Role of inflammatory and liver function markers in assessing the prognosis of patients with COVID‑19

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused Coronavirus disease 2019 in early December, 2019. The disease begins as a respiratory disease with varied outcomes, from complete recovery to long-standing complications, such as respiratory distress, heart ailments and stroke. The present study was undertaken to identify the derangements in liver function and inflammatory status which may be used to diagnose the severity and thus assess the prognosis of patients with COVID-19 infection. The present study was conducted at a tertiary care teaching hospital. The study population included 456 patients with COVID-19, confirmed by the reverse transcription-PCR of nasopharyngeal swabs for SARS-CoV-2. Data were collected from patient files. The study was approved by the institutional ethics committee. Data are expressed based on the normality of distribution. Variables were compared and correlation analyses were performed. Receiver operating characteristics and the Youden index were applied to obtain cut-off values. The results revealed an increase in C-reactive protein (CRP), ferritin, D-dimer, lactate dehydrogenase (LDH), aspartate aminotransferase (AST) and total bilirubin levels. In addition, there was evidence of leukocytosis, neutrophilia, lymphopenia and an increased neutrophil-to-lymphocyte ratio (NLR). The NLR exhibited an area under the curve of 0.77, with a cut-off value of 2.23 mg/l. Collectively, the findings of the present study demonstrate that the CRP, LDH, neutrophil and eosinophil counts along with the total leucocyte counts and absolute lymphocyte counts, NLR, erythrocyte sedimentation rate, D-dimer, ferritin and AST levels serve to predict the severity and prognosis of patients with COVID-19. AST appears to be a more sensitive marker than alanine aminotransferase. However, the De Ritis ratio, although not as sensitive as AST, may provide insight towards morbidity.

DNA damage in peripheral blood lymphocytes of severely ill COVID-19 patients in relation to inflammatory markers and parameters of hemostasis

“…Our investigation also indicated that COVID-19 patients showed markedly deviations in the concentrations of ferritin, LDH, AST, ALT, CK, pro-BNP, urea, and creatinine. This is in line with the results of previous studies that dealt with the diagnostic and prognostic value of laboratory findings in COVID-19 patients [ 8 , 47 , 48 ]. The aggrevated inflammatory response in SARS-CoV-2 infection causes multiorgan dysfunction that is reflected through a remarkable increase in different laboratory parameters.…”

Correlation of Biomarkers in Severe COVID-19 Patients Cross-sectional Study

“…White blood cell and neutrophil counts were observed to be significantly greater in individuals with increased ALT, and both indices had substantial positive relationships with aminotransferases [24]. Another study by Moorthy et al, there was negative correlation between liver function tests with the WBC [25]. Diaz et al research found that although the influence of lymphocytes on AST, ALP, and even ALT was lost toward the end of the study, the relationship between lymphocytes and AST, ALP, and even ALT remains robust [26].…”

Albumin levels, mean platelet volume, and neutrophil lymphocyte ratio as predictors of COVID-19 outcomes

“…On the other side, the increase of 1 MPV unit between the first and third days during treatment is inseparable from thrombocytopenia, which is experienced by 58-95% of severe cases of COVID-19 and increased by 1.76 times the risk of mortality [24,25]. Then significantly increased NLRs are also commonly found in patients treated in intensive care units with severe disease, with each unit increase in NLR associated with an 8% increase in the risk of death from COVID-19 [10,26].…”

“…Systemic inflammation increases capillary permeability and albumin transfer to extracellular, so albumin levels tend to decrease as a marker of endothelial damage [8,9]. Cytokine storm conditions will reduce lymphocyte production in the bone marrow and increase the use of lymphocytes and neutrophil production as an inflammatory response increasing the neutrophil-lymphocyte ratio (NLR) [7,10,11]. In addition, a cytokine storm will cause coagulation abnormalities and thrombus formation, characterized by an increase in the mean platelet volume (MPV) as a reflection of pro-inflammatory and prothrombotic [7,12].…”