The Relationship between Routine Blood Parameters and the Prognosis of COVID-19 Patients in the Emergency Department

Abstract

The aim of this study is to investigate the routine blood parameters of COVID-19 patients at the time of admission to the emergency department and their relationship with the severity of the disease and prognosis. A total of 500 patients, who were diagnosed with severe COVID-19 and hospitalized in the intensive care unit between 01.04.2020 and 01.02.2021 in the emergency department of a pandemic hospital, were retrospectively analyzed. Demographic, clinical, and laboratory data of the patients were obtained from the hospital registry system. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR) were calculated using neutrophil, lymphocyte, monocyte, and platelet counts. These patients were divided into two groups: survivors and deceased. All parameters obtained from routine blood analysis were statistically compared between these two groups. While 280 out of 500 patients survived, 220 died. Of all patients, the mean age was 67 years and 51.8% were males. There was a significant difference between the two groups in terms of age, gender, length of hospital stay, need for mechanical ventilation, white blood cell, neutrophil, lymphocyte, monocyte, eosinophil, platelet counts, CRP, ferritin, procalcitonin values, NLR, MLR, and PLR ( p < 0.001 for all). While NLR alone and MLR + NEU and NLR + PLR + MLR combinations had the highest AUC values (0.930, 0.947, and 0.939, respectively), MLR and PLR alone showed the lowest AUC values (0.875 and 0.797, respectively). The sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs) in the prediction of death according to the cutoff values of the parameters have been determined. A significant correlation was determined between age, NLR, MLR, and PLR and duration of hospital stay ( p < 0.001 for all). Routine blood parameters and NLR, MLR, and PLR can assist emergency physicians to identify the severity and early prognosis of COVID-19 patients.

Early Routine Biomarkers of SARS-CoV-2 Morbidity and Mortality: Outcomes from an Emergency Section

“…Severe forms of COVID-19 cause severe tissue damage and the subsequent release of large amounts of LDH into the circulation, indicating a severe form of interstitial pneumonia [ 42 ]. Our data displays how D-dimer, CRP, Ferritin and LDH could represent important routine biomarkers of COVID-19 disease, as shown in previous studies [ 17 , 24 , 43 , 44 ].…”

“…This was due to the great variability of clinical manifestations during the first phase of the infection [ 16 ]. In a previous study investigating COVID-19 survivors and deceased, the authors found significant differences between the two groups in terms of white blood cells, neutrophils, lymphocytes, monocytes, eosinophils, platelet counts, CRP, ferritin, and procalcitonin values from routine blood analysis [ 17 ]. The authors found a significant correlation between age, neutrophil/monocyte/platelet-to-lymphocyte ratio, and duration of hospital stay [ 17 ].…”

“…In a previous study investigating COVID-19 survivors and deceased, the authors found significant differences between the two groups in terms of white blood cells, neutrophils, lymphocytes, monocytes, eosinophils, platelet counts, CRP, ferritin, and procalcitonin values from routine blood analysis [ 17 ]. The authors found a significant correlation between age, neutrophil/monocyte/platelet-to-lymphocyte ratio, and duration of hospital stay [ 17 ]. Accordingly, in the present study, we analyzed and compared routine biomarkers at the entrance to the emergency room of COVID-19-positive patients who subsequently developed a serious illness and spent time in the intensive care unit (ICU) or died to the values of patients attending only the emergency room who were discharged shortly thereafter for the absence of severe symptoms.…”

“…Accordingly, in the present study, we analyzed and compared routine biomarkers at the entrance to the emergency room of COVID-19-positive patients who subsequently developed a serious illness and spent time in the intensive care unit (ICU) or died to the values of patients attending only the emergency room who were discharged shortly thereafter for the absence of severe symptoms. Thus, the purpose of this retrospective study was to disclose, at the level of an emergency unit, those blood parameters that might serve as an early indication of a severe COVID-19 progression as observed for hospitalized patients [ 17 , 18 , 19 , 20 , 21 ]. We focused on Aspartate transaminase (AST), Alanine transaminase (ALT), Lactate dehydrogenase (LDH), Creatine kinase (CK), Myoglobin (MGB), Ferritin, CRP and D-dimer, all known to have a crucial role in COVID-19 onset and evolution and usually measured in the routine blood parameters of the Policlinico Umberto I hospital emergency section.…”

Application of a Decision Tree Model to Predict the Outcome of Non-Intensive Inpatients Hospitalized for COVID-19

“…Another retrospective study proposed a clinical risk score for critically ill patients with COVID-19, which was validated by including clinical symptoms, signs, and laboratory tests [ 15 ]. Furthermore, the results of the studies have been valuable for blood chemistry tests; white blood cells, neutrophils, lymphocytes, monocytes, eosinophils, platelets, CRP, D-dimer, and PCT were analyzed [ 16 , 17 ].…”