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Can COVID-19 Clinic be Predicted by Biomarkers at First Admission to Hospital?

Year 2023, Volume: 20 Issue: 1, 163 - 169, 27.04.2023
https://doi.org/10.35440/hutfd.1202883

Abstract

Background: Various inflammatory biomarkers have been associated with increased risk of severe disease, termed “cytokine storm,” in COVID-19 patients. In this study, it was aimed to investigate whether there is signi-ficant difference in terms of inflammatory markers suchas lymphocyte count, CRP, sedimentation, ferritin, gender and age between the patients who recovered and died.
Materials and Methods: In our study, we used routine laboratory test results from patients in diagnosis and treatment process between 03.04.2020-31.12.2020. We investigated CRP, sedimentation, fibrinogen, ferritin, troponin-I, D-dimer and hemogram parameters retrospectively. We searched for statistical significance based on the parameters in the first admission blood.
Results: Which included 213 patients with positive PCR test, 83 died from COVID-19-related causes, while the others were discharged. Except for the platelet counts, we found a statistically significant difference in the others. These tests were higher in patients who died at the time of first presentation. The biomarkers with the best performance in predicting ROC curve survival were Troponin-I, CRP, Ferritin, Neutrophil, and D-dimer. There was a significant difference in favor of males in mortality rates by gender. When the patients are exami-ned, it can be said that mortality increases with age.
Conclusions: The COVID-19 pandemic has been a global disaster with high complication, mortality and more economic impact. In this process, cost-effective and appropriate indicators were needed to simplify the diag-nostic process and assess disease severity. Recent studies showed how biomarkers could change with COVID-19 severity. These results can be used as an aid in clinical practice to determine treatment, guide ICU admis-sion, and predict clinical course. Troponin-I, CRP, D-dimer, LDH and are interesting biomarkers that can be used for short-term risk stratification of patients admitted with COVID-19. More research on the prognostic value of biomarkers is needed to increase reliability and reproducibility.

