Chopra Parul, Sehgal Tushar, Yadav Ranjan, Meena Suneeta, Maitra Souvik, Soni Kapil Dev, Subramanian Arulselvi, Prakash Shyam, Mathur Purva, Mittan Sandeep, Tavolacci Sooyun, Kaushik Ajeet, Gulia Kiran, Mostafavi Ebrahim, Gupta Abhishek, Trikha Anjan, Gupta Ritu, Chosdol Kunzang, Mohan Anant, Mani Kalaivani, Sinha Subrata, Datta Sudip Kumar
Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India.
Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
EJIFCC. 2023 Apr 18;34(1):42-56. eCollection 2023 Apr.
Inflammatory and hematological markers are used extensively for early prognostication and monitoring in COVID-19.We aimed to determine whether routinely prescribed laboratory markers can predict adverse outcome at presentation in COVID-19.
This retrospective observational study was performed on 401 samples collected between July to December 2020 from COVID-19 positive subjects, admitted at All India Institute of Medical Sciences, Delhi, India. Clinical details and laboratory investigations within 3 days of COVID-19 positivity were obtained. Clinical outcomes were noted from patient medical records, till discharge or death. Laboratory parameters, with individually defined cut-offs, were used, either singly or in combination to distinguish survival and death for those having severe and non-severe disease at initial presentation.
Total Leukocyte count, Absolute neutrophil count, Neutrophil to Lymphocyte ratio, C-Reactive Protein (CRP), Interleukin-6 (IL-6), Lactate Dehydrogenase, Ferritin and Lymphocyte to CRP ratio (LCR) were significantly altered at presentation in severe COVID-19 as compared to non-severe cases; and, also in those who died due to COVID-19 compared to those who survived. A combination of four markers, CRP (≥3.9mg/dL); IL-6 (≥45.37pg/ml); Ferritin (≥373ng/mL); 1/LCR ≥0.405 was found to strongly predict mortality in cases with non-severe presentation as also in severe cases.
The combination of routinely used markers, CRP, IL-6, Ferritin and 1/LCR can be used to predict adverse outcomes, even in those presenting with mild to moderate disease. This would identify subset of patients who would benefit from closer monitoring than usual for non-severe disease.
炎症和血液学标志物在新型冠状病毒肺炎（COVID-19）的早期预后评估和监测中被广泛应用。我们旨在确定常规检测的实验室标志物能否预测COVID-19患者就诊时的不良结局。
本回顾性观察性研究对2020年7月至12月期间在印度德里全印医学科学研究所收治的401例COVID-19阳性患者的样本进行了分析。收集了COVID-19确诊后3天内的临床资料和实验室检查结果。从患者病历中记录临床结局，直至出院或死亡。使用具有单独定义临界值的实验室参数，单独或联合使用以区分初次就诊时患有严重和非严重疾病患者的生存和死亡情况。
与非严重病例相比，严重COVID-19患者就诊时的白细胞总数、绝对中性粒细胞计数、中性粒细胞与淋巴细胞比值、C反应蛋白（CRP）、白细胞介素-6（IL-6）、乳酸脱氢酶、铁蛋白和淋巴细胞与CRP比值（LCR）均有显著变化；与存活患者相比，因COVID-19死亡患者的这些指标也有显著变化。发现四种标志物联合使用，即CRP（≥3.9mg/dL）；IL-6（≥45.37pg/ml）；铁蛋白（≥373ng/mL）；1/LCR≥0.405，能够强烈预测非严重和严重病例的死亡率。
常规使用的标志物CRP、IL-6、铁蛋白和1/LCR联合使用可用于预测不良结局，即使是轻度至中度疾病患者。这将识别出比非严重疾病常规监测更能受益于密切监测的患者亚组。
