Indian Journal of Medical Biochemistry

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VOLUME 24 , ISSUE 2 ( May-August, 2020 ) > List of Articles

REVIEW ARTICLE

Laboratory Changes in SARS-CoV-2 Infection: A Review

Devesh Sharma, Mohit Mehndiratta, Dinesh Puri

Keywords : Acute respiratory distress syndrome, Biochemical and hematological changes, COVID-19, Pandemic, SARS-CoV-2

Citation Information : Sharma D, Mehndiratta M, Puri D. Laboratory Changes in SARS-CoV-2 Infection: A Review. Indian J Med Biochem 2020; 24 (2):62-65.

DOI: 10.5005/jp-journals-10054-0142

License: CC BY-NC 4.0

Published Online: 05-01-2021

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim: To review the updated literature to find out the biochemical and hematological changes that occur in the SARS CoV-2 (COVID-19) infection that is causing the ongoing global pandemic. Background: The outbreak of COVID-19 infection began in December 2019 in Wuhan, Hubei province, and within a few months, by March 2019, it had taken the shape of a pandemic. Six months down the road, knowledge about the pathogenesis of this infection has grown rapidly. Although it is predominantly a respiratory infection, COVID-19 is now known to affect almost every organ of the body. The unpredictable clinical course has been attributed to multiple biochemical and hematological changes that are caused by the COVID-19 virus. Review results: An in-depth analysis of recently published data has highlighted that various biochemical and hematological alterations can be attributed to COVID-19 infection. These include hypoalbuminemia, reduced number of lymphocytes, elevated levels of aspartate transaminase (AST), homocysteine, and biomarkers such as ferritin. Other parameters such as lactate dehydrogenase (LDH), C-reactive protein (CRP), IL-6, Procalcitonin (PCT), D-Dimer, neutrophil–lymphocyte ratio (NLR), and angiotensin II correlate with the extent of viral load and predicted the course of the disease. Conclusion: Knowledge about the alteration biochemical and hematological markers in the COVID-19 infection is helpful in the estimation of the extent of viral load and in the prediction of the clinical course of the infection. Clinical significance: Monitoring the biochemical and hematological biomarkers, especially, CRP, ferritin, LDH, D-Dimer, and NLR, is useful for triaging patients infected with COVID-19 early in the course of disease and thus may prevent disease progression by the institution of early interventions.


