Title : Inflammatory markers and hematologic indices in the prediction of severity of COVID-19: A single center study in southern philippines
Abstract:
Background: Various diagnostic tests across COVID-19 literatures were employed as surrogate markers in COVID-19, wherein interleukin-6 (IL-6) – gauge for cytokine storm or impending severity – is not readily available among the third world countries particularly the Philippines. Objectives: This study determined the clinical value of inflammatory markers and hematologic indices as warning indicators in the prediction of severity of COVID-19 infection. Cut-off values were also determined. Methods: Demographics, baseline inflammatory markers and hematologic indices were retrieved from the database covering April-December 2020 as a single-center retrospective cohort. Univariate, Multivariate, and Receiver Operator Characteristic analyses were done. Results: There were 1,368 patients: 845 nonsevere cases (61.77%) and 523 severe cases (38.23%). Diabetes, hypertension, leukemia, cancer, cardiovascular disease, chronic lung disease, liver disease and chronic kidney disease are seen more in severe group. HIV did not establish significant difference between two groups. Markers C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin & procalcitonin; and indices neutrophil-to-lymphocyte ratio (NLR), fibrinogen, & D-dimer are significantly higher in severe group. Diabetes (OR 2.19, 95% CI 1.01-4.76 p<0.05) and cancer (OR 4.58, 95% CI 1.24-4.76 p<0.05) emerged as potent independent risk factors for COVID severity. CRP (OR 1.24, 95% CI 1.12-1.37 p<0.05), LDH (OR 1.02, 95% CI 1.001-1.004 p<0.05), and ferritin (OR 1.004, 0.998-1.009 p<0.05) show the highest predictive value in developing severe COVID-19. Optimal cut-off values predictive of severity were determined more than 1.85 mg/dL for CRP (79% Sensitivity, 84% Specificity), more than 644.85 U/L for LDH (78.7% Sensitivity, 81.6% Specificity), and more than 621.4 ng/mL for ferritin (71.3% Sensitivity, 74.8% Specificity). Conclusion: Nonsevere cases with diabetes, cancer, and high levels of CRP (>1.85 mg/dL), LDH (>644.85 U/L), and ferritin (>621.4 ng/mL) have high predilection to become severe or O2-requiring in the course of infection. Utmost caution and monitoring at the onset are warranted. Keywords: Severe COVID-19, Inflammatory markers, Hematologic Indices, CRP, LDH, Ferritin
Audience take away:
- To discern what are the risks for having COVID-19 Severe
- To know the cohort of patients who contract COVID Infection that need further monitoring
- To know the predictors or comorbidities that carry risks of having Severe COVID-19
- To know Diagnostic Tests that are high yield in predicting COVID-19 Severe or to those that might need further monitoring