References

  • 1. Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unk-nown etiology in Wuhan, China: The mystery and the miracle. J Med Virol 2020;92(4):401-2.
  • 2. Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Methods Mol Biol 2015;1282:1- 23
  • 3. Rothan HA, Byrareddy SN. The epidemiology and pathogene-sis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020;102433.
  • 4. Chen Y, Liu Q, Guo D. Emerging coronaviruses: genome struc-ture, replication, and pathogenesis. J Med Virol 2020;92:418-23.
  • 5. Rocklov J, Sjodin H, Wilder-Smith, A. COVID-19 outbreak on the Diamond Princess Cruise ship: estimating the epidemic potential and effectiveness of public health countermeasu-res. J Travel Med 2020 May 18;27(3)
  • 6. Jin Y, Yang H, Ji W, Wu W, Chen S, Zhang W, et al. Virology, epidemiology, pathogenesis, and control of COVID-19. Viru-ses 2020 Mar 27;12(4).
  • 7. Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angioten-sin-converting enzyme 2 (ACE2) as a SARS- CoV-2 receptor: molecular mechanisms and potential therapeutic target. In-tensive Care Med 2020;46:586- 90.
  • 8. Cao X. COVID‐19: immunopathology and its implications for therapy. Nat Rev Immunol. 2020; 20: 269‐ 270.
  • 9. Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P et al. Coronavirus infecti-ons and immune responses. J Med Vi-rol. 2020; 92(4): 424‐ 432.
  • 10. Chen, T, Wu D, Chen H, Yan W, Yang D, Chen G et al. Clinical characteristics of 113 deceased patients with coronavirus di-sease 2019: retrospective study. BMJ. 2020 Mar 26;368:m1091.
  • 11. Shi S, Qin M, Shen B, Cai Y, Lui T, Yang F et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan. JAMA cardiology, 5 (7), 802–810.
  • 12. Huang, I, Pranata R, Lim MA, Qehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Therapeutic ad-vances in respiratory disease, 14, 1753466620937175.
  • 13. Ponti, G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progres-sion. Critical reviews in clinical laboratory science, 2020 Sep;57(6):389-399.
  • 14. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Charac-teristics of 138 Hospitalized Patients With 2019 Novel Corona-virus-Infected Pneumonia in Wuhan, Chi-na. JAMA. 2020;323(11):1061–1069.
  • 15. Gao Y, Li T, Han M, Li X, Wu D, Xu Y et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol. 2020 Jul;92(7):791–796.
  • 16. Min CK, Cheon S, Ha NY, Sohn KM, Kim Y, Aigerim A et al. Comparative and kinetic analysis of viral shedding and immu-nological responses in MERS patients representing a broad spectrum of disease severity. Sci Rep. 2016. Article number: 25359.
  • 17. Yousif NG. Fibronectin promotes migration and invasion of ovarian cancer cells through up-regulation of FAK–PI 3 K/A kt pathway. Cell Biol Int. 2014 Jan;38(1):85–91.
  • 18. Ferrari D, Motta A, Strollo M, Banfi G, Locatelli M. Routine blood tests as a potential diagnostic tool for COVID-19. Clin Chem Lab Med. 2020 Jun 25;58(7):1095–1099.
  • 19. Pan F, Yang L, Li Y, Liang B, Li L, Ye T et al. Factors associated with death outcome in patients with severe coronavirus di-sease-19 (COVID-19): a case-control study. Int J Med Sci. 2020;17(9):1281–1292.
  • 20. Pan F, Yang L, Li Y, Liang B, Li L, Ye T et al. Factors associated with death outcome in patients with severe coronavirus di-sease-19 (COVID-19): a case-control study. Int J Med Sci 2020 May 18;17(9):1281-1292
  • 21. Li Q, Cao Y, Chen L, Wu D, Yu J, Wang H et al. Hematological features of persons with COVID-19. Leukemia 2020 Aug;34(8):2163-2172.
  • 22. Potempa, L.A, Rajab IM, Hart PC, Bordon J, Fernandez-Botran R. Insights into the use of C-reactive protein as a diagnostic index of disease severity in COVID-19 infections. American journal of tropical medicine and hygiene 2020 Aug;103(2):561-563.
  • 23. Wang G, Wu C, Zhang Q, Wu F, Yu B, Lv J et al. C-reactive protein level may predict the risk of COVID-19 aggrava-tion. Open forum infectious diseases, 2020 Apr 29;7(5):ofaa153.
  • 24. Tan C, Huang Y, Shi F, Tan K, Ma Q, Chen Y et al. C-reactive protein correlates with computed tomographic findings and predicts severe COVID-19 early. Journal of medical virology, 2020 Jul;92(7):856- 862.
  • 25. Poggiali E, Zaino D, İmmovilli P, Rovero L, Losi G, Dacrema A et al. Lactate dehydrogenase and C-reactive protein as predictors of respiratory failure in CoVID-19 patients. Clinica chimica acta, 2020 Oct;509:135-138.
  • 26. Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis. 2020 Jan- Dec;14:1753466620937175.
  • 27. Allwood BW, Koegelenberg CF, Ngah VD, SigwadhiLN, Irusen EM,Lalla U at al. Predicting COVID-19 outcomes from clinical and laboratory parameters in an intensive care facility during the second wave of the pandemic in South Africa. IJID Re-gion, Available online 1 April 2022
  • 28. Zhou F, Yu T, Du R, Fan G, Lui Y, Lui Z et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lan-cet. 2020;395(10229):1054–1062.
  • 29. Lin Z, Long F, Yang Y, Chen X, Xu L, Yang M. Serum ferritin as an independent risk factor for severity in COVID-19 patients. J Infect. 2020 Oct; 81(4): 647–679.

Hastaneye İlk Başvurudaki Biyobelirteçlerle COVID-19 Kliniği Tahmin Edilebilir mi?

Year 2023, Volume: 20 Issue: 1, 163 - 169, 27.04.2023
https://doi.org/10.35440/hutfd.1202883

