Epidemiological and laboratory profile of patients confirmed with Covid-19 and admitted to a reference hospital
DOI:
https://doi.org/10.33448/rsd-v10i15.23067Keywords:
SARS-CoV-2; D-dimer; Intensive Care Unit; Lactate dehydrogenase; Aspartate aminotransferase; Acute respiratory syndrome.Abstract
The new coronavirus, SARS-CoV-2, which causes COVID-19 is easily transmitted from person to person. About 15% develop severe pneumonia and of these, 6% progress to severe acute respiratory syndrome (SARS) and multiple organ failure. Identify biomarkers that can predict which individuals are likely to be affected by severe disease and are at risk of death is crucial. However, the pathophysiology of the disease is not completely elucidated and the characterization of the clinical profile of people infected with SARS-CoV-2 remains unclear. Therefore, the objective of this study was to evaluate the epidemiological and laboratory profile of patients confirmed with COVID-19 and admitted to the University Hospital Lauro Wanderley, based on the correlation of laboratory tests to the evolution of the disease, determination of the most influential variables in the worsening of the disease. Data consisted of complete blood count and serum biochemical analyzes. Overall, 74 patients met all criteria of this study and were included, 40 from the Intensive Care Unit (ICU), and 34 from the Infectious Diseases Infirmary (IDP), both exclusively for patients with COVID-19. Based on these findings, patients with increased WBC count, ALT, AST, and LDH should be closely monitored as these factors predict ICU admission and mortality. Among other laboratory parameters, patients admitted to the ICU have higher levels of D-dimer compared to IDI patients. The results suggests that higher levels of D-dimer on admission is related to a worse prognosis of the disease.
References
Ai, J., Gong, J., Xing, L., He, R., Tian, F., Wang, J., Wang, J., Pei, S., Chen, D., Huang, G., Zhang, M., Qu, G., Fan, W., Lin, H., Li, D., & Pei, B. (2020). Analysis of factors associated early diagnosis in coronavirus disease 2019 (COVID-19). MedRxiv. https://doi.org/10.1101/2020.04.09.20059352
Badawi, A., & Ryoo, S. G. (2016). Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): a systematic review and meta-analysis. International Journal of Infectious Diseases, 49. https://doi.org/10.1016/j.ijid.2016.06.015
Chai, X., Hu, L., Zhang, Y., Han, W., Lu, Z., Ke, A., Zhou, J., Shi, G., Fang, N., Fan, J., Cai, J., Fan, J., & Lan, F. (2020). Specific ACE2 expression in cholangiocytes may cause liver damage after 2019-nCoV infection. BioRxiv. https://doi.org/10.1101/2020.02.03.931766
Chen, G., Wu, D., Guo, W., Cao, Y., Huang, D., Wang, H., Wang, T., Zhang, X., Chen, H., Yu, H., Zhang, X., Zhang, M., Wu, S., Song, J., Chen, T., Han, M., Li, S., Luo, X., Zhao, J., & Ning, Q. (2020). Clinical and immunological features of severe and moderate coronavirus disease 2019. Journal of Clinical Investigation, 130(5). https://doi.org/10.1172/JCI137244
Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., Qiu, Y., Wang, J., Liu, Y., Wei, Y., Xia, J., Yu, T., Zhang, X., & Zhang, L. (2020). Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. The Lancet, 395(10223). https://doi.org/10.1016/S0140-6736(20)30211-7
Chen, X., Yang, Y., Huang, M., Liu, L., Zhang, X., Xu, J., Geng, S., Han, B., Xiao, J., & Wan, Y. (2020). Differences between COVID‐19 and suspected then confirmed SARS‐CoV‐2‐negative pneumonia: A retrospective study from a single center. Journal of Medical Virology, 92(9). https://doi.org/10.1002/jmv.25810
Cheng, Y., Luo, R., Wang, K., Zhang, M., Wang, Z., Dong, L., Li, J., Yao, Y., Ge, S., & Xu, G. (2020). Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney International, 97(5). https://doi.org/10.1016/j.kint.2020.03.005
