HAEMATOLOGICAL PARAMETERS AND OUTCOME IN HOSPITALIZED PATIENTS WITH COVID-19: A DEVELOPING COUNTRY EXPERIENCE

Authors

  • Raheel Iftikhar AFBMTC/NIBMT
  • Sultan Mehmood Kamran Pak Emirates Military Hospital, Rawalpindi-Pakistan
  • Zill-e-Humayun Mirza Pak Emirates Military Hospital, Rawalpindi-Pakistan
  • Arshad Naseem Pak Emirates Military Hospital, Rawalpindi-Pakistan
  • Syed Asif Ali Shah Armed Forces Bone Marrow Transplant Centre, National Institute of Blood and Marrow Transplant, Rawalpindi
  • Sidra Riaz Pak Emirates Military Hospital, Rawalpindi-Pakistan
  • Imran Fazal Pak Emirates Military Hospital, Rawalpindi-Pakistan
  • Wasim Alamgir Pak Emirates Military Hospital, Rawalpindi-Pakistan
  • Farrukh Saeed Pak Emirates Military Hospital, Rawalpindi-Pakistan
  • Salman Saleem Pak Emirates Military Hospital, Rawalpindi-Pakistan
  • Rao Saad Ali Pak Emirates Military Hospital, Rawalpindi-Pakistan
  • Qamar Chaudhry Armed Forces Bone Marrow Transplant Centre, National Institute of Blood and Marrow Transplant, Rawalpindi

Abstract

Background: Coronavirus disease 2019 (COVID-19) is a multisystem disorder and haematological abnormalities are frequently documented in affected patients. Methods: This retrospective study included 549 patients hospitalized with COVID-19 from 1st June to 15th July 2020 at Pak Emirates hospital, Rawalpindi Pakistan. p<0.05 was considered statistically significant. Results: Median age was 60 years (range 12–94 years), males 442 (80.5%) and females 107 (19.5%). There was no patient with mild illness, 181 (32.9%) had moderate, 158 (28.7%) severe and 210 (38.2%) patients had critical disease. Patients with severe and critical disease had lower absolute lymphocyte count (ALC) and platelets (p<0.001 for both) while higher white blood cell count (WBC), neutrophil lymphocyte ratio (NLR), C-reactive protein (CRP), interleukin-6 (IL-6) and lactate dehydrogenase levels (LDH) levels (all p<0.001). Overall survival of study cohort was 83.2%(n=457). Median haemoglobin and platelet count were significantly lower (p<0.001) while WBC, ANC, NLR, prothrombin time (PT), activated partial thromboplastin time (APTT), ferritin, IL-6, LDH were significantly higher (p<0.001) for patients who died.  On multivariate logistic regression analysis WBC count>10x109/l (odds ratio [OR] 2.19 [95% CI 1.3–4.2] p=0.01), NLR>9 (OR 3.4 [95% CI 0.87–6.8], p<0.001), platelets<150x109/l (OR 3.9 [95% CI 1.4–9.8] p<0.001), CRP >100; (OR 4.1[95% CI 0.78-10.9] p<0.001) and ferritin >1000 (OR 5.3 [95% CI 1.9–13.5], p<0.001) were associated with increased risk of death in patients with COVID-19. Conclusion: Monitoring of haematological, coagulation and inflammatory parameters provide reliable, convenient, rapid and cost-effective method for predicting disease severity, complications and prognosis of COVID-19 patients.

Author Biographies

Raheel Iftikhar, AFBMTC/NIBMT

Armed Forces Bone Marrow Transplant Centre, National Institute of Blood and Marrow Transplant, Rawalpindi

Sultan Mehmood Kamran, Pak Emirates Military Hospital, Rawalpindi-Pakistan

Pak Emirates Military Hospital, Rawalpindi-Pakistan

Zill-e-Humayun Mirza, Pak Emirates Military Hospital, Rawalpindi-Pakistan

Pak Emirates Military Hospital, Rawalpindi-Pakistan

Arshad Naseem, Pak Emirates Military Hospital, Rawalpindi-Pakistan

Pak Emirates Military Hospital, Rawalpindi-Pakistan

Syed Asif Ali Shah, Armed Forces Bone Marrow Transplant Centre, National Institute of Blood and Marrow Transplant, Rawalpindi

Armed Forces Bone Marrow Transplant Centre, National Institute of Blood and Marrow Transplant, Rawalpindi-Pakistan

