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) remains 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 the severity of COVID-19. Many factors could be associated with a cytokine storm but they are incompletely understood. This study presents characteristics of COVID-19 patients and explore the clinical and inflammatory parameters of severe and critically ill COVID-19 patients in the intensive care unit (ICU). Method: This 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. Haematologic parameters, serum electrolyte, renal function, liver function, pancreas enzyme, D-dimer, inflammatory cytokines interferon (IFN)-gamma, tumour 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. Comparative analyses were done between sex, existing comorbidities, body mass index (BMI), and COVID-19 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 leucocytosis and neutrophilia, with a 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 were found among 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.

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…”