COVID-19 and Laboratory Markers from Romanian Patients—A Narrative Review

Abstract

COVID-19 has significantly impacted the whole world, and Romania was no exception. Biomarkers play a crucial role in understanding and managing the disease. However, research regarding laboratory analyses for patients with COVID-19 is fairly limited. For detection, PCR testing is still considered the golden standard, while antibodies are still useful for monitoring both patients and their vaccination status. In our country, biomarkers such as CRP, LDH, transaminases, cardiac, and iron markers have been used to assess the status of patients and even predict illness outcome. CRP, IL-6, LDH, FER, fibrinogen, creatinine, and vitamin D levels have been associated with increased severity, risk of ICU admission, and death. Cardiac markers and D-dimers are also good predictors, but their role seems more important in patients with complications. HDL cholesterol and BUN levels were also suggested as potential biomarkers. Hematological issues in SARS-CoV-2 infections include neutrophilia, lymphopenia and their ratio, while PCT, which is a marker of bacterial infections, is better to be used in patients with co- or supra-infections. The current research is a narrative review that focuses on the laboratory results of Romanian COVID-19 patients. The goal of this article is to provide an update on the research on biomarkers and other laboratory tests conducted inside the borders of Romania and identify gaps in this regard. Secondly, options for further research are discussed and encouraged.

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“…Several biomarkers that have consistently been used to assess severity, ICU admission, and death are as follows: CRP, IL-6, D-dimers, LDH, 25-OHD, ferritin, and HDL cholesterol. Generally speaking, for CRP, IL-6, D-dimers, LDH, and ferritin, the more severe cases have had more elevated values, while HDL cholesterol and 25-OHD have proven an inverse relationship to severity [ 12 , 13 , 14 , 15 , 16 ].…”

“…25-OHD was not studied by the research group of Mocanu et al; however, previous research has noted its impact in COVID-19 [ 15 , 16 ]. While still on the subject of vitamin D, it is important to note that the median level for the whole lot was 20.82, which is considered the threshold value between normal values and deficiency, with many authors claiming that the optimal levels should be between 30 and 50 ng/mL [ 4 , 14 , 16 ]. As such, considering that half of the patients were under this value, supplementation of vitamin D is recommended.…”

“…Other important biomarkers have been researched since the beginning of the pandemic, such as the C-reactive protein (CRP), interleukin 6 (IL-6), hepatic, pulmonary, cardiac, renal, and iron markers. Of all researched potential biomarkers, some, including CRP, IL-6, D-dimers lactate dehydrogenase (LDH), 25-OH vitamin D (25-OHD), ferritin (FER), and high-density lipoprotein cholesterol (HDL), have proven a better capacity to properly assess severity, risk of ICU admission, and even death [ 12 , 13 , 14 , 15 , 16 ].…”