Sidra Riaz, Pak Emirates Military Hospital, Rawalpindi-Pakistan

Pak Emirates Military Hospital, Rawalpindi-Pakistan

Imran Fazal, Pak Emirates Military Hospital, Rawalpindi-Pakistan

Pak Emirates Military Hospital, Rawalpindi-Pakistan

Wasim Alamgir, Pak Emirates Military Hospital, Rawalpindi-Pakistan

Pak Emirates Military Hospital, Rawalpindi-Pakistan

Farrukh Saeed, Pak Emirates Military Hospital, Rawalpindi-Pakistan

Pak Emirates Military Hospital, Rawalpindi-Pakistan

Salman Saleem, Pak Emirates Military Hospital, Rawalpindi-Pakistan

Pak Emirates Military Hospital, Rawalpindi-Pakistan

Rao Saad Ali, Pak Emirates Military Hospital, Rawalpindi-Pakistan

Pak Emirates Military Hospital, Rawalpindi-Pakistan

Qamar Chaudhry, Armed Forces Bone Marrow Transplant Centre, National Institute of Blood and Marrow Transplant, Rawalpindi

Armed Forces Bone Marrow Transplant Centre, National Institute of Blood and Marrow Transplant, Rawalpindi-Pakistan

References

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395(10223):497–506.

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382(8):727–33.

Ding X, Yu Y, Lu B, Huo J, Chen M, Kang Y, et al. Dynamic profile and clinical implications of hematological parameters in hospitalized patients with coronavirus disease 2019. Clin Chem Lab Med 2020;58(8):1365–71.

Deng Y, Liu W, Liu K, Fang YY, Shang J, Zhou L, et al. Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 (COVID-19) in Wuhan, China: a retrospective study. Chin Med J (Engl) 2020;133(11):1261–7.

Henry BM, de Oliveira MHS, Benoit S, Plebani M, Lippi G. 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 2020;58(7):1021–8.

Yuan X, Huang W, Ye B, Chen C, Huang R, Wu F, et al. Changes of hematological and immunological parameters in COVID-19 patients. Int J Hematol 2020;112(4):553–9.

Fu J, Kong J, Wang W, Wu M, Yao L, Wang Z, et al. The clinical implication of dynamic neutrophil to lymphocyte ratio and D-dimer in COVID-19: A retrospective study in Suzhou China. Thromb Res 2020;192:3–8.

Zhang Y, Cao W, Xiao M, Li YJ, Yang Y, Zhao J, et al. [Clinical and coagulation characteristics in 7 patients with critical COVID-2019 pneumonia and acro-ischemia]. Zhonghua Xue Ye Xue Za Zhi 2020;41(4):302–7.

Liao D, Zhou F, Luo L, Xu M, Wang H, Xia J, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: a retrospective cohort study. Lancet Haematol 2020;7(9):e671–8.

Zhang Y, Xiao M, Zhang S, Xia P, Cao W, Jiang W, et al. Coagulopathy and antiphospholipid antibodies in patients with Covid-19. N Engl J Med 2020;382(17)e38.

Clinical Management Guidelines for COVID-19 Infections. 2020;4:1–14.

Rubenfeld G, Thompson T, Ferguson N, Caldwell E, Fan E, Camporota L, et al. Acute respiratory distress syndrome. The Berlin definition. JAMA 2012;307(23):2526–33.

Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315(8):801–10.

Toh C, Hoots WK. The scoring system of the Scientific and Standardisation Committee on Disseminated Intravascular Coagulation of the International Society on Thrombosis and Haemostasis: a 5‐year overview. J Thromb Haemost 2007;5(3):604–6.

Richardson S, Hirsch JS, Narasimhan M, Crawford JM, McGinn T, Davidson KW, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA 2020;323(20):2052–9.

Terpos E, Ntanasis‐Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, et al. Hematological findings and complications of COVID‐19. Am J Hematol 2020;95(7):834–47.

He X, Yao F, Chen J, Wang Y, Fang X, Lin X, et al. The poor prognosis and influencing factors of high D-dimer levels for COVID-19 patients. Scientific Reports. 2021: 19;11(1):1-7.

Fan BE, Chong VCL, Chan SSW, Lim GH, Lim KGE, Tan GB, et al. Hematologic parameters in patients with COVID‐19 infection. Am J Hematol 2020;95(6):E131–4.

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382(18):1708–20.

Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis 2020;71(15):762–8.

Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta 2020;506:145–8.

Ciccullo A, Borghetti A, Dal Verme LZ, Tosoni A, Lombardi F, Garcovich M, et al. Neutrophil-to-lymphocyte ratio and clinical outcome in COVID-19: a report from the Italian front line. Int J Antimicrob Agents 2020;56(2):106017.

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020;18(5):1233–4.

Wu C, Chen X, Cai Y, Zhou X, Xu S, Huang H, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020;180(7):934–43.

Downloads

Published

2021-06-28

Most read articles by the same author(s)