Ding, J., Karp, J. E., & Emadi, A. (2017). Elevated lactate dehydrogenase (LDH) can be a marker of immune suppression in cancer: Interplay between hematologic and solid neoplastic clones and their microenvironments. Cancer Biomarkers, 19(4). https://doi.org/10.3233/CBM-160336
Ferrari, D., Motta, A., Strollo, M., Banfi, G., & Locatelli, M. (2020). Routine blood tests as a potential diagnostic tool for COVID-19. Clinical Chemistry and Laboratory Medicine (CCLM), 58(7). https://doi.org/10.1515/cclm-2020-0398
Giannitsis, E., Mair, J., Christersson, C., Siegbahn, A., Huber, K., Jaffe, A. S., Peacock, W. F., Plebani, M., Thygesen, K., Möckel, M., Mueller, C., & Lindahl, B. (2017). How to use D-dimer in acute cardiovascular care. European Heart Journal: Acute Cardiovascular Care, 6(1). https://doi.org/10.1177/2048872615610870
Guan, W., Ni, Z., Hu, Y., Liang, W., Ou, C., He, J., Liu, L., Shan, H., Lei, C., Hui, D. S. C., Du, B., Li, L., Zeng, G., Yuen, K.-Y., Chen, R., Tang, C., Wang, T., Chen, P., Xiang, J., … Zhong, N. (2020). Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine, 382(18). https://doi.org/10.1056/NEJMoa2002032
Han, Y., Zhang, H., Mu, S., Wei, W., Jin, C., Xue, Y., Tong, C., Zha, Y., Song, Z., & Gu, G. (2020). Lactate dehydrogenase, a Risk Factor of Severe COVID-19 Patients: A Retrospective and Observational Study. MedRxiv. https://doi.org/10.1101/2020.03.24.20040162
Hsih, W.-H., Cheng, M.-Y., Ho, M.-W., Chou, C.-H., Lin, P.-C., Chi, C.-Y., Liao, W.-C., Chen, C.-Y., Leong, L.-Y., Tien, N., Lai, H.-C., Lai, Y.-C., & Lu, M.-C. (2020). Featuring COVID-19 cases via screening symptomatic patients with epidemiologic link during flu season in a medical center of central Taiwan. Journal of Microbiology, Immunology and Infection, 53(3). https://doi.org/10.1016/j.jmii.2020.03.008
Jaillon, S., Berthenet, K., & Garlanda, C. (2019). Sexual Dimorphism in Innate Immunity. Clinical Reviews in Allergy & Immunology, 56(3). https://doi.org/10.1007/s12016-017-8648-x
Ji, H.-L., Zhao, R., Matalon, S., & Matthay, M. A. (2020). Elevated Plasmin(ogen) as a Common Risk Factor for COVID-19 Susceptibility. Physiological Reviews, 100(3). https://doi.org/10.1152/physrev.00013.2020
Keski, H. (2021). Hematological and Inflammatory Parameters to Predict the Prognosis in COVID-19. Indian Journal of Hematology and Blood Transfusion, 37(4). https://doi.org/10.1007/s12288-021-01407-y
Kuang, Z., Yang, Y., Wei, W., Wang, J., Long, X., Li, K., Tong, C., Sun, Z., & Song, Z. (2020). Clinical characteristics and prognosis of community-acquired pneumonia in autoimmune disease-induced immunocompromised host: A retrospective observational study. World Journal of Emergency Medicine, 11(3). https://doi.org/10.5847/wjem.j.1920-8642.2020.03.003
Liang, W., Liang, H., Ou, L., Chen, B., Chen, A., Li, C., Li, Y., Guan, W., Sang, L., Lu, J., Xu, Y., Chen, G., Guo, H., Guo, J., Chen, Z., Zhao, Y., Li, S., Zhang, N., Zhong, N., & He, J. (2020). Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19. JAMA Internal Medicine, 180(8). https://doi.org/10.1001/jamainternmed.2020.2033
Liao, Y.-C., Liang, W.-G., Chen, F.-W., Hsu, J.-H., Yang, J.-J., & Chang, M.-S. (2002). IL-19 Induces Production of IL-6 and TNF-α and Results in Cell Apoptosis Through TNF-α. The Journal of Immunology, 169(8). https://doi.org/10.4049/jimmunol.169.8.4288
Lippi, G., & Plebani, M. (2020). Laboratory abnormalities in patients with COVID-2019 infection. Clinical Chemistry and Laboratory Medicine (CCLM), 58(7). https://doi.org/10.1515/cclm-2020-0198
Mardani, R., Ahmadi Vasmehjani, A., Zali, F., Gholami, A., Mousavi Nasab, S. D., Kaghazian, H., Kaviani, M., & Ahmadi, N. (2020). Laboratory Parameters in Detection of COVID-19 Patients with Positive RT-PCR; a Diagnostic Accuracy Study. Archives of Academic Emergency Medicine, 8(1).
