Early hematological indicators of severe COVID‐19 disease in hospitalized patients: Data from a South Asian population

Abstract

Introduction Outbreak of corona virus disease in 2019 (COVID‐19) has resulted in significant morbidity and mortality worldwide. Our aim is to document hematological parameters of patients with COVID‐19 during initial stage of diagnosis and to identify early hematological indicators of severe infection. Materials and methods This retrospective study was conducted at Shifa International Hospital, Pakistan from April to November 2020. Patients hospitalized with COVID‐19, diagnosed on RT‐PCR and had a complete blood count (CBC) done within 48 hours of diagnosis were included. Data was analyzed using IBM® SPSS Statistics. Results A total of 425 patients were included in this study out of whom 272(64%) were males. The mean age was 55.61 ± 17.84 years. 95 patients (22.4%) had normal blood counts within 48 hours of COVID‐19 diagnosis. Cytopenias were seen in 193(45.4%) patients. There were 75(17.6%) mortalities during the study period. Chi‐square test showed that thrombocytopenia, lymphopenia and neutrophilic leucocytosis were significantly associated with mortality (P = .037, P < .001, P < .001 respectively) and need for ventilator (P = .009, P < .001, P < .001, respectively). Neutrophilia was also associated with development of Acute Respiratory Distress Syndrome (P < .001). On ROC analysis, Neutrophil‐to‐Lymphocyte Ratio yielded an area under the curve (AUC) of 0.693 and 0.660 for the outcomes mortality and need for ventilator, respectively. For a subset of 288 patients who had D‐dimer levels checked within 48 hours of COVID‐19 diagnosis, the AUC for mortality and ventilator need was 0.708 and 0.671, respectively. Conclusion Hematological indices are vital indicators in the prognosis and risk stratification of COVID‐19 during initial stages of disease.

Comparison of hematologic abnormalities between hospitalized coronavirus disease 2019 positive and negative patients with correlation to disease severity and outcome

“…SARS‐CoV‐2 induced cytokines release, direct virus‐induced myelocytotoxicity, and overproduction of marrow in response to stress/inflammation causing mobilization of marrow reserves in the peripheral blood circulation are a few hypotheses explaining the reason for granulocytic left shift akin to bacterial infections in severe cases. Sharif et al, in their study, reported that neutrophilic leucocytosis was significantly associated with the development of acute respiratory distress syndrome, mortality, and need for a ventilator 24 . Most of the deceased patients in the current study showed significant leucocytosis with marked neutrophilia and toxic granulation as compared to survivors, indicating that these patients might have a secondary bacterial infection as an underlying cause of death.…”

“…Sharif et al, in their study, reported that neutrophilic leucocytosis was significantly associated with the development of acute respiratory distress syndrome, mortality, and need for a ventilator. 24 Most of the deceased patients in the current study showed significant leucocytosis with marked neutrophilia and toxic granulation as compared to survivors, indicating that these patients might have a secondary bacterial infection as an underlying cause of death.…”

Evaluation of Hematological, Coagulation and Inflammatory Parameters in COVID- 19 in a Tertiary Care Setting of Sindh, Pakistan

“…Sample size was calculated using WHO calculator. 8 Informed consent about the sampling and research was taken from patients or their families.…”

“…7 Commonly affected parameters include platelet count, absolute lymphocyte count, neutrophil count, NLR ratio and D dimers. 8 We carried out this study to determine hematological, coagulation and inflammatory markers in hospitalized PCR positive covid patients which can be used as a monitoring tool and give an idea about disease severity as well. Furthermore, these parameters can also give us an idea where PCR facility is not available so the suspected patients may be timely isolated, referred and managed at the desired facility.…”

Evaluation of lymphocyte count, T-cell subsets and neutrophil-to-lymphocyte ratio as early predictors for severity and outcome of COVID-19 disease–a report from a highly complex hospital in Brazil

“…In fact, lymphopenia is one of the laboratory markers of the SARS-CoV-2 infection and has been considered a poor prognostic factor regarding the severity of the COVID-19 disease 7 , 8 .…”