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  1. @OurWorldInData Total confirmed COVID-19 deaths: how rapidly are they increasing?: @OurWorldInData, 2020. Available: https://ourworldindata.org/grapher/covid-confirmed-deaths-since-5th-death.
  2. Esakandari H, Nabi-Afjadi M, Fakkari-Afjadi J, et al., A comprehensive review of COVID-19 characteristics. Biol Proced Online [Internet]. 2020 Aug 4 [cited 2020 Sep 24];22. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402395/.
  3. Lin L, Lu L, Cao W, et al. Hypothesis for potential pathogenesis of SARS-CoV-2 infection-a review of immune changes in patients with viral pneumonia. Emerg Microbes Infect 2020;9(1):727–732. DOI: 10.1080/22221751.2020.1746199.
  4. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China - PubMed [Internet]. [cited 2020 Sep 25]. Available from: https://pubmed.ncbi.nlm.nih.gov/31986264/.
  5. Cytokine release syndrome in severe COVID-19: interleukin-6 receptor antagonist tocilizumab may be the key to reduce mortality - PubMed [Internet]. [cited 2020 Sep 25]. Available from: https://pubmed.ncbi.nlm.nih.gov/32234467/.
  6. Henry BM, de Oliveira MHS, Benoit S, et al. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med CCLM 2020;58(7):1021–1028. DOI: 10.1515/cclm-2020-0369.
  7. Yang Z, Shi J, He Z, et al. Predictors for imaging progression on chest CT from coronavirus disease 2019 (COVID-19) patients. Aging 2020;12(7):6037–6048. DOI: 10.18632/aging.102999Google Search [Internet]. [cited 2020 Sep 25]. Available from: https://www.google.com/search?q=Yang+Z%2C+Shi+J%2C+He+Z%2C+et+al.+Predictors+for+imaging+progression+on+chest+CT+from+coronavirus+disease+2019+(COVID-19)+patients.+Aging.+2020%3B12%3A6037%E2%80%936048.&oq=Yang+Z%2C+Shi+J%2C+He+Z%2C+et+al.+Predictors+for+imaging+progression+on+chest+CT+from+coronavirus+disease+2019+(COVID-19)+patients.+Aging.+2020%3B12%3A6037%E2%80%936048.&aqs=chrome.69i57.24083j0j4&sourceid=chrome&ie=UTF-8.
  8. Characterization of the receptor-binding domain (RBD) of 2019 novel coronavirus: implication for development of RBD protein as a viral attachment inhibitor and vaccine | Cellular & Molecular Immunology [Internet]. [cited 2020 Sep 25]. Available from: https://www.nature.com/articles/s41423-020-0400-4.
  9. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020;8(5):475–481. DOI: 10.1016/S2213-2600(20)30079-5.
  10. Lei F, Liu Y-M, Zhou F, et al. Longitudinal association between markers of liver injury and mortality in COVID-19 in China. Hepatology 2020;72(2):389–398. DOI: 10.1002/hep.31301.
  11. Tan C, Huang Y, Shi F, et al. C-reactive protein correlates with CT findings and predicts severe COVID-19 early. J Med Virol 2020;92(7):856–862. DOI: 10.1002/jmv.25871.
  12. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus- infected pneumonia in Wuhan, China. JAMA 2020;323(11):1061–1069. DOI: 10.1001/jama.2020. 1585.
  13. Mehta P, McAuley DF, Brown M, et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020;395(10229):1033–1034. DOI: 10.1016/S0140-6736(20)30628-0.
  14. Lippi G, Plebani M. Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): a metaanalysis. Clin Chim Acta 2020;505:190–191. DOI: 10.1016/j.cca.2020.03.004.
  15. Du R-H, Liang L-R, Yang C-Q, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J 2020;55(5):2000524. DOI: 10.1183/13993003.00524-2020.
  16. Cossarizza A, De Biasi S, Guaraldi G, et al. SARS-CoV-2, the virus that causes COVID-19. Cytometry 2020;97(4):340–343. DOI: 10.1002/cyto.a.24002.
  17. Long L, Zeng X, Zhang X, et al. Short-term outcomes of coronavirus disease 2019 and risk factors for progression. Eur Respir J 2020;55(5):2000990. DOI: 10.1183/13993003.00990-2020.
  18. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis. Clin Chim Acta 2020;506:145–148. DOI: 10.1016/j.cca.2020.03.022.
  19. Lippi G, Favaloro EJ. D-dimer is associated with severity of coronavirus disease 2019: a pooled analysis. Thromb Haemost 2020;120(5):876–878. DOI: 10.1055/s-0040-1709650.
  20. Wang K, Zuo P, Liu Y, et al. Clinical and laboratory predictors of in-hospital mortality in patients with COVID-19: a cohort study in Wuhan, China. Clin Infect Dis 2020. ciaa538. DOI: 10.1093/cid/ciaa538.
  21. 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(4):844–847. DOI: 10.1111/jth.14768.
  22. Donoghue M, Hsieh F, Baronas E, et al. A novel angiotensin-converting enzyme-related carboxypeptidase (ACE2) converts angiotensin I to angiotensin 1-9. Circ Res 2000;87(5):E1–E9. DOI: 10.1161/01.RES.87.5.e1.
  23. Russwurm S, Wiederhold M, Oberhoffer M, et al. Molecular aspects and natural source of procalcitonin. Clin Chem Lab Med 1999;37(8):789–797. DOI: 10.1515/CCLM.1999.119.
  24. Cleland DA, Eranki AP. Procalcitonin. StatPearls; [Internet]. Treasure Island (FL): StatPearls Publishing; 2020.
  25. Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis 2020(15). DOI: 10.1093/cid/ciaa248.
  26. Lippi G, Henry BM. Eosinophil count in severe coronavirus disease 2019 (COVID-19). QJM Mon J Assoc Phys 2020;113(7):511–512.
  27. Bhat T, Teli S, Rijal J, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther 2013;11(1):55–59. DOI: 10.1586/erc.12.159.
  28. Yan Q, Li P, Ye X, et al. Longitudinal peripheral blood transcriptional analysis of COVID-19 patients captures disease progression and reveals potential biomarkers. medRxiv 2020.
  29. Jolicoeur P, Lamontagne L. Impairment of bone marrow pre-B and B cells in MHV3 chronically-infected mice. Adv Exp Med Biol 1995;380:193–195.
  30. Xu P, Zhou Q, Xu J. Mechanism of thrombocytopenia in COVID-19 patients. Ann Hematol 2020. 1–4.
  31. Terpos E, Ntanasis-Stathopoulos I, Elalamy I, et al. Hematological findings and complications of COVID-19. Am J Hematol 2020;95(7): 834–847. DOI: 10.1002/ajh.25829.
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