemia are significant indicators of COVID-19 severity. Patients with
both hypoalbuminemia and lymphopenia have a higher risk of severe COVID-19. Laboratory parameter
abnormalities on admission are significantly associated with clinical progression, can serve as independent
predictors of COVID-19 severity and could be useful markers of risk scarification considered in combination with
clinical details and other laboratory tests while designing the patient treatment.
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