Differential diagnosis and prospective grading of COVID-19 at the early stage with simple hematological and biochemical variables

Abstract

We evaluated simple laboratory variables to discriminate COVID-19 from bacterial pneumonia or influenza and for the prospective grading of COVID-19. Multivariate logistic regression and receiver operating characteristic curve (ROC) were used to estimate the diagnostic performance of the significant discriminating variables. A comparative analysis was performed with different severity. The leukocytosis ( P = 0.017) and eosinopenia ( P = 0.001) were discriminating variables between COVID-19 and bacterial pneumonia with AUC of 0.778 and 0.825. Monocytosis ( P = 0.003), the decreased lymphocyte-to-monocyte ratio (LMR) ( P < 0.001), and the increased neutrophil-to-lymphocyte ratio (NLR) ( P = 0.028) were predictive of influenza with AUC of 0.723, 0.895 and 0.783, respectively. Serum amyloid protein (SAA), lactate dehydrogenase (LDH), CD3 + cells, and the fibrinogen degradation products (FDP) had a good correlation with the severity of COVID-19 graded by age (≥50) and NLR (≥3.13). Simple laboratory variables are helpful for rapid diagnosis on admission and hierarchical management of COVID-19 patients.

Do Blood Eosinophils Predict in-Hospital Mortality or Severity of Disease in SARS-CoV-2 Infection? A Retrospective Multicenter Study

“…A large majority of patients in our cohort had deep eosinopenia (below 50/mm 3 ). In a retrospective study of 48 patients with COVID-19, Song et al [ 20 ] also found eosinopenia (below 40/mm 3 ) in 75% of patients. These findings are also consistent with a recent meta-analysis [ 18 ].…”

“…However, eosinopenia could be coupled with other markers in a multimarker approach or in a combined severity prediction score, increasing the prognostic value of this biomarker in COVID-19. It should be noted that, similarly, numerous other biochemical markers have been described to identify the most severe patients, including lymphopenia, neutrophils, neutrophil to lymphocyte ratio, CRP level, and D-Dimers [ 18 , 20 , 21 ]. More studies are, thus, required to further explore this prospect.…”

Genome‐wide screening of SARS‐CoV‐2 infection‐related genes based on the blood leukocytes sequencing data set of patients with COVID‐19

“…6 However, a negative qRT-PCR test result is not sufficient to exclude SARS-CoV-2 infection, and a combination of symptoms, radiological examination, and hematological examination are required to improve the sensitivity and accuracy of COVID-19 diagnosis. 7 Published studies have revealed that some hematological/biochemical changes in patients (e.g., normal or decreased leukocytes) may contribute to the diagnosis of COVID-19. 8,9 After SARS-CoV-2 infection, immune cells are activated, which can result in a significant increase in immune cell infiltration into the lung tissue.…”

Diagnóstico da COVID-19 em laboratórios de análises clínicas

“…Achados laboratoriais como a leucocitose, trombocitopenia, eosinopenia, linfopenia e relação de neutrófilos/linfócitos ≥ 3,13 estão relacionados a maior gravidade e a um mau prognóstico para COVID-19. Estudos mostram que leucócitos e neutrófilos estão significativamente aumentados em casos graves (Goudouris, 2021;Kavsak;Wit;Worster, 2020;Pourbagheri-Sigaroodi et al, 2020;Song et al, 2021;Soraya;Ulhaq, 2020).…”