Evaluation of hematological parameters as an indicator of disease severity in Covid-19 patients: Pakistan's experience.

BACKGROUND: The severity of COVID-19 could be evaluated by examining several blood parameters mainly white blood cell (WBC) count, granulocytes, platelet, and novel hemocytometric markers neutrophils to lymphocyte ratio (NLR), platelet-to-lymphocyte (PLR), and lymphocyte to monocyte ratio (LMR). The current study was conducted to investigate alteration in blood parameters and their association with the severity and mortality of COVID-19 patients. METHODOLOGY: An observational cross-sectional study was conducted retrospectively, a total of 101 COVID-19 positive patients were examined: 52 were mild, 24 were moderate, 09 were severe, and 16 were critically diseased patients. We also recorded 16 deaths associated with the critical group. The overall mean age observed in our study was 48.94 years, where the mean age for critical individuals was 62.12 ± 14.35 years. RESULTS: A significant association between the disease severity and elevation in blood parameters were observed. The WBC's and granulocyte count were significantly increased (p value <0.001) while the mean platelet count (165.0 × 109 /L) and red blood cell volume distribution width (RDW) were decreased in the critical group (57.86%) compared to mild group's patients (177.3%) (p = 0.83). The lymphocytes count was decreased in critical patients (1.40 × 109 /L) compared to mild patients (1.92 × 109 /L) (p = 0.28). A significant association was observed in platelet-lymphocyte ratio (p < 0.001), Neutrophil-Lymphocyte ratio (p = <0.001), and Lymphocyte-Monocyte ratio (0.011). CONCLUSION: These blood parameters could be used as a suitable biomarker for the prognosis and severity of COVID-19. Evaluating novel hemograms NLR, PLR, and LMR can aid clinicians to identify potentially severe cases at early stages, initiate effective management in time, and conduct early triage which may reduce the overall mortality of COVID-19 patients.

Hematological and biochemical parameters as diagnostic and prognostic markers in SARS-COV-2 infected patients of Pakistan: a retrospective comparative analysis.

Objectives: This study was conducted to investigate alteration in blood parameters and their association with the presence, severity, and mortality of COVID-19 patients as the data on hematological abnormalities associated with the Pakistani COVID-19 patients is limited.Methodology: A double-centered, hospital-based comparative retrospective case study was conducted, to include all the admitted patients (n = 317) having COVID-19 Polymerase chain reaction (PCR) positive. The control group (n = 157) tested negative for COVID-19.Results: Of 317 admitted cases, the majority were males n = 198 (62.5%). Associated comorbidities, lower lymphocytes, platelets, and higher White blood cells, neutrophil, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were found in COVID-19 cases as compared to healthy controls (p < 0.001 for all). The biochemical parameters of cases including Ferritin, D-Dimer, CRP, IL-6, LDH, ALT, AST, and APTT also showed a statistically significant difference compared with standard values (p < 0.001 for all). However, their comparison with a severity level of the severe and non-severe groups showed significance for WBCs, neutrophils, NLR (p < 0.001 for all), and PLR (p = 0.06) only. Receiver operating characteristic curve analysis showed that NLR had the highest area under curve (0.84) followed by 1/lymphocyte (0.82), neutrophils (0.74), PLR (0.67),1/platelets (0.68) and WBC's (0.65). Comparison of cases and controls with recommended cut-off values derived from sensitivity and 1-specificity was also done (p < 0.001).Conclusion: Monitoring all the hematological and biochemical parameters including novel hemograms NLR, PLR can aid clinicians to identify potentially severe cases at early stages and initiate effective management in time which may reduce the overall mortality of COVID-19 patients.