Abstract

Amaç: COVID-19 hastalarında çeşitli enflamatuvar biyobelirteçlerin artmış seviyeleri bulunmuştur ve “sitokin fırtınası” olarak adlandırılan şiddetli hastalık riski ile ilişkilendirilmiştir. Bu çalışmada iyileşen ve ölen hastalar arasında lenfosit sayısı, CRP, sedimantasyon, ferritin gibi inflamatuar belirteçler ile cinsiyet ve yaş açısından anlamlı farklılık olup olmadığının araştırılması amaçlanmıştır.
Materyal ve metod: Çalışmamızda 03.04.2020-31.12.2020 tarihleri arasında hastalardan teşhis ve tedavi amaçlı istenen rutin laboratuvar sonuçlarını kullandık. Bunlardan CRP, sedimantasyon, fibrinojen, ferritin, troponin-I, D-dimer ve hemogram parametreleri geriye dönük olarak baktık. Başvuru sırasında ilk istenen kandaki paramet-reler temel alınarak istatiksel anlamlılık araştırdık.
Bulgular: COVID-19 PCR testi pozitif 213 hastanın olduğu retrospektif çalışmamızda; 83’ü COVID-19’a bağlı nedenlerden hayatını kaybederken, diğerleri iyileşerek taburcu oldu. Trombosit sayısı hariç diğerlerinde istatis-tiksel olarak anlamlı fark tespit ettik. Bu testler ölen hastalarda ilk başvuru anında daha yüksekti. ROC eğrisi sağkalımı tahminlemede; Troponin-I, CRP, Ferritin, Nötrofil ve D-dimer en iyi biyobelirteçlerdi. Cinsiyete göre ölüm oranlarında erkekler lehine anlamlı fark bulduk. Hastaların yaşları incelendiğinde yaşla birlikte mortalite-nin arttığı tespit ettik.
Sonuç: COVID-19 pandemisi, yüksek komplikasyon, ölüm oranı ve ekonomik etki ile küresel bir felaket oldu. Bu süreçte teşhisi hızlandırmak ve hastalık şiddetini değerlendirmek için düşük maliyetli, uygun göstergelere ihtiyaç duyuldu. Bugüne kadar yapılan çalışmalar, biyobelirteçlerin COVID-19 hastalık ciddiyetine göre nasıl değişebileceğine dair kanıtlar bulunduğunu göstermektedir. Bu sonuçlar, klinik uygulamada tedaviyi belirlemek, yoğun bakım ünitesine kabulü yönlendirmek ve kliniği tahmin edebilmek için yardımcı olarak kullanılabilir. Troponin-I, CRP, D-dimer, LDH ve COVID-19 ile kabul edilen hastaların kısa vadeli risk sınıflandırması için kullanı-labilecek biyobelirteçlerdir. Güvenilirliği ve tekrarlanabilirliği artırmak için bunların prognoza etkileri üzerine daha fazla araştırma yapılmalıdır.

