Inflammatory laboratory findings associated with severe illness among hospitalized individuals with COVID-19 in Medan, Indonesia: a cross-sectional study

Abstract

Background: Coronavirus disease (COVID-19) is still a global health problem. COVID-19 patients with severe pneumonia have a higher risk for critical illness, mostly complicated by acute respiratory distress syndrome. The inflammatory response is critical, and the cytokine storm increases severity of COVID-19. Many factors could be associated with a cytokine storm but these are incompletely understood. The aim of this study is to present characteristics of patients with COVID-19 and explore the clinical and inflammatory parameters of severe and critically ill COVID-19 patients in the intensive care unit (ICU). Method: The cross-sectional study was conducted in all severe COVID-19 patients admitted to the ICU. Peripheral blood was taken for laboratory examination within 24 hours of admission. Hematologic parameters, serum electrolyte, renal function, liver function, pancreas enzyme, D-dimer, inflammatory cytokines interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, IL-10, monocyte chemoattractant protein-1 (MCP-1), and C-reactive protein (CRP) were assessed in this study. Comparison analyses were done between sex, comorbidity existed, body mass index (BMI), and vaccination status. Results: A total of 80 subjects were included in the study. The most frequent comorbidities found among the subjects were obesity (36.35%) and diabetes (22.5%). Only 13.75% of subjects were vaccinated. Laboratory results indicated leukocytosis and neutrophilia, with neutrophil-lymphocyte-ratio (NLR) of 7. The mean inflammatory findings (IL-6, IL-10, TNF-alpha, IFN-gamma, MCP-1), D-dimer, CRP, and lipase increased. Lipase levels were higher in men (p=0.003) and in comorbidity groups. No significant differences found with different BMI groups. Lipase, IL-6, and MCP-1 levels were significantly higher (p=0.019, <0.0001, and 0.03, respectively) in the non-vaccinated group. Conclusions: Most patients with severe COVID-19 have comorbidities and increased inflammatory markers.

Serum homocysteine level and severity of coronavirus disease-2019 (COVID-19)

“…The elevated homocysteine level due to the polymorphism causes deterioration and increased mortality rate in COVID-19 patients. The polymorphism itself is more prominent in the Latino population [20]. Analysis by Keskin et al showed that homocysteine has AUC of 0.835 with sensitivity of 81.8% and specificity of 82.4% in stratifying severe COVID-19 cases.…”

Laboratory predictors for COVID-19 Intensive Care Unit admissions in Trinidad and Tobago

“…Noteworthy to mention is that the study sample of COVID-19 patients cared for at the facilities during the study period included more females than males, however, a significantly higher number of male ICU patients compared to female ICU patients was observed in this study which supports previous observations that indicated gender as a potential determinant of likelihood to develop serious complications that might require ICU care [ 23 , 26 , 27 ]. This observed difference could be attributed to behavioral differences between the sexes, notably that more men engage in smoking and alcohol consumption than women [ 28 ] heightening their risk of chronic diseases such as hypertension, cardiovascular disease, and chronic pulmonary disease, which have been associated with a greater likelihood of developing severe illness with COVID-19 [ 29 ] . Hormonal factors may also play a role in the observed heightened risk of developing severe COVID-19 in males.…”

The Role of Critical Laboratory Parameters to Determine the Severity and Prognosis of COVID-19 : Systematic Review

“…A study conducted by Darmadi, et al, stated that most severe COVID-19 patients have comorbidities, are non-vaccinated, and had elevated inflammatory markers. 6 Laboratory parameters included in this study were haematologic parameters (hemoglobin, leukocytes, thrombocytes, neutrophils, lymphocytes, monocytes), serum electrolyte (sodium, potassium, chloride, calcium), renal function (urea, creatinine), liver function [aspartate transaminase (AST); alanine transaminase (ALT)], pancreatic enzymes (amylase, lipase), D-dimer, inflammatory cytokines (IFN-gamma, TNF-alpha, IL-6, IL-10, MCP-1), and C-reactive protein (CRP). Laboratory results indicated leucocytosis and neutrophilia.…”

“…Lipase, IL-6, and MCP-1 levels were significantly higher. 6 Clinicians can use laboratory parameters to evaluate the functional activity of the organs, which can be impaired by the virus' ability to damage several vital organs. These parameters can be the markers clinicians use to make crucial decisions.…”

“…Those laboratory parameters, as stated in a study conducted by Darmadi, et al, are used in daily practice to stratify the risk of morbidity and mortality in COVID-19 patients at the time and during the time of hospitalization, especially to detect cytokine storms in patients with COVID-19. 6…”