Significance of Hematological Parameters and
Biochemical Markers
in Severe Forms of Covid-19
Anne–Lise
Mihaela VOICULESCU*1, 2, Andreea ANGHEL3,
Leonard GURGAS3, Natalia ROSOIU1, 3, 4
1 IOSUD University Ovidius
Constanta, Doctoral School of Applied Sciences in Biology/ Biochemistry,
2 Medical Center “Unirea”
3 Faculty of Medicine,
University Ovidius Constanta
4 Titular
Member of the Academy of Romanian Scientists
* Corresponding author e-mail: ane141069@yahoo.com
Abstract
SARS-CoV-2 is a new virus that affects the human population, about which
not all the details are known, and for which the research is ongoing. Several
common in vitro diagnostic tests have been implicated in the unfavorable
progression of COVID-19, providing potentially important prognostic
information.
According
to some synthesis studies, the progressively low values of the lymphocyte /
leukocyte ratio, and progressively increased of the neutrophil / lymphocyte and
neutrophil / platelets ratios, correlate with the more severe evolution of
COVID-19. The existence of a number of lymphocytes <20% on day 10-12
indicates a pre-severe condition, and a number of <5% on days 17-19
indicates a critical one.
D-dimers
are the most important prognostic element in monitoring patients with severe
forms of COVID-19. Elevated levels of D-dimers compared to the reference
biological interval observed at hospitalization of patients with COVID-19 and
their marked increase, up to 3-4 times the initial value, were associated with
increased mortality, which probably reflects the activation of coagulation in
infection / sepsis, cytokine storm and imminent organ failure.
Increasing
ALT values by more than 5 times the reference biological interval increased the
risk of mortality of patients with COVID-19 by seven times. High levels of AST
compared to the biological reference range were observed in both patients with
non-severe COVID-19
disease as well as in a double the number of patients with severe disease.
The
value of serum creatinine at hospitalization is a predictor of the death of
hospitalized patients for COVID-19. More frequent measurements of serum
creatinine are recommended in the management of COVID-19 to improve the early
detection of renal lesions in patients with COVID-19.
At
patients confirmed with COVID19, elevated levels of highly sensitive troponin I
(hs-cTnI) were observed during hospitalization, and
more than 50% of those who died had a significantly higher concentration of hs-cTnI compared to the biological interval of reference.
Hyperferritinemia has been associated with an increased severity of
COVID-19 disease, because of elevated ferritin levels compared to the reference
biological range, the so-called "cytokine storm" is developed which
can be fatal for half of COVID-19 patients, especially for the elderly.
Lactate dehydrogenase
(LDH) has been associated with altered outcomes in patients with viral
infections. In an American study (n = 1532 COVID-19 patients), the association
between elevated LDH levels (that were measured as soon as possible after hospitalization ) and the severity of the disease in
patients with COVID-19 was assessed. Elevated LDH levels were associated with a
6 fold increase in the chance of developing severe
symptoms and a 16 fold increase in mortality in patients with COVID-19.
C-reactive protein (CRP) is part of the
acute phase plasma proteins. COVID-19 increases CRP. This seems to correlate
the severity and prognosis of the disease. Studies have found low levels of PCR
in patients who do not require oxygen therapy (mean 11 mg / L,) compared to
patients who have become hypoxemic (mean 66 mg / L).
Keywords: hematological parameters, biochemical markers, severe
evolution of COVID-19
DOI https://doi.org/10.56082/annalsarscibio.2020.2.88
