Do Laboratory Biomarkers Predict Survival in Severe COVID-19? A Cross-sectional Study

Abstract

BackgroundAvailable research compared serum biomarkers such as lymphocyte count, C-reactive protein, ferritin, Lactate Dehydrogenase and D-dimers to predict survival in patients with mild, moderate and severe COVID-19. This study aims to compare these biomarkers among survivors and non-survivors of severe COVID-19. MethodsThis was a cross-sectional study based on patient’s data retrieved from Hospital Information System. Sixty-nine patients for whom a record of the biomarkers and survival status was available, were included in the study. For every patient, baseline and peak values were selected for CRP level, serum ferritin level, serum LDH level and serum D-Dimer level. Similarly, baseline and trough levels were selected for lymphocytes. Data were analyzed using SPSS version 21. Mean and standard deviation was used to compare the biomarkers with paired t-test. P value less than 0.05 was taken as significant. ResultsThe mean age of the study population was 55.5±9.1 years and 72.5% were male. Among survivors, the increase in CRP level was not significant (from 15.80±9.8 mg/dl to 17.87 ±8.4 mg/dl, p=0.45) while among the non-survivor, the increase in CRP level was significant (from 16.68± 10.90 mg/dl to 20.77±12.69 mg/dl, p=0.04). There was no significant rise in serum LDH levels in survivors (from 829.59±499 U/L to 1018.6±468 U/L, p=0.20) while there was a statistically significant increase in serum LDH level in non-survivors (from 816.2±443.08 U/L to 1056.61±480.54 U/L, p=0.003). Lymphocyte count decreased significantly in both survivors (p=0.001) and non-survivors (p=0.001). There was no statistically significant elevation in serum ferritin among the survivors and non-survivors (p > 0.05). The D-Dimer level increased significantly in both survivors (p=0.01) and non-survivors (p=0.001).Conclusions In severe COVID-19 patients, serum CRP and LDH can be used for risk stratification and predicting survival. Lymphopenia, increase in serum ferritin and D-dimers may not predict survival.Trial Registration Not applicable

Comparison of first and second waves of COVID-19 through severity markers in ICU patients of a developing country

“…Another similar study compared these markers among survivors and non-survivors showed that lymphocyte count decreased significantly in both survivors (from 0.94 to 0.51 × 10 9 cells/L) and non-survivors (from 1.24 to 0.61 × 10 9 cells/L), respectively. Among survivors, the increase in CRP level was from 158.0 to 178.7 mg/L while among nonsurvivors, the increase in CRP level was from 166.8 to 207.7 mg/L [17]. There was an equal rise in serum ferritin among the survivors (1321.13 to 2141.18 ng/mL) and non-survivors (1227.01 to 1662.7 ng/mL).…”

“…The rise in serum LDH levels in survivors was 829.59 to 1018.6 U/L while in nonsurvivors it was 816.2 to 1056.61 U/L. D-dimer levels increased significantly in both survivors and non-survivors (from 7.2 to 28.8 µg/mL, and from 8.75 to 29.52 µg/mL, respectively) [17]. Similarly, another study concluded peak D-dimer levels of 42.2 µg/ml on day 22 of admission in non-survivors, peak lymphocytopenia on day 7 for survivors (0.91 x 10 9 cells/L), and day 22 for nonsurviving patients (0.42 x 10 9 cells/L).…”