The Evaluation of Hematological Parameters and Their Correlation with Disease Prognosis in COVID-19 Disease in Iran
-
Farhad Shahi
,
Reza Safaee
,
Saba Fekrvand
,
Fatemeh Fathi
,
Mohammad Reza Dabiri
,
Alireza Abdollahi
,
Hanieh Hosseini
Abstract
Background: Since 2019, Coronavirus has been a highly contagious disease. The COVID-19 outbreak was declared a pandemic by the World Health Organization in March 2020. Variable laboratory findings are reported in COVID-19 patients, among which elevated levels of D-dimer, lactate dehydrogenase, as well as lymphopenia, have been reported to be associated with increased severity of disease symptoms requiring ventilator support, intensive care unit admission, and mortality.
Materials and Methods: In the current study, inclusion criteria were: patient age above 18 years and hospitalization in the Imam Khomeini hospital with COVID-19 disease confirmed with nasopharyngeal swab polymerase chain reaction tests. Levels of white blood cells, neutrophils, lymphocytes, hemoglobin, platelets, D-dimer, C-reactive protein, LDH, and ferritin were measured and their correlation with the final patients’ outcome was evaluated.
Results: A total of 208 patients were included in the present study. Higher neutrophil to lymphocyte ratio, (WBC count excluding lymphocyte)/lymphocyte, LDH, platelet to lymphocyte ratio, ferritin, and D-dimer were significantly related to O2 dependency. Neutrophil to lymphocyte ratio, (WBC count excluding lymphocyte)/lymphocyte and LDH were significantly related to higher rates of mortality. Higher Hb and lymphocyte count were significantly related to higher rates of survival.
Conclusion: Hematological parameters including neutrophil to lymphocyte ratio, (WBC count excluding lymphocyte)/lymphocyte, LDH, platelet to lymphocyte ratio, ferritin, D-dimer, Hb, and lymphocyte count were significantly related to the prognosis of patients with COVID-19 disease. This could help decide which COVID-19 patients have priority for hospitalization and intensive medical care, particularly when the pandemic disease causes limitations in healthcare service.
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2. Reyes JG, Farias JG, Henríquez-Olavarrieta S, et al. The hypoxic testicle: physiology and pathophysiology. Oxid Med Cell Longev. 2012;2012:929285.
3. Jiang F, Deng L, Zhang L, et al. Review of the clinical characteristics of coronavirus disease 2019 (COVID-19). J Gen Intern Med. 2020;35(5):1545-1549.
4. Altavilla D, Romeo C, Squadrito F, et al. Molecular pathways involved in the early and late damage induced by testis ischemia: evidence for a rational pharmacological modulation. Curr Med Chem. 2012;19(8):1219-24.
5. Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. Bmj. 2020;368:m1091.
6. Yüce M, Filiztekin E, Özkaya KG. COVID-19 diagnosis —A review of current methods. Biosens Bioelectron. 2021;172:112752.
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8. Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43.
9. Shi S, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802-810.
10. Bourouiba L. Turbulent gas clouds and respiratory pathogen emissions: potential implications for reducing transmission of COVID-19. JAMA. 2020;323(18):1837-8.
11. Yao Y, Cao J, Wang Q, et al. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study. J Intensive Care. 2020;8:49.
12. Fan BE. Hematologic parameters in patients with COVID-19 infection: a reply. Am J Hematol. 2020;95(8):E215.
13. Terpos E, Ntanasis‐Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, et al. Hematological findings and complications of COVID‐19. American journal of hematology. 2020;95(7):834-47.
14. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
15. Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033-4.
16. Tay MZ, Poh CM, Rénia L, et al. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol. 2020;20(6):363-74.
17. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420-422.
18. Del Valle DM, Kim-Schulze S, Huang H-H, et al. An inflammatory cytokine signature predicts COVID-19 severity and survival. Nat Med. 2020;26(10):1636-43.
19. Zeng F, Huang Y, Guo Y, et al. Association of inflammatory markers with the severity of COVID-19: A meta-analysis. Int J Infect Dis. 2020;96:467-74.
20. Guthrie GJ, Charles KA, Roxburgh CS, et al. The systemic inflammation-based neutrophil–lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol. 2013;88(1):218-30
21. Hu H, Yao X, Xie X, et al. Prognostic value of preoperative NLR, dNLR, PLR and CRP in surgical renal cell carcinoma patients. World J Urol. 2017;35(2):261-270.
