Main Article Content

Karthick Elango https://orcid.org/0009-0006-3358-7532
Sathya Selvarajan https://orcid.org/0000-0002-6390-1522
Sowmya Krishnamurthy https://orcid.org/0000-0002-3070-9411

Abstract

COVID-19 (Corona Virus Disease 2019) was a life-changing pandemic with impact on social, environmental, health, and economic issues. Various inflammatory and hematological biomarkers studied individually or in combination in the literature have shown significant results with regard to COVID-19 pathology, severity, and prognosis. Yet the question of interest is how covid-19 inflammatory cascade impacts the interlink between the biomarkers during different stages. This study aims to retrospectively analyse ferritin, albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, direct bilirubin, blood urea nitrogen (BUN), creatinine, D-dimer, Lactate Dehydrogenase (LDH), C Reactive Protein (CRP) and Interleukin-6 (IL-6) levels between two groups based on COVID-19 severity.  A retrospective cross-sectional study was conducted with laboratory data of COVID-19 patients admitted at Sri Ramachandra Medical College Hospital, India. The sample size was 104 [Group1: severe disease, n=52; Group-2: mild disease, n=52]. After normality testing, data were compared between the two groups followed by correlation analysis between the variables. A p<0.05 was considered statistically significant. On comparison, Group 2 (severe COVID-19 disease) showed significant difference in the levels of all the biomarkers (p<0.005) except Creatinine (p<0.128) when compared with Group 1 (mild COVID-19 disease). Significant correlation was obtained between all biomarkers (p<0.005) except creatinine. The correlation analysis primarily explains the inflammatory cascade involved in disease. Ferritin appears to have a standalone effect on disease severity, progression, organ dysfunction. This understanding can be used to provide better and more timely care.

Downloads

Download data is not yet available.

Article Details

How to Cite
Elango, K., Selvarajan, S. and Krishnamurthy, S. (2024) “Comparative analysis of various laboratory biomarkers based on the severity of COVID-19 in a tertiary care hospital in South India”, Indonesian Journal of Medical Laboratory Science and Technology, 6(1), pp. 35–43. doi: 10.33086/ijmlst.v6i1.5389.
Section
Articles
Biomarkers of inflammation, COVID-19, Laboratory profile in COVID-19, Serum ferritin

References

Ruscitti P, Berardicurti O, Di Benedetto P, Cipriani P, Iagnocco A, Shoenfeld Y, Giacomelli R. Severe COVID-19, another piece in the puzzle of the hyperferritinemic syndrome. An immunomodulatory perspective to alleviate the storm. Frontiers in immunology. 2020 May 28;11:1130. https://doi.org/10.3389%2Ffimmu.2020.01130 DOI: https://doi.org/10.3389/fimmu.2020.01130

Szarpak L, Ruetzler K, Safiejko K, Hampel M, Pruc M, Kanczuga-Koda L, Filipiak KJ, Jaguszewski MJ. Lactate dehydrogenase level as a COVID-19 severity marker. Am J Emerg Med. 2021 Jul 1;45(45):638-9. https://doi.org/10.1016%2Fj.ajem.2020.11.025 DOI: https://doi.org/10.1016/j.ajem.2020.11.025

Wang L. C-reactive protein levels in the early stage of COVID-19. Medecine et maladies infectieuses. 2020 Jun 1;50(4):332-4. https://doi.org/10.1016/j.medmal.2020.03.007 DOI: https://doi.org/10.1016/j.medmal.2020.03.007

Luglio M, Tannuri U, de Carvalho WB, Bastos KL, Rodriguez IS, Johnston C, Delgado AF. COVID-19 and liver damage: narrative review and proposed clinical protocol for critically ill pediatric patients. Clinics. 2020 Nov 11;75. https://doi.org/10.6061/clinics/2020/e2250 DOI: https://doi.org/10.6061/clinics/2020/e2250

