A Combination of Inflammatory and Hematological Markers is Strongly Associated with the Risk of Death in Both Mild and Severe Initial Disease in Unvaccinated Individuals with COVID-19 Infection

Parul Chopra; Tushar Sehgal; Ranjan Yadav; Suneeta Meena; Souvik Maitra; Kapil Dev Soni; Arulselvi Subramanian; Shyam Prakash; Purva Mathur; Sandeep Mittan; Sooyun Tavolacci; Ajeet Kaushik; Kiran Gulia; Ebrahim Mostafavi; Abhishek Gupta; Anjan Trikha; Ritu Gupta; Kunzang Chosdol; Anant Mohan; Kalaivani Mani; Subrata Sinha; Sudip Kumar Datta

A Combination of Inflammatory and Hematological Markers is Strongly Associated with the Risk of Death in Both Mild and Severe Initial Disease in Unvaccinated Individuals with COVID-19 Infection

EJIFCC. 2023 Apr 18;34(1):42-56. eCollection 2023 Apr.

Authors

Parul Chopra¹, Tushar Sehgal¹, Ranjan Yadav¹, Suneeta Meena¹, Souvik Maitra², Kapil Dev Soni², Arulselvi Subramanian³, Shyam Prakash¹, Purva Mathur³, Sandeep Mittan⁴, Sooyun Tavolacci⁵, Ajeet Kaushik⁶, Kiran Gulia⁷, Ebrahim Mostafavi^{8

9}, Abhishek Gupta¹⁰, Anjan Trikha², Ritu Gupta¹¹, Kunzang Chosdol¹², Anant Mohan¹³, Kalaivani Mani¹⁴, Subrata Sinha^{1

12}, Sudip Kumar Datta¹

Affiliations

¹ Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India.
² Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
³ Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India.
⁴ Department of Obstetrics, Gynecology and Medical Oncology, Montefiore Medical Center, The University Hospital for Albert Einstein College of Medicine, New York, USA.
⁵ Department of Hematology and Medical Oncology, Center for Thoracic Oncology, Tisch Cancer Institute and Icahn School of Medicine at Mount Sinai, New York, USA.
⁶ Nano Biotech Laboratory, Department of Environmental Engineering, Florida Polytechnic University, Florida, USA.
⁷ Department of Materials and Manufacturing, School of Engineering, University of Wolverhampton, England, UK.
⁸ Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
⁹ Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
¹⁰ School of Allied Health and Midwifery, Faculty of Education, Health and Wellbeing, University of Wolverhampton, UK.
¹¹ Laboratory Oncology Unit, Dr. BRAIRCH, All India Institute of Medical Sciences, New Delhi, India.
¹² Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India.
¹³ Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India.
¹⁴ Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.

PMID: 37124653
PMCID: PMC10131235

Abstract

Background: Inflammatory and hematological markers are used extensively for early prognostication and monitoring in COVID-19.We aimed to determine whether routinely prescribed laboratory markers can predict adverse outcome at presentation in COVID-19.

Methods: This retrospective observational study was performed on 401 samples collected between July to December 2020 from COVID-19 positive subjects, admitted at All India Institute of Medical Sciences, Delhi, India. Clinical details and laboratory investigations within 3 days of COVID-19 positivity were obtained. Clinical outcomes were noted from patient medical records, till discharge or death. Laboratory parameters, with individually defined cut-offs, were used, either singly or in combination to distinguish survival and death for those having severe and non-severe disease at initial presentation.

Findings: Total Leukocyte count, Absolute neutrophil count, Neutrophil to Lymphocyte ratio, C-Reactive Protein (CRP), Interleukin-6 (IL-6), Lactate Dehydrogenase, Ferritin and Lymphocyte to CRP ratio (LCR) were significantly altered at presentation in severe COVID-19 as compared to non-severe cases; and, also in those who died due to COVID-19 compared to those who survived. A combination of four markers, CRP (≥3.9mg/dL); IL-6 (≥45.37pg/ml); Ferritin (≥373ng/mL); 1/LCR ≥0.405 was found to strongly predict mortality in cases with non-severe presentation as also in severe cases.

Conclusion and interpretation: The combination of routinely used markers, CRP, IL-6, Ferritin and 1/LCR can be used to predict adverse outcomes, even in those presenting with mild to moderate disease. This would identify subset of patients who would benefit from closer monitoring than usual for non-severe disease.

Keywords: COVID-19; hematological markers; inflammatory markers; mortality; severity.