Assessment of Severity and Outcome of COVID-19 Cases by Haematological and Biochemical Markers at Tertiary Care Centre in India

Background: In December 2019, a cluster of pneumonia cases caused by a novel corona virus (2019-nCov), later named as severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) was detected in China. In India, 30th January 2020 first positive case ofSARS-CoV-2was reported from Kerala. The reverse transcriptase polymerase chain reaction (RT-PCR) is the standard method of choice for diagnosis of SARS-CoV-2 infection. Certain biomarker molecules that are being evaluated for assessment of severity and prognosis are; D-dimer, C reactive protein (CRP), lactate dehydrogenase (LDH), complete blood counts (CBC) and serum ferritin. The elevated levels of these biomarkers were associated with extent of inflammation.

Objective: This prospective study was designed to assess the severity and prognosis of pneumonia cases caused by SARS-CoV-2 using different haematological and biochemical biomarkers.

Materials and Methods: This study was conducted among 242 participants attending covid-19 facility of BRD Medical College Gorakhpur, after confirmation by RT-PCR. Different haematological and biochemical biomarkers were analyzed using 5 ml fasting venous blood samples and these were analysed in auto analysers using standard protocol as per manufacturer’s instructions. Finally result was analyzed using standard statistical calculation by %positivity, confidence interval, p values and ≤ 0.05 is considered as statistically significant.

Results: Among a total of 242 COVID-19 cases based on different haematological and biomarkers assessment; 92 were critically ill and 150 non-critically ill. The mean ±SD of various haematological parameters among critically ill cases were; haemoglobin (13.0±1.8),TLC (13846.13±3903.76),PLT (92213.48±61415.07),NLR(36.5±30.4).The mean ±SD of the biochemical parameters of critically ill participant was; CRP 44.7±35.4 (95%CI 25.06,2.93),D. dimer 2.9±2.6 (95%CI 1.69,0.10), serum ferritin 1204.7±750.7 (95%CI 581.8,60.1),LDH 397.2±180.8 (95% CI 133.01,0.0163). The level of different haematological and biochemical parameters was raised also in non-critically ill cases but at lower side. Out of these 242 cases; 106 (43.8%) were died and 136 (56.2%) survived but the mortality was high in critically ill cases.

Conclusion: Our findings show that level of D-dimer, LDH, CRP, NLR and serum ferritin,can be used to assess the severity and prognosis of COVID-19 cases. Among these biomarkers; D-dimer levels correlate more precisely with severity and can be considered as a reliable prognostic marker.