Predictive Value of C-reactive Protein, Lactate Dehydrogenase, Ferritin and D-dimer Levels in Diagnosing COVID-19 Patients: a Retrospective Study

Abstract

Background: Since December 2019. millions of people in the world have been affected with the novel Coronavirus disease-2019 (COVID-19) pandemic, and high economic impact has affect many countries especially low socioeconomic one like Iraq due to the high cost and limited availability of RT-PCR for diagnosis of COVID-19, so there should be predictive low cost easily available laboratory tests that can be used before proceeding to the high cost techniques. Objective: In this retrospective study we aimed to evaluate the diagnostic accuracy of CRP, ferritin, LDH and D-dimer in predicting positive cases of COVID-19 in Iraq. Methods: It is a retrospective observational cohort study based on STARD guidelines to determine the diagnostic accuracy of (CRP, LDH, ferritin and D dimer) for COVID-19 of electronic medical records of private medical center in Najaf city, at which 566 individuals were recruited. The investigated subjects were either in close contact with previously COVID-19 positive patients or have one or more symptoms of COVID-19. They were categorized into 2 groups, 205 subjects diagnosed with RT-PCR as COVID-19 negative, and 361 COVID-19 positive patients, results of study variables of the cohort were recruited from the medical records. Results: Combining of these parameters had the following findings: CRP + ferritin; AUC: 0.77 with 55% sensitivity and 97% specificity, Ferritin + LDH; AUC: 0.83 with 65% sensitivity and 92% specificity, CRP+LDH; AUC: 0.78 with 56% sensitivity and 98% specificity, CRP + LDH + ferritin; AUC: 0.85, with 73% sensitivity and 88% specificity, CRP + LDH + ferritin + D dimer; AUC: 0.85 75% sensitivity and 87% specificity. Conclusion: Combination of routine laboratory biomarkers (CRP, LDH and ferritin ±D dimer) can be used to predict the diagnosis of COVID-19 with an accepted sensitivity and specificity before proceeding to definitive diagnosis by RT-PCR.

Safety and long-term improvement of mesenchymal stromal cell infusion in critically COVID-19 patients: a randomized clinical trial

“…In the placebo group, the levels were always higher than the reference ranges. Those results are in accordance with studies that show that the inflammatory biomarkers were increased in COVID-19 patients [ 102 , 103 ].…”

The relationship between CRP at admission and thorax CT findings in patients diagnosed with COVID‐19

“…Therefore, thorax CT is vital in preclinical screening and is highly recommended as a first‐line strategy for investigating possible cases of COVID‐19 10 . In addition, the combination of routine laboratory biomarkers (CRP, LDH, and ferritin ±D‐ dimer) can be used for the diagnosis of COVID‐19 with an accepted sensitivity and specificity before making a definitive diagnosis by RT‐PCR 11 . However, different results have been reported between CRP levels and the severity of thorax CT involvement, clinical outcomes and disease prognosis in patients diagnosed with COVID‐19 12‐14 …”

Tranilast as an Adjunctive Therapy in Hospitalized Patients with Severe COVID- 19: A Randomized Controlled Trial

“…Several studies have noted the increased levels of pro-inflammatory cytokines, such as IL-1, IL-6, and TNF, in patients with COVID-19 ( 34 , 35 , 36 , 37 ). NLR, CRP, LDH, and d-dimer also have a diagnostic and predictive role in some inflammatory diseases, including the COVID-19 ( 38 , 39 , 40 , 41 , 42 , 43 , 44 ). According to our results, Tranilast could reduce the NLR, CRP, and d-dimer in the intervention group compared to the control group, highlighting its effect on preventing severe and destructive inflammation, especially in the inflammatory phase of the disease.…”