Phipps MM, Barraza LH, LaSota ED, Sobieszczyk ME, Pereira MR, Zheng EX, Fox AN, Zucker J, Verna EC. Acute liver injury in COVID‐19: prevalence and association with clinical outcomes in a large US cohort. Hepatology. 2020 Sep;72(3):807-17. https://doi.org/10.1002/hep.31404 DOI: https://doi.org/10.1002/hep.31404

COVID-19 Treatment Guidelines [Internet]. [cited 2023 Nov 3]. Information on COVID-19 Treatment, Prevention and Research. Available from: https://www.covid19treatmentguidelines.nih.gov/

Ghahramani S, Tabrizi R, Lankarani KB, Kashani SM, Rezaei S, Zeidi N, Akbari M, Heydari ST, Akbari H, Nowrouzi-Sohrabi P, Ahmadizar F. Laboratory features of severe vs. non-severe COVID-19 patients in Asian populations: a systematic review and meta-analysis. European journal of medical research. 2020 Dec;25(1):1-0. https://doi.org/10.1186/s40001-020-00432-3 DOI: https://doi.org/10.1186/s40001-020-00432-3

Biju D, Johnson S, Valsan C, Prasad AB, Kuttichira P. Clinicoepidemiological and laboratory findings of COVID positive patients presenting to a tertiary care centre in South India: A retrospective analysis. Clinical Epidemiology and Global Health. 2022 Jan 1;13:100931. https://doi.org/10.1016/j.cegh.2021.100931 DOI: https://doi.org/10.1016/j.cegh.2021.100931

Kurien SS, David RS, Chellappan AK, Varma RP, Pillai PR, Yadev I, Kurien S, David R, Chellappan A, Yadev IP. Clinical profile and determinants of mortality in patients with COVID-19: a retrospective analytical cross-sectional study in a tertiary care center in South India. Cureus. 2022 Mar 12;14(3). https://doi.org/10.7759/cureus.23103 DOI: https://doi.org/10.7759/cureus.23103

Perricone C, Bartoloni E, Bursi R, Cafaro G, Guidelli GM, Shoenfeld Y, Gerli R. COVID-19 as part of the hyperferritinemic syndromes: the role of iron depletion therapy. Immunologic research. 2020 Aug;68:213-24. https://doi.org/10.1007/s12026-020-09145-5 DOI: https://doi.org/10.1007/s12026-020-09145-5

Taniguchi K, Karin M. IL-6 and related cytokines as the critical lynchpins between inflammation and cancer. InSeminars in immunology. 2014 Feb 1;26(1):54-74. https://doi.org/10.1016/j.smim.2014.01.001 DOI: https://doi.org/10.1016/j.smim.2014.01.001

Coomes EA, Haghbayan H. Interleukin‐6 in COVID‐19: a systematic review and meta‐analysis. Reviews in medical virology. 2020 Nov;30(6):1-9. https://doi.org/10.1002/rmv.2141 DOI: https://doi.org/10.1002/rmv.2141

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Yu T. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The lancet. 2020 Feb 15;395(10223):507-13. https://doi.org/10.1016/s0140-6736(20)30211-7 DOI: https://doi.org/10.1016/S0140-6736(20)30211-7

Pepys MB, Hirschfield GM. C-reactive protein: a critical update. The Journal of clinical investigation. 2003 Jun 15;111(12):1805-12. https://doi.org/10.1172/jci18921 DOI: https://doi.org/10.1172/JCI200318921

Liu F, Li L, Xu M, Wu J, Luo D, Zhu Y, Li B, Song X, Zhou X. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. Journal of clinical virology. 2020 Jun 1;127:104370. https://doi.org/10.1016/j.jcv.2020.104370 DOI: https://doi.org/10.1016/j.jcv.2020.104370

Villard O, Morquin D, Molinari N, Raingeard I, Nagot N, Cristol JP, Jung B, Roubille C, Foulongne V, Fesler P, Lamure S. The plasmatic aldosterone and C-reactive protein levels, and the severity of Covid-19: the Dyhor-19 study. Journal of clinical medicine. 2020 Jul 21;9(7):2315. https://doi.org/10.3390/jcm9072315 DOI: https://doi.org/10.3390/jcm9072315

