Which hematological markers have predictive value as early indicators of severe COVID-19 cases in the emergency department?

Abstract

IntroductionCoronavirus 2019 disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a pandemic infectious disease that causes morbidity and mortality. To date there are no proven diagnostic or prognostic parameters, but clinicians can use predictive parameters, such as the leukocyte and lymphocyte counts, C-reactive protein (CRP), D-dimer, and ferritin levels, and radiological imaging [1-3]. In the inflammation process of COVID-19, CRP, platelet, ferritin, and leukocyte values may increase, while albumin and lymphocyte values may decrease [4][5][6].White blood cells (WBCs), including neutrophils, lymphocytes, monocytes, have been used as inflammatory Background/aim: Coronavirus 2019 disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a pandemic infectious disease that causes morbidity and mortality. As a result of high mortality rate among the severe COVID-19 patients, the early detection of the disease stage and early effective interventions are very important in reducing mortality. Hence, it is important to differentiate severe and nonsevere cases from each other. To date, there are no proven diagnostic or prognostic parameters that can be used in this manner. Due to the expensive and not easily accessible tests that are performed for COVID-19, researchers are investigating some parameters that can be easily used. In some recent studies, hematological parameters have been evaluated to see if they can be used as predictive parameters. Materials and methods:In the current study, almost all hematological parameters were used, including the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, mean platelet volume to lymphocyte ratio, mean platelet volume to platelet ratio, plateletcrit, and D-dimer/fibrinogen ratio, neutrophil/lymphocyte/platelet scoring system, and systemic immune-inflammation index. A total of 750 patients, who were admitted to Ankara City Hospital due to COVID-19, were evaluated in this study. The patients were classified into 2 groups according to their diagnosis (confirmed or probable) and into 2 groups according to the stage of the disease (nonsevere or severe). Results:The values of the combinations of inflammatory markers and other hematological parameters in all of the patients with severe COVID-19 were calculated, and the predicted values of these parameters were compared. According to results of the study, nearly all of the hematological parameters could be used as potential diagnostic biomarkers for subsequent analysis, because the area under the curve (AUC) was higher than 0.50, especially for the DFR and NLR, which had the highest AUC among the parameters. Conclusion:Our findings indicate that, the parameters those enhanced from complete blood count, which is a simple laboratory test, can help to identify and classify COVID-19 patients into non-severe to severe groups.

Predictive Ability of Complete Blood Count, Mean Platelet Ratio, Mean Platelet Volume, and Neutrophil/Lymphocyte Ratio for Severe Pneumonia among RT-PCR or Radiologically Proven COVID-19 Patients

“…More than 60% of the patients were above 40 years of age, with a minority being under 18 years of age. The prevalence of severe pneumonia and the proportion of the patients who succumbed to the disease in the study was comparable to that of other studies across the world (9,12,13,(22)(23)(24)(25).…”

“…Contrary to this, in the study byZhong et al (8), it was observed that the Mean Platelet Ratio > 7.44 fL was signi cantly associated with severe pneumonia in COVID-19 patients, and MPR directly correlated with AST, BUN, serum creatinine, and indirectly with lymphocytes and albumin. In a retrospective cohort study (16) and cross-sectional study(24),it was found that the MPR was also not a signi cant indicator of severity in COVID-19 patients. While studies (25) report a signi cantly lower values of MPV and MPR in the COVID-19 patients as compared to those suffering from in uenza, such a statistically signi cant difference could not be appreciated within the cohort of COVID-19 patients, i.e., between COVID-19 infection and COVID-19 severe pneumonia.…”

The Effect of Covid-19 Infection in Early Pregnancy on Hematological Parameters and Miscarriage Rate

“…Hassanipour et al reported a signi cant increase in neutrophils in patients and mortality accompanied by decreased lymphocyte count in one case [18]. It has been reported in many studies that increased NLR during SARS -Cov -2 infection is associated with poor prognosis [19][20][21][22]. In our study, although there was a slight increase in the inpatient group compared to the control group, no signi cant increase was observed in NLR rates.…”

Mean Platelet Volume as a Predictor of COVID-19 Severity: A Prospective Cohort Study in the Highlands of Peru

“…MPV has been evaluated in multiple retrospective studies, both alone and in association with other markers. San et al found that a high MPV/lymphocyte index is associated with severe forms of COVID-19 ( p < 0.001) [ 23 ], this association was also found for a higher level of MPV [ 24 , 25 , 26 ]. On the other hand, a prognostic model determined that a decreasing trend of MPV can be a useful marker to assess the evolution of the patient with COVID-19 [ 27 ].…”