Indian Journal of Medical Biochemistry

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VOLUME 25 , ISSUE 2 ( May-August, 2021 ) > List of Articles


Biochemical Markers Associated with COVID-19 Disease Severity in a Tertiary Care Teaching Hospital

Keywords : Biomarkers, Coronavirus disease-2019, C-reactive protein, Ferritin, Lactate dehydrogenase, Procalcitonin

Citation Information : Biochemical Markers Associated with COVID-19 Disease Severity in a Tertiary Care Teaching Hospital. Indian J Med Biochem 2021; 25 (2):83-87.

DOI: 10.5005/jp-journals-10054-0183

License: CC BY-NC 4.0

Published Online: 29-10-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Aims and objectives: The coronavirus disease-2019 (COVID-19) pandemic has led to an urgent need for reliable biomarkers to identify disease severity. Infection with COVID-19 is rapidly spreading posing a serious threat to community health. This study aims to identify the most effective biomarker among C-reactive protein, procalcitonin, lactate dehydrogenase, and ferritin to predict disease severity. The routine biochemical markers (LFT, RFT, electrolytes, CKNAC, CKMB, blood glucose level) were also evaluated for correlation with disease severity. Materials and methods: The present study is retrospective type. The study protocol was approved by IEC. The levels of biochemical markers of admitted COVID-19 positive patients were analyzed after determining the normal distribution and their significance was determined by calculating the p value. The accuracy of the biomarkers [C-reactive protein (CRP), PCT, lactate dehydrogenase (LDH), and ferritin] was checked using ROC analysis. Results: Five hundred and ninety-one COVID-19 positive patients admitted to the hospital (from May 2020 to December 2020) were considered for the study. Out of these 231 (39.1%) were admitted to the intensive care unit (ICU) and 360 (61%) were in-ward patients. The mean age of the study population was 50.39 ± 16.7, with ICU patients significantly older than non-ICU patients (p < 0.001) and 50–75 years being the most common age group. There was a statistically significant difference in the values of CRP, LDH, PCT, ferritin, AST, albumin, urea, CKNAC, sodium, potassium, and blood glucose levels (p value < 0.05). Conclusion: The severity of COVID-19 disease can be identified at an early stage by following the different routine biochemical marker levels and subsequently improve prognosis. Inflammatory markers (CRP, PCT, LDH, and ferritin) serve as useful guidance for determining disease severity in COVID-19 patients.

  1. Organization WH, Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance, 13 March 2020. World Health Organization, 2020.
  2. Mattiuzzi C, Lippi G. Which lessons shall we learn from the 2019 novel coronavirus outbreak? Ann Transl Med 2020;8(3):48. DOI: 10.21037/atm.2020.02.06.
  3. Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Eng J Med 2020;80(6):656–665. DOI: 10.1056/NEJMoa2002032.
  4. Ai T, Yang Z, Hou H, et al. Correlation of chest CT and RT-PCR testing in coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology 2020(2):200642. DOI: 10.1148/radiol.2020200642.
  5. Rodriguez-Morales AJ, Cardona-Ospina JA, Villamizar-Pena R, et al. Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis. Travel Med Infect Dis 2020. 101623. DOI: 10.1016/j.tmaid.2020.101623.
  6. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARSCoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respirat Med 2020;8(5):P475–P481. DOI: 10.1016/S2213-2600(20)30079-5.
  7. Liu K, Fang Y-Y, Deng Y, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J 2020;133(9):1025–1031. DOI: 10.1097/CM9.0000000000000744.
  8. 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):791–796. DOI: 10.1002/jmv.25770.
  9. Mardani R, Vasmehjani AA, Zali F, et al. Laboratory parameters in detection of COVID-19 patients with positive RT-PCR; a diagnostic accuracy study. Archi Acade Emerg Med 2020;8(1):e43.
  10. Xiang J, Wen J, Yuan X, et al. Potential biochemical markers to identify severe cases among COVID-19 patients. medRxiv 2020. preprint 10.1101/2020.03.19.20034447.
  11. Al Ghamdi M, Alghamdi KM, Ghandoora Y, et al. Treatment outcomes for patients with middle Eastern respiratory syndrome coronavirus (MERS CoV) infection at a coronavirus referral center in the Kingdom of Saudi Arabia. BMC Infect Dis 2016;16(1):17. DOI: 10.1186/s12879-016-1492-4.
  13. Strategy for COVID19 testing in India (Version 5, dated 18/05/2020).
  14. Randox Kit Inserts, Abbott kit inserts and Quidel Triage Troponin I Panel for considered parameters.
  15. Burtis C, Ashwood E, Bruns D. Tietz textbook of clinical chemistry and molecular diagnostics. 5th ed., Ch. 60, Elsevier; 2012. p. 2131.
  16. Mcpherson P. Henry's clinical diagnosis and management by laboratory methods. Appendix 5, Table A5-4, 23rd ed., Elsevier; 2007. p. 1555.
  17. Zheng F, Tang W, Li H, et al. Clinical characteristics of 161 cases of coronavirus disease 2019 (COVID-19) in Changsha. Eur Rev Med Pharmacol Sci 2020;24(6):3404–3434. DOI: 10. 10.26355/eurrev_202003_20711.
  18. Chen G, Wu D, Guo W, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest 2020;130(5):2620–2629. DOI: 10.1172/JCI137244.
  19. Szarpak L, Ruetzler K, Safiejko K, et al. Lactate dehydrogenase level as a COVID-19 severity marker. Am J Emerg Med 2021;45:638–639. DOI: 10.1016/j.ajem.2020.11.025.
  20. Lopez C, Kim J, Pandey A, et al. Simultaneous onset of COVID-19 and autoimmune haemolytic anaemia. Br J Haematol 2020;190(1):31–32. DOI: 10.1111/bjh.16786.
  21. Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis 2020;71(15):762–768. DOI: 10.1093/cid/ciaa248.
  22. Zheng Y, Xu H, Yang M, et al. Epidemiological characteristics and clinical features of 32 critical and 67 noncritical cases of COVID-19 in Chengdu. J Clin Virol 2020;127:104366. DOI: 10.1016/j.jcv.2020.104366.
  23. Carubbi F, Salvati L, Alunno A, et al. Ferritin is associated with the severity of lung involvement but not with worse prognosis in patients with COVID-19: data from two Italian COVID-19 units. Sci Rep 2021;11:4863. DOI: 10.1038/s41598-021-83831-8.
  24. Ruscitti P, Berardicurti O, Barile A, et al. Severe COVID-19 and related hyperferritinaemia: more than an innocent bystander? Ann Rheuma Dis 2020;79(11):1515–1516. DOI: 10.1136/annrheumdis-2020-217618.
  25. Liu F, Li L, Xu M, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol 2020;127:104370. DOI: 10.1016/j.jcv.2020.104370.
  26. Tersalvi G, Vicenzi M, Calabretta D, et al. Elevated troponin in patients with coronavirus disease 2019: possible mechanisms. J Card Fail 2020;26(6):470–475. DOI: 10.1016/j.cardfail.2020. 04.009.
  27. Asghar MS, Haider Kazmi SJ, Ahmed Khan N, et al. Clinical profiles, characteristics, and outcomes of the first 100 admitted COVID-19 patients in Pakistan: a single-center retrospective study in a tertiary care hospital of Karachi. Cureus 2020;12(6):e8712. DOI: 10.7759/cureus.c34.
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