Henry BM, Aggarwal G, Wong J, Benoit S, Vikse J, Plebani M, Lippi G. Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis. The American journal of emergency medicine. 2020 Sep 1;38(9):1722-6. https://doi.org/10.1016%2Fj.ajem.2020.05.073 DOI: https://doi.org/10.1016/j.ajem.2020.05.073

Li C, Ye J, Chen Q, Hu W, Wang L, Fan Y, Lu Z, Chen J, Chen Z, Chen S, Tong J. Elevated lactate dehydrogenase (LDH) level as an independent risk factor for the severity and mortality of COVID-19. Aging (Albany NY). 2020 Aug 8;12(15):15670. https://doi.org/10.18632/aging.103770 DOI: https://doi.org/10.18632/aging.103770

Luo W, Yu H, Gou J, Li X, Sun Y, Li J, Liu L. Clinical pathology of critical patient with novel coronavirus pneumonia (COVID-19). Preprints. 2020;2020020407. https://www.preprints.org/manuscript/202002.0407/v1

Li Y, Zhao K, Wei H, Chen W, Wang W, Jia L, Liu Q, Zhang J, Shan T, Peng Z, Liu Y. Dynamic relationship between D‐dimer and COVID‐19 severity. British journal of haematology. 2020 Jul;190(1):e24. https://doi.org/10.1111/bjh.16811 DOI: https://doi.org/10.1111/bjh.16811

Gupta N, Zhao YY, Evans CE. The stimulation of thrombosis by hypoxia. Thrombosis research. 2019 Sep 1;181:77-83. https://doi.org/10.1016/j.thromres.2019.07.013 DOI: https://doi.org/10.1016/j.thromres.2019.07.013

Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. Journal of thrombosis and hemostasis. 2020 May 1;18(5):1094-9. https://doi.org/10.1111/jth.14817 DOI: https://doi.org/10.1111/jth.14817

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, Xiang J, Wang Y, Song B, Gu X, Guan L. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The lancet. 2020 Mar 28;395(10229):1054-62. https://doi.org/10.1016/s0140-6736(20)30566-3 DOI: https://doi.org/10.1016/S0140-6736(20)30566-3

Abdelrahman MM, Abdel-Baset AA, Younis MA, Mahmoud MG, Shafik NS. Liver function test abnormalities in COVID-19 patients and factors affecting them - a retrospective study. Clin Exp Hepatol. 2021 Sep;7(3):297-304. https://doi.org/10.5114/ceh.2021.109225 DOI: https://doi.org/10.5114/ceh.2021.109225

Han X, Ye Q. Kidney involvement in COVID-19 and its treatments. J Med Virol. 2021 Mar;93(3):1387-1395. doi: 10.1002/jmv.26653. Epub 2020 Nov 22. https://doi.org/10.1002/jmv.26653 DOI: https://doi.org/10.1002/jmv.26653

Yamamoto A, Wada H, Ichikawa Y, Mizuno H, Tomida M, Masuda J, Makino K, Kodama S, Yoshida M, Fukui S, Moritani I. Evaluation of biomarkers of severity in patients with COVID-19 infection. Journal of clinical medicine. 2021 Aug 24;10(17):3775. https://doi.org/10.3390%2Fjcm10173775 DOI: https://doi.org/10.3390/jcm10173775

Chen L, Liu HG, Liu W, Liu J, Liu K, Shang J, Deng Y, Wei S. Analysis of clinical features of 29 patients with 2019 novel coronavirus pneumonia. Zhonghua jie he he hu xi za zhi= Zhonghua jiehe he huxi zazhi= Chinese journal of tuberculosis and respiratory diseases. 2020 Feb 6;43:E005. https://doi.org/10.3760/cma.j.issn.1001-0939.2020.0005

Chen C, Yan JT, Zhou N, Zhao JP, Wang DW. Analysis of myocardial injury in patients with COVID-19 and association between concomitant cardiovascular diseases and severity of COVID-19. Zhonghua xin xue guan bing za zhi. 2020:567-71. https://doi.org/10.3760/cma.j.cn112148-20200225-00123