Miao, C., Zhuang, J., Jin, M., Xiong, H., Huang, P., Zhao, Q., Miao, L., Du, J., Yang, X., Huang, P., & Hong, J. (2020). A comparative multicenter study on the clinical and imaging features of confirmed and unconfirmed patients with COVID19. MedRxiv. https://doi.org/10.1101/2020.03.22.20040782
Pan, Y., Ye, G., Zeng, X., Liu, G., Zeng, X., Jiang, X., Zhao, J., Chen, L., Guo, S., Deng, Q., Hong, X., Yang, Y., Li, Y., & Wang, X. (2020). Can routine laboratory tests discriminate SARS‐CoV‐2‐infected pneumonia from other causes of community‐acquired pneumonia? Clinical and Translational Medicine, 10(1). https://doi.org/10.1002/ctm2.23
Rodrigues, T. S., de Sá, K. S. G., Ishimoto, A. Y., Becerra, A., Oliveira, S., Almeida, L., Gonçalves, A. v., Perucello, D. B., Andrade, W. A., Castro, R., Veras, F. P., Toller-Kawahisa, J. E., Nascimento, D. C., de Lima, M. H. F., Silva, C. M. S., Caetite, D. B., Martins, R. B., Castro, I. A., Pontelli, M. C., … Zamboni, D. S. (2021). Inflammasomes are activated in response to SARS-CoV-2 infection and are associated with COVID-19 severity in patients. Journal of Experimental Medicine, 218(3). https://doi.org/10.1084/jem.20201707
Rojas, M., Rodríguez, Y., Monsalve, D. M., Acosta-Ampudia, Y., Camacho, B., Gallo, J. E., Rojas-Villarraga, A., Ramírez-Santana, C., Díaz-Coronado, J. C., Manrique, R., Mantilla, R. D., Shoenfeld, Y., & Anaya, J.-M. (2020). Convalescent plasma in Covid-19: Possible mechanisms of action. Autoimmunity Reviews, 19(7). https://doi.org/10.1016/j.autrev.2020.102554
Tan, L., Wang, Q., Zhang, D. et al. Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Sig Transduct Target Ther 5, 33 (2020). https://doi.org/10.1038/s41392-020-0148-4
Tian, W., Jiang, W., Yao, J., Nicholson, C. J., Li, R. H., Sigurslid, H. H., Wooster, L., Rotter, J. I., Guo, X., & Malhotra, R. (2020). Predictors of mortality in hospitalized COVID‐19 patients: A systematic review and meta‐analysis. Journal of Medical Virology, 92(10). https://doi.org/10.1002/jmv.26050
Wang, D., Hu, B., Hu, C., Zhu, F., Liu, X., Zhang, J., Wang, B., Xiang, H., Cheng, Z., Xiong, Y., Zhao, Y., Li, Y., Wang, X., & Peng, Z. (2020). Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA, 323(11). https://doi.org/10.1001/jama.2020.1585
Wang, Z. F., Su, F., Lin, X. J., Dai, B., Kong, L. F., Zhao, H. W., & Kang, J. (2011). Serum D-dimer changes and prognostic implication in 2009 novel influenza A(H1N1). Thrombosis Research, 127(3). https://doi.org/10.1016/j.thromres.2010.11.032
WORLD HEALTH ORGANIZATION (WHO). (2021). Coronavirus.
Xu, H., Zhong, L., Deng, J., Peng, J., Dan, H., Zeng, X., Li, T., & Chen, Q. (2020). High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. International Journal of Oral Science, 12(1). https://doi.org/10.1038/s41368-020-0074-x
Zhang, J. J. Y., Lee, K. S., Ang, L. W., Leo, Y. S., & Young, B. E. (2020). Risk Factors for Severe Disease and Efficacy of Treatment in Patients Infected With COVID-19: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis. Clinical Infectious Diseases, 71(16). https://doi.org/10.1093/cid/ciaa576
Zhang, Y., Zheng, L., Liu, L., Zhao, M., Xiao, J., & Zhao, Q. (2020). Liver impairment in COVID‐19 patients: A retrospective analysis of 115 cases from a single centre in Wuhan city, China. Liver International, 40(9). https://doi.org/10.1111/liv.14455
Zhao, D., Yao, F., Wang, L., Zheng, L., Gao, Y., Ye, J., Guo, F., Zhao, H., & Gao, R. (2020). A Comparative Study on the Clinical Features of Coronavirus 2019 (COVID-19) Pneumonia With Other Pneumonias. Clinical Infectious Diseases, 71(15). https://doi.org/10.1093/cid/ciaa247
Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., Xiang, J., Wang, Y., Song, B., Gu, X., Guan, L., Wei, Y., Li, H., Wu, X., Xu, J., Tu, S., Zhang, Y., Chen, H., & Cao, B. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet, 395(10229). https://doi.org/10.1016/S0140-6736(20)30566-3
Zhu, W., Xie, K., Lu, H., Xu, L., Zhou, S., & Fang, S. (2020). Initial clinical features of suspected coronavirus disease 2019 in two emergency departments outside of Hubei, China. Journal of Medical Virology, 92(9). https://doi.org/10.1002/jmv.25763
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Humberto de Carvalho Aragão Neto; Camila Medeiros Costa; João Carlos Lima Rodrigues Pita; Ricardo Dias de Castro; Inácio Ricardo Alves Vasconcelos; Rubens Batista Benedito
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.