Prognostic significance of ferritin, D-dimer, lymphocyte / monocyte ratio and some biochemical markers in patients with SARS-CoV-2
Main Article Content
Objective: The disease caused by Covid-19 that progress with severe acute respiratory distress syndrome (SARS) and can result in death, spread all over the world emerging from China. It is important to know the cases that expected to show a fatal course beforehand due to the cases resulting in death. In this study we analyzed the changes observed in ferritin, D-dimer, lymphocyte and monocyte levels, which are easily measured in patients, and evaluated how these determinants can be used as prognostic factors of the disease.
Materials and methods: One hundred patients who applied to Bezmialem Vakif University Hospital between April 2020 – May 2020, who were Covid-19 PCR positive, and had infiltration in their pulmonary computerised tomography scan, were included in the study. These patients were divided into two groups as normal service patients and intensive care unit patients. Ferritin, D-dimer, lymphocyte and monocyte levels, ALT, AST, LDH, and CRP levels were recorded at the time of diagnosis. Lymphocyte/monocyte ratio (LMR) was calculated.
Results: Ferritin and D-dimer levels, ALT, AST, LDH, and CRP levels were found to be statistically and significantly higher in the mortality group compared to non-mortality (p<0.05). LMR, on the other hand, was found to be statistically and significantly lower in the mortality group (p<0.05).
Conclusion: Ferritin, D-dimer levels and LMR can be determinant laboratory findings in the prognosis of the disease that are detected in the Covid-19 patients at the dime of diagnosis. More studies should be conducted to objectively evaluate disease-related prognostic factors.
WHO, World Health Organization. WHO Director‐General's Opening Remarks at the Media Briefing on COVID‐19‐11 March 2020. 2020.
Chen, G., D. Wu, W. Guo, Y. Cao, D. Huang, et al., Clinical and immunological features of severe and moderate coronavirus disease 2019. 2020. 130(5).
Jiang, L., K. Tang, M. Levin, O. Irfan, S.K. Morris, et al., COVID-19 and multisystem inflammatory syndrome in children and adolescents. 2020.
Rothan, H.A. and S.N.J.J.o.a. Byrareddy, The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. 2020: p. 102433.
Kannan, S., P.S.S. Ali, A. Sheeza, and K.J.E.R.M.P.S. Hemalatha, COVID-19 (Novel Coronavirus 2019)-recent trends. 2020. 24(4): p. 2006-2011.
Gomez-Pastora, J., M. Weigand, J. Kim, X. Wu, J. Strayer, et al., Hyperferritinemia in critically ill COVID-19 patients - Is ferritin the product of inflammation or a pathogenic mediator? Clin Chim Acta, 2020. 509: p. 249-251.
Lagadinou, M., E.E. Solomou, N. Zareifopoulos, M. Marangos, C. Gogos, et al., Prognosis of COVID-19: Changes in laboratory parameters. 2020. 62(13.4): p. 47-16.2.
YARALI, H.N. and A.K.J.T.Ç.H.D. YOZGAT, Hematologic Parameters of Patients with COVID-19 Infection. 2020. 14(COVID-19): p. 48-50.
Russell, C.D., A. Parajuli, H.J. Gale, N.S. Bulteel, P. Schuetz, et al., The utility of peripheral blood leucocyte ratios as biomarkers in infectious diseases: A systematic review and meta-analysis. 2019. 78(5): p. 339-348.
Feng, X., L. Li, J. Wu, L. Zhang, Z. Sun, et al., Complete Blood Count Score Model Integrating Reduced Lymphocyte‐Monocyte Ratio, Elevated Neutrophil‐Lymphocyte Ratio, and Elevated Platelet‐Lymphocyte Ratio Predicts Inferior Clinical Outcomes in Adult T‐Lymphoblastic Lymphoma. 2019. 24(11): p. e1123.
Feng, F., G. Zheng, Q. Wang, S. Liu, Z. Liu, et al., Low lymphocyte count and high monocyte count predicts poor prognosis of gastric cancer. 2018. 18(1): p. 1-7.
Li, T., H. Lu, W.J.E.M. Zhang, and Infections, Clinical observation and management of COVID-19 patients. 2020. 9(1): p. 687-690.
Rosário, C., G. Zandman-Goddard, E.G. Meyron-Holtz, D.P. D’Cruz, and Y.J.B.m. Shoenfeld, The hyperferritinemic syndrome: macrophage activation syndrome, Still’s disease, septic shock and catastrophic antiphospholipid syndrome. 2013. 11(1): p. 185.
Ruscitti, P., O. Berardicurti, P. Di Benedetto, P. Cipriani, A. Iagnocco, et al., Severe COVID-19, another piece in the puzzle of the hyperferritinemic syndrome. An immunomodulatory perspective to alleviate the storm. 2020. 11.
Levi, M. and T.J.T.r. van der Poll, Coagulation and sepsis. 2017. 149: p. 38-44.
Zhang, L., X. Yan, Q. Fan, H. Liu, X. Liu, et al., D‐dimer levels on admission to predict in‐hospital mortality in patients with Covid‐19. 2020. 18(6): p. 1324-1329.
Kollias, A., K.G. Kyriakoulis, E. Dimakakos, G. Poulakou, G.S. Stergiou, et al., Thromboembolic risk and anticoagulant therapy in COVID‐19 patients: emerging evidence and call for action. 2020. 189(5): p. 846-847.
Cui S., S. Chen, X. Li, S. Liu, F.J.J.o.T. Wang, et al., Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. 2020.
Xu, H., L. Zhong, J. Deng, J. Peng, H. Dan, et al., High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. 2020. 12(1): p. 1-5.
Fathi, N. and N.J.C.B.I. Rezaei, Lymphopenia in COVID‐19: Therapeutic opportunities. 2020.
Chai, X., L. Hu, Y. Zhang, W. Han, Z. Lu, et al., & Cai, J.(2020). Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection.
Xu, Z., L. Shi, Y. Wang, J. Zhang, L. Huang, et al., Pathological findings of COVID-19 associated with acute respiratory distress syndrome. 2020. 8(4): p. 420-422.
Demir HA, Changes in liver function in patients with COVID-19 and the demographics of the disease in a mid-sized city of Turkey: A retrospectiveanalysis, Medical Science and Discovery 2020;7(12):739-44
Hadjadj, J.; Yatim, N.; Barnabei, L.; Corneau, A.; Boussier, J.; Smith, N.; Péré, H.; Charbit, B.; Bondet, V.; Chenevier-Gobeaux, C.; et al. Impaired type I interferon activity and inflammatory responses in severe COVID-19 patients. Science 2020, 369, 718–724.