RELATION OF THREE-TIME POINT ESTIMATION OF INFLAMMATORY MARKERS WITH THE SEVERITY AND OUTCOME IN PATIENTS OF COVID-19 IN A TERTIARY CARE HOSPITAL OF PESHAWAR
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Abstract
Objective:
To assess the correlation of different time point estimations of inflammatory markers of Covid-19 with the severity and outcome of the disease.
Methodology:
This study was conducted from December 2021 to May 2022 in the covid-19 ward/ICU of Rehman Medical Institute, Peshawar. Total 116 adult subjects from both genders were included in study. Three-time point estimation of markers for the assessment of severity and outcome of disease was done. Patients were divided into deceased and recovered categories on outcome and into mild, moderate, severe, and critical categories on disease severity basis.
Results:
Three-time point estimation of markers on outcome basis showed that all the markers were significantly higher in deceased subjects as compared to recovered ones. Three-time point estimation according to disease severity revealed that all the markers were higher in critically ill as compared to mildly ill patients. Similarly, majority of the markers were higher in severe as compared to mild, and higher in critical as compared to moderate categories. On ROC curve analysis of markers on admission, only lactate dehydrogenase (LDH) had a good AUC. On multivariable logistic regression analysis after adjustment for covariates, old age, LDH, neutrophil-lymphocyte ratio (NLR), diabetes mellitus (DM) and ischemic heart disease (IHD) predicted the mortality.
Conclusion:
LDH, white blood cell (WBC) count, and NLR based on three-time point estimation correlated with morbidity and mortality. Old age, NLR, and LDH on admission, and comorbidities like DM and IHD were significantly associated with mortality.
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References
Sharifpour M, Rangaraju S, Liu M, Alabyad D, Nahab FB, Creel-Bulos CM, et al. On behalf of the Emory COVID-19 Quality & Clinical Research Collaborative. C-reactive protein as a prognostic indicator in hospitalized patients with COVID-19. PLoS One. 2020; 15(11):1-10. DOI:10.1371/Journal.Pone.0242400.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020; 395(10229):1054-62. DOI:10.1016/S0140-6736(20)30566-3.
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:10.1016/S0140-6736(20)30183-5.
Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: a retrospective study. BMJ. 2020; 368:1-12. DOI:10.1136/Bmj.M1091.
Hirano T, Murakami M. COVID- 19: a new virus, but a familiar receptor and cytokine release syndrome. Immuni. 2020; 52(5):731-33. DOI: 10.1016/j.immuni.2020.04.003.
McGonagle D, Sharif K, O'Regan A, Bridgewood C: The role of cytokines including interleukin-6 in COVID- 19 induced pneumonia and macrophage activation syndrome-like disease. Autoimmune Rev. 2020; 19(6):1-7. DOI: 10.1016/j.autrev.2020.102537.
Levi M, Thachil J, Iba T, Levy JH. Coagulation abnormalities and thrombosis in patients with COVID-19. Lancet Haematol. 2020; 7(6): e438-40. DOI:10.1016/S2352-3026(20)30145-9.
Rosário C, Zandman-Goddard G, Meyron-Holtz EG, D'Cruz DP, Shoenfeld Y: The hyperferritinemic syndrome: macrophage activation syndrome, still's disease, septic shock and catastrophic antiphospholipid syndrome. BMC Med. 2013;11:1-11. DOI: 10.1186/1741-7015-11-185.
Torti FM, Torti SV. Regulation of ferritin genes and protein. Blood. 2002; 99(10):3505-16. DOI: 10.1182/blood.V99.10.3505.
Assiri A, Al-Tawfiq JA, Al-Rabeeah AA, Al-Rabiah FA, Al-Hajjar S, Al-Barrak A, et al. Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study. Lancet Infect Dis. 2013; 13(9):752-61. DOI: 10.1016/S1473-3099(13)70204-4.
Sirikutt P, Kalayanarooj S. Serum lactate and lactate dehydrogenase as parameters for the prediction of dengue severity. J Med Assoc Thai. 2014; 97:220-31.
Klein R, Nagy O, Tóthová C, Chovanová F: Clinical and diagnostic significance of lactate dehydrogenase and its isoenzymes in animals. Vet Med Int. 2020; 2020:1-11. DOI: 10.1155/2020/5346483.
Anurag A, Jha PK, Kumar A. Differential white blood cell count in the COVID- 19: a cross-sectional study of 148 patients. Diabetes Metab Syndr. 2020; 14(6):2099-102. DOI: 10.1016/j.dsx.2020.10.029.
Zeng Z, Yu H, Chen H, Qi W, Chen L, Chen G, et al. Longitudinal changes of inflammatory parameters and their correlation with disease severity and outcomes in patients with COVID-19 from Wuhan, China. Crit Care. 2020; 24:1-12. DOI: 10.1186/s13054-020-03255-0.
Organization WH. Clinical management of COVID-19: interim guidance, World Health Organization, 2020. Available from URL: https://apps.who.int/iris/handle/10665/332196.
Osibogun A, Balogun M, Abayomi A, Idris J, Kuyinu Y, Kuyinu Y. Outcomes of COVID-19 patients with comorbidities in southwest Nigeria. PLoS One. 2021; 16(3):1-12. DOI: 10.1371/journal.pone.0248281.
Lau ES, McNeill JN, Paniagua SM, Liu EE. Sex differences in inflammatory markers in patients hospitalized with COVID-19 infection: insights from the MGH COVID-19 patient registry. PLoS One. 2021;16(4):1-9. DOI: 10.1371/journal.pone.0250774.
Maddani SS, Gupta N, Umakanth S, Joylin S, Saravu K. Neutrophil-lymphocyte ratio in patients with covid- 19 as a simple tool to predict requirement of admission to a critical care unit. Indian J Crit Care Med. 2021; 25(5):535-39. DOI: 10.5005/jp-journals-10071-23801.
Asghar MS, Haider Kazmi SJ, Khan NA, Akram M, Hassan M et al. Poor prognostic biochemical markers predicting fatalities caused by COVID-19: a retrospective observational study from a developing country. Cureus. 2020;12(8):1-12. DOI:10.7759/cureus.9575.
Jusufovic V, Umihanic S, Alibegovic E, Piljic D, Mujkanovic A, Bijedic A, et al. Ferritin and LDH as predictors of mortality in COVID-19 infection, Bosnia and Herzegovina single-center study. Res Sq. 2021; 1-11. DOI: 10.21203/rs.3.rs-143696/v1.
Rastad H, Karim H, Ejtahed HS, Tajbakhsh R, Noorisepehr M, Babaei M, et al. Risk and predictors of in-hospital mortality from COVID-19 in patients with diabetes and cardiovascular disease. Diabetol Metab Syndr. 2020; 12:1-11. DOI: 10.1186/s13098-020-00565-9.
Kong KA, Jung S, Yu M, Park J, Kang IS. Association between cardiovascular risk factors and the severity of coronavirus disease 2019: nationwide epidemiological study in Korea. Front Cardiovasc Med. 2021; 8:1-10. DOI: 10.3389/fcvm.2021.732518.
Gu T, Chu Q, Yu Z, Fa B, Li A, Xu L, et al. History of coronary heart disease increased the mortality rate of patients with COVID-19: a nested case-control study. BMJ Open. 2020; 10(9):1-8. DOI: 10.1136/bmjopen-2020-038976.