Chatterjee Bijoya, Modi Nikunj, Desai Khushi, Murugan Yogesh, Trivedi Ami
Department of Biochemistry, Shri MP Shah Government Medical College, Jamnagar, Gujarat, India.
Department of Internal Medicine, Trinity Health Livonia Hospital, Michigan, USA.
J Family Med Prim Care. 2024 Aug;13(8):3220-3224. doi: 10.4103/jfmpc.jfmpc_226_24. Epub 2024 Jul 26.
Laboratory markers like lymphopenia, thrombocytopenia, elevated D-dimer, and C-reactive protein (CRP) predict worse outcomes in coronavirus disease 2019 (COVID-19). However, a comprehensive analysis of hematologic and coagulation parameter alterations based on fever status is lacking.
This retrospective study analyzed 300 COVID-19 patients hospitalized from March to December 2020. Demographic, clinical, and laboratory data were extracted from electronic medical records. Patients were stratified into fever (n = 200) and no fever (n = 100) groups. Hematologic, coagulation, and inflammatory markers were compared between groups using appropriate statistical tests. Multivariate regression identified independent predictors of fever.
Fever was associated with leukocytosis, neutrophilia, lymphopenia, thrombocytopenia, elevated CRP, D-dimer, procalcitonin, interleukin-6, neutrophil to lymphocyte ratio (NLR), and ferritin compared to no fever (all < 0.05). D-dimer (r = 0.42), CRP (r = 0.52), NLR (r = 0.48), and interleukin-6 (r = 0.46) demonstrated the strongest correlation with fever ( < 0.001). High D-dimer >1000 ng/mL (adjusted odds ratio 2.7), CRP >100 mg/L (3.1), lymphopenia <1.0 × 109/L (2.8), NLR >4 (2.9), and thrombocytopenia <150 × 109/L (2.7) were significant independent predictors of fever status ( < 0.005). These parameters had moderate sensitivity (40-60%) and high specificity (74-88%) for discriminating febrile patients with AUC of 0.85.
Marked alterations in hematologic, coagulation, and inflammatory markers occur in COVID-19 based on fever. Routine laboratory parameters can facilitate diagnosis and risk stratification.
淋巴细胞减少、血小板减少、D-二聚体升高和C反应蛋白（CRP）等实验室指标预示着2019冠状病毒病（COVID-19）的预后较差。然而，目前缺乏基于发热状态对血液学和凝血参数改变进行的综合分析。
这项回顾性研究分析了2020年3月至12月住院的300例COVID-19患者。从电子病历中提取人口统计学、临床和实验室数据。患者被分为发热组（n = 200）和无发热组（n = 100）。使用适当的统计检验比较两组之间的血液学、凝血和炎症指标。多变量回归确定发热的独立预测因素。
与无发热相比，发热与白细胞增多、中性粒细胞增多、淋巴细胞减少、血小板减少、CRP、D-二聚体、降钙素原、白细胞介素-6、中性粒细胞与淋巴细胞比值（NLR）和铁蛋白升高相关（均P < 0.05）。D-二聚体（r = 0.42）、CRP（r = 0.52）、NLR（r = 0.48）和白细胞介素-6（r = 0.46）与发热的相关性最强（P < 0.001）。高D-二聚体>1000 ng/mL（调整比值比2.7）、CRP>100 mg/L（3.1）、淋巴细胞减少<1.0×10⁹/L（2.8）、NLR>4（2.9）和血小板减少<150×10⁹/L（2.7）是发热状态的显著独立预测因素（P < 0.005）。这些参数对鉴别发热患者具有中等敏感性（40 - 60%）和高特异性（74 - 88%），曲线下面积为0.85。
COVID-19患者基于发热状态在血液学、凝血和炎症指标上出现明显改变。常规实验室参数有助于诊断和风险分层。