22. Wang M, Zhu Q, Fu J, et al. Differences of inflammatory and non-inflammatory indicators in Coronavirus disease-19 (COVID-19) with different severity. Infect Genet Evol. 2020;85:104511.
23. Yang AP, Liu Jp, Tao Wq, et al. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504.
24. Seddigh-Shamsi M, Mahali SN, Mozdourian M, et al. Investigation of hematological parameters related to the severity of COVID-19 disease in Mashhad, Iran. Immunopathol Persa. 2021;7(2):e19.
25. Waris A, Din M, Khalid A, et al. Evaluation of hematological parameters as an indicator of disease severity in Covid‐19 patients: Pakistan's experience. J Clin Lab Anal. 2021;35(6):e23809.
26. Zhou Y, Fu B, Zheng X, et al. Pathogenic T-cells and inflammatory monocytes incite inflammatory storms in severe COVID-19 patients. Natl Sci Rev. 2020;7(6):998-1002.
27. Elshazli RM, Toraih EA, Elgaml A, et al. Diagnostic and prognostic value of hematological and immunological markers in COVID-19 infection: A meta-analysis of 6320 patients. PloS One. 2020;15(8):e0238160.
28. Henry BM. COVID-19, ECMO, and lymphopenia: a word of caution. Lancet Respir Med. 2020;8(4):e24.
29. Wang L, He WB, Yu XM, et al. Prolonged prothrombin time at admission predicts poor clinical outcome in COVID-19 patients. World J Clin Cases. 2020;8(19):4370-4379.
30. Kuper H, Adami HO, Trichopoulos D. Infections as a major preventable cause of human cancer. J Intern Med. 2000;248(3):171-83.
31. Blaser MJ, Chyou P, Nomura A. Age at establishment of Helicobacter pylori infection and gastric carcinoma, gastric ulcer, and duodenal ulcer risk. Cancer Res. 1995;55(3):562-5.
32. Scholl S, Pallud C, Beuvon F, et al. Anti-colony-stimulating factor-1 antibody staining in primary breast adenocarcinomas correlates with marked inflammatory cell infiltrates and prognosis. J Natl Cancer Inst. 1994;86(2):120-6.
33. Shacter E, Weitzman SA. Chronic inflammation and cancer. Oncology (Williston Park). 2002;16(2):217-26.
34. Menges T, Engel J, Welters I, et al. Changes in blood lymphocyte populations after multiple trauma: association with posttraumatic complications. Crit care Med. 1999;27(4):733-40.
35. Waris A, Din M, Khalid A, et al. Evaluation of hematological parameters as an indicator of disease severity in Covid-19 patients: Pakistan's experience. J Clin Lab Anal. 2021;35(6):e23809.
36. Bonow RO, Fonarow GC, O’Gara PT, et al. Association of coronavirus disease 2019 (COVID-19) with myocardial injury and mortality. JAMA Cardiol. 2020;5(7):751-3.
37. Gasparyan AY, Ayvazyan L, Mukanova U, et al. The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases. Ann Lab Med. 2019;39(4):345-357.
38. Tao Z, Xu J, Chen W, et al. Anemia is associated with severe illness in COVID-19: A retrospective cohort study. J Med Virol. 2021;93(3):1478-88.
39. Lin Z, Long F, Yang Y, et al. Serum ferritin as an independent risk factor for severity in COVID-19 patients. J Infect. 2020;81(4):647-79.
40. Rhodes CE, Denault D, Varacallo M. Physiology, Oxygen Transport. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.
2022 Nov 14.
41. Taneri PE, Gómez-Ochoa SA, Llanaj E, et al. Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis. Eur J Epidemiol. 2020;35(8):763-773.
42. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.
43. Ali N. Elevated level of C-reactive protein may be an early marker to predict risk for severity of COVID-19. J Med Virol. 2020;92(11):2409-11.
44. Gao Y, Li T, Han M, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol. 2020;92(7):791-6.
45. Guan Wj, Ni Zy, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. Clin Infect Dis. 2021;73(11):e4208-e4213.
46. Liao D, Zhou F, Luo L, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study. Lancet Haematol. 2020;7(9):e671-e8.
47. Tang N, Li D, Wang X, et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(5):1233-1234.
48. Campbell CM, Kahwash R. Will complement inhibition be the new target in treating COVID-19–related systemic thrombosis? Circulation. 2020;141(22):1739-41.
49. Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417-8.
50. Oudkerk M, Büller HR, Kuijpers D, et al. Diagnosis, prevention, and treatment of thromboembolic complications in COVID-19: report of the National Institute for Public Health of the Netherlands. Radiology. 2020;297(1):E216-E222.
51. Klok FA, Kruip MJHA, van der Meer NJM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thromb Res. 2020;191:148-50.
52. Lodigiani C, Iapichino G, Carenzo L, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020;191:9-14.
2. Reyes JG, Farias JG, Henríquez-Olavarrieta S, et al. The hypoxic testicle: physiology and pathophysiology. Oxid Med Cell Longev. 2012;2012:929285.
3. Jiang F, Deng L, Zhang L, et al. Review of the clinical characteristics of coronavirus disease 2019 (COVID-19). J Gen Intern Med. 2020;35(5):1545-1549.
4. Altavilla D, Romeo C, Squadrito F, et al. Molecular pathways involved in the early and late damage induced by testis ischemia: evidence for a rational pharmacological modulation. Curr Med Chem. 2012;19(8):1219-24.
5. Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. Bmj. 2020;368:m1091.
6. Yüce M, Filiztekin E, Özkaya KG. COVID-19 diagnosis —A review of current methods. Biosens Bioelectron. 2021;172:112752.
7. https://coronavirus.jhu.edu/data/mortality.
8. Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43.
9. Shi S, Qin M, Shen B, et al. Association of cardiac injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802-810.
10. Bourouiba L. Turbulent gas clouds and respiratory pathogen emissions: potential implications for reducing transmission of COVID-19. JAMA. 2020;323(18):1837-8.
11. Yao Y, Cao J, Wang Q, et al. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: a case control study. J Intensive Care. 2020;8:49.
12. Fan BE. Hematologic parameters in patients with COVID-19 infection: a reply. Am J Hematol. 2020;95(8):E215.
13. Terpos E, Ntanasis‐Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, et al. Hematological findings and complications of COVID‐19. American journal of hematology. 2020;95(7):834-47.
14. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.
15. Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395(10229):1033-4.
16. Tay MZ, Poh CM, Rénia L, et al. The trinity of COVID-19: immunity, inflammation and intervention. Nat Rev Immunol. 2020;20(6):363-74.
17. Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420-422.
18. Del Valle DM, Kim-Schulze S, Huang H-H, et al. An inflammatory cytokine signature predicts COVID-19 severity and survival. Nat Med. 2020;26(10):1636-43.
19. Zeng F, Huang Y, Guo Y, et al. Association of inflammatory markers with the severity of COVID-19: A meta-analysis. Int J Infect Dis. 2020;96:467-74.
20. Guthrie GJ, Charles KA, Roxburgh CS, et al. The systemic inflammation-based neutrophil–lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol. 2013;88(1):218-30
21. Hu H, Yao X, Xie X, et al. Prognostic value of preoperative NLR, dNLR, PLR and CRP in surgical renal cell carcinoma patients. World J Urol. 2017;35(2):261-270.
22. Wang M, Zhu Q, Fu J, et al. Differences of inflammatory and non-inflammatory indicators in Coronavirus disease-19 (COVID-19) with different severity. Infect Genet Evol. 2020;85:104511.
23. Yang AP, Liu Jp, Tao Wq, et al. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504.
24. Seddigh-Shamsi M, Mahali SN, Mozdourian M, et al. Investigation of hematological parameters related to the severity of COVID-19 disease in Mashhad, Iran. Immunopathol Persa. 2021;7(2):e19.
25. Waris A, Din M, Khalid A, et al. Evaluation of hematological parameters as an indicator of disease severity in Covid‐19 patients: Pakistan's experience. J Clin Lab Anal. 2021;35(6):e23809.
26. Zhou Y, Fu B, Zheng X, et al. Pathogenic T-cells and inflammatory monocytes incite inflammatory storms in severe COVID-19 patients. Natl Sci Rev. 2020;7(6):998-1002.
27. Elshazli RM, Toraih EA, Elgaml A, et al. Diagnostic and prognostic value of hematological and immunological markers in COVID-19 infection: A meta-analysis of 6320 patients. PloS One. 2020;15(8):e0238160.