References

  • 1. Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unk-nown etiology in Wuhan, China: The mystery and the miracle. J Med Virol 2020;92(4):401-2.
  • 2. Fehr AR, Perlman S. Coronaviruses: an overview of their replication and pathogenesis. Methods Mol Biol 2015;1282:1- 23
  • 3. Rothan HA, Byrareddy SN. The epidemiology and pathogene-sis of coronavirus disease (COVID-19) outbreak. J Autoimmun 2020;102433.
  • 4. Chen Y, Liu Q, Guo D. Emerging coronaviruses: genome struc-ture, replication, and pathogenesis. J Med Virol 2020;92:418-23.
  • 5. Rocklov J, Sjodin H, Wilder-Smith, A. COVID-19 outbreak on the Diamond Princess Cruise ship: estimating the epidemic potential and effectiveness of public health countermeasu-res. J Travel Med 2020 May 18;27(3)
  • 6. Jin Y, Yang H, Ji W, Wu W, Chen S, Zhang W, et al. Virology, epidemiology, pathogenesis, and control of COVID-19. Viru-ses 2020 Mar 27;12(4).
  • 7. Zhang H, Penninger JM, Li Y, Zhong N, Slutsky AS. Angioten-sin-converting enzyme 2 (ACE2) as a SARS- CoV-2 receptor: molecular mechanisms and potential therapeutic target. In-tensive Care Med 2020;46:586- 90.
  • 8. Cao X. COVID‐19: immunopathology and its implications for therapy. Nat Rev Immunol. 2020; 20: 269‐ 270.
  • 9. Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P et al. Coronavirus infecti-ons and immune responses. J Med Vi-rol. 2020; 92(4): 424‐ 432.
  • 10. Chen, T, Wu D, Chen H, Yan W, Yang D, Chen G et al. Clinical characteristics of 113 deceased patients with coronavirus di-sease 2019: retrospective study. BMJ. 2020 Mar 26;368:m1091.
  • 11. Shi S, Qin M, Shen B, Cai Y, Lui T, Yang F et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan. JAMA cardiology, 5 (7), 802–810.
  • 12. Huang, I, Pranata R, Lim MA, Qehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Therapeutic ad-vances in respiratory disease, 14, 1753466620937175.
  • 13. Ponti, G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progres-sion. Critical reviews in clinical laboratory science, 2020 Sep;57(6):389-399.
  • 14. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Charac-teristics of 138 Hospitalized Patients With 2019 Novel Corona-virus-Infected Pneumonia in Wuhan, Chi-na. JAMA. 2020;323(11):1061–1069.
  • 15. Gao Y, Li T, Han M, Li X, Wu D, Xu Y et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol. 2020 Jul;92(7):791–796.
  • 16. Min CK, Cheon S, Ha NY, Sohn KM, Kim Y, Aigerim A et al. Comparative and kinetic analysis of viral shedding and immu-nological responses in MERS patients representing a broad spectrum of disease severity. Sci Rep. 2016. Article number: 25359.
  • 17. Yousif NG. Fibronectin promotes migration and invasion of ovarian cancer cells through up-regulation of FAK–PI 3 K/A kt pathway. Cell Biol Int. 2014 Jan;38(1):85–91.
  • 18. Ferrari D, Motta A, Strollo M, Banfi G, Locatelli M. Routine blood tests as a potential diagnostic tool for COVID-19. Clin Chem Lab Med. 2020 Jun 25;58(7):1095–1099.
  • 19. Pan F, Yang L, Li Y, Liang B, Li L, Ye T et al. Factors associated with death outcome in patients with severe coronavirus di-sease-19 (COVID-19): a case-control study. Int J Med Sci. 2020;17(9):1281–1292.
  • 20. Pan F, Yang L, Li Y, Liang B, Li L, Ye T et al. Factors associated with death outcome in patients with severe coronavirus di-sease-19 (COVID-19): a case-control study. Int J Med Sci 2020 May 18;17(9):1281-1292
  • 21. Li Q, Cao Y, Chen L, Wu D, Yu J, Wang H et al. Hematological features of persons with COVID-19. Leukemia 2020 Aug;34(8):2163-2172.
  • 22. Potempa, L.A, Rajab IM, Hart PC, Bordon J, Fernandez-Botran R. Insights into the use of C-reactive protein as a diagnostic index of disease severity in COVID-19 infections. American journal of tropical medicine and hygiene 2020 Aug;103(2):561-563.
  • 23. Wang G, Wu C, Zhang Q, Wu F, Yu B, Lv J et al. C-reactive protein level may predict the risk of COVID-19 aggrava-tion. Open forum infectious diseases, 2020 Apr 29;7(5):ofaa153.
  • 24. Tan C, Huang Y, Shi F, Tan K, Ma Q, Chen Y et al. C-reactive protein correlates with computed tomographic findings and predicts severe COVID-19 early. Journal of medical virology, 2020 Jul;92(7):856- 862.
  • 25. Poggiali E, Zaino D, İmmovilli P, Rovero L, Losi G, Dacrema A et al. Lactate dehydrogenase and C-reactive protein as predictors of respiratory failure in CoVID-19 patients. Clinica chimica acta, 2020 Oct;509:135-138.
  • 26. Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis. 2020 Jan- Dec;14:1753466620937175.
  • 27. Allwood BW, Koegelenberg CF, Ngah VD, SigwadhiLN, Irusen EM,Lalla U at al. Predicting COVID-19 outcomes from clinical and laboratory parameters in an intensive care facility during the second wave of the pandemic in South Africa. IJID Re-gion, Available online 1 April 2022
  • 28. Zhou F, Yu T, Du R, Fan G, Lui Y, Lui Z et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lan-cet. 2020;395(10229):1054–1062.
  • 29. Lin Z, Long F, Yang Y, Chen X, Xu L, Yang M. Serum ferritin as an independent risk factor for severity in COVID-19 patients. J Infect. 2020 Oct; 81(4): 647–679.
There are 29 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Research Article
Authors

Nuray Arı 0000-0001-9983-5021

Rabia Güney Kavuşak 0000-0001-8788-8310

Nazllı Yanık 0000-0002-1023-8747

Mehmet Erten 0000-0002-6664-4568

Early Pub Date April 27, 2023
Publication Date April 27, 2023
Submission Date November 15, 2022
Acceptance Date March 30, 2023
Published in Issue Year 2023 Volume: 20 Issue: 1

Cite

Vancouver Arı N, Güney Kavuşak R, Yanık N, Erten M. Hastaneye İlk Başvurudaki Biyobelirteçlerle COVID-19 Kliniği Tahmin Edilebilir mi?. Harran Üniversitesi Tıp Fakültesi Dergisi. 2023;20(1):163-9.

Harran Üniversitesi Tıp Fakültesi Dergisi  / Journal of Harran University Medical Faculty