28. Henry BM. COVID-19, ECMO, and lymphopenia: a word of caution. Lancet Respir Med. 2020;8(4):e24.
29. Wang L, He WB, Yu XM, et al. Prolonged prothrombin time at admission predicts poor clinical outcome in COVID-19 patients. World J Clin Cases. 2020;8(19):4370-4379.
30. Kuper H, Adami HO, Trichopoulos D. Infections as a major preventable cause of human cancer. J Intern Med. 2000;248(3):171-83.
31. Blaser MJ, Chyou P, Nomura A. Age at establishment of Helicobacter pylori infection and gastric carcinoma, gastric ulcer, and duodenal ulcer risk. Cancer Res. 1995;55(3):562-5.
32. Scholl S, Pallud C, Beuvon F, et al. Anti-colony-stimulating factor-1 antibody staining in primary breast adenocarcinomas correlates with marked inflammatory cell infiltrates and prognosis. J Natl Cancer Inst. 1994;86(2):120-6.
33. Shacter E, Weitzman SA. Chronic inflammation and cancer. Oncology (Williston Park). 2002;16(2):217-26.
34. Menges T, Engel J, Welters I, et al. Changes in blood lymphocyte populations after multiple trauma: association with posttraumatic complications. Crit care Med. 1999;27(4):733-40.
35. Waris A, Din M, Khalid A, et al. Evaluation of hematological parameters as an indicator of disease severity in Covid-19 patients: Pakistan's experience. J Clin Lab Anal. 2021;35(6):e23809.
36. Bonow RO, Fonarow GC, O’Gara PT, et al. Association of coronavirus disease 2019 (COVID-19) with myocardial injury and mortality. JAMA Cardiol. 2020;5(7):751-3.
37. Gasparyan AY, Ayvazyan L, Mukanova U, et al. The platelet-to-lymphocyte ratio as an inflammatory marker in rheumatic diseases. Ann Lab Med. 2019;39(4):345-357.
38. Tao Z, Xu J, Chen W, et al. Anemia is associated with severe illness in COVID-19: A retrospective cohort study. J Med Virol. 2021;93(3):1478-88.
39. Lin Z, Long F, Yang Y, et al. Serum ferritin as an independent risk factor for severity in COVID-19 patients. J Infect. 2020;81(4):647-79.
40. Rhodes CE, Denault D, Varacallo M. Physiology, Oxygen Transport. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.
2022 Nov 14.
41. Taneri PE, Gómez-Ochoa SA, Llanaj E, et al. Anemia and iron metabolism in COVID-19: a systematic review and meta-analysis. Eur J Epidemiol. 2020;35(8):763-773.
42. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62.
43. Ali N. Elevated level of C-reactive protein may be an early marker to predict risk for severity of COVID-19. J Med Virol. 2020;92(11):2409-11.
44. Gao Y, Li T, Han M, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol. 2020;92(7):791-6.
45. Guan Wj, Ni Zy, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. Clin Infect Dis. 2021;73(11):e4208-e4213.
46. Liao D, Zhou F, Luo L, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study. Lancet Haematol. 2020;7(9):e671-e8.
47. Tang N, Li D, Wang X, et al. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(5):1233-1234.
48. Campbell CM, Kahwash R. Will complement inhibition be the new target in treating COVID-19–related systemic thrombosis? Circulation. 2020;141(22):1739-41.
49. Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417-8.
50. Oudkerk M, Büller HR, Kuijpers D, et al. Diagnosis, prevention, and treatment of thromboembolic complications in COVID-19: report of the National Institute for Public Health of the Netherlands. Radiology. 2020;297(1):E216-E222.
51. Klok FA, Kruip MJHA, van der Meer NJM, et al. Confirmation of the high cumulative incidence of thrombotic complications in critically ill ICU patients with COVID-19: An updated analysis. Thromb Res. 2020;191:148-50.
52. Lodigiani C, Iapichino G, Carenzo L, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thromb Res. 2020;191:9-14.
| Files | ||
| Issue | Vol 17, No 2 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijhoscr.v17i2.12645 | |
| Keywords | ||
| COVID-19 Hematological parameters Disease prognosi Final outcome ICU admission | ||
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How to Cite
1.
Shahi F, Safaee R, Fekrvand S, Fathi F, Dabiri MR, Abdollahi A, Hosseini H. The Evaluation of Hematological Parameters and Their Correlation with Disease Prognosis in COVID-19 Disease in Iran. Int J Hematol Oncol Stem Cell Res. 2023;17(2):89-99.
