October 2020 Vol. 8 No.10

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Original Research Article

Predictive value of hematologic and coagulation parameters in assessment of severity and evolution of COVID-19 patients

Viola Maria Popov¹, Lelia Iliescu², Marius Ioan Balea³, Horatiu Ioani⁴, Mihaela Andreescu¹, Daniela Georgescu¹, Ruxandra Diana Sinescu^5,6, Catalina Parvu², Andra Grigorie², Oana Constantin², Ana Rus², Adriana Badea², Dana Mihaela Badoiu Niculae², Claudia Despan¹, Meilin Omer¹, Geanina Ofiteru¹, Oana Patrinoiu¹, Mihaela Popescu¹, Marius Lucian Balea¹, Felicia Mihai¹, Silvia Ion¹, Horia Bumbea^6,7, Valentin Nedelcu³, Daniela Gologanu³, Gabriel Popescu^6,8, Adriana Hristea^6,8, Elisabeta Stoica⁶, Bogdan Mastalier^6,9, Remus Gabriel Mihalcea⁸, Bogdan Diaconescu^6,11

¹Hematology Department Colentina Clinical Hospital Bucharest Romania
²Intensive Care Unit Department Colentina Clinical Hospital Bucharest Romania
³Pneumology Colentina Clinical Hospital Bucharest Romania
⁴Neurosurgery Department, Colentina Clinical Hospital Bucharest Romania
⁵Plastic Surgery and Reconstructive Microsurgery Department, “Elias” Emergency University Hospital, Bucharest, Romania
⁶“Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
⁷Hmatology Department, Emergency University Hospital Bucharest Romania
⁸Infectious Diseases Matei Bals Institute Bucharest Romania
⁹Surgery Department, Colentina Clinical Hospital Bucharest Romania
¹⁰Management Department Colentina Clinical Hospital Bucharest Romania
¹¹Surgery Department, Emergency Clinical Hospital Floreasca Bucharest Romania

*Corresponding Author's Email: violamariap@gmail.com
Phone: +40724523016
 

Received: 28 August 2020  I  Accepted: 16 September 2020  I  Published: 25 October 2020  I  Article ID: MRJMMS-20-136
Copyright © 2020 Author(s) retain the copyright of this article.
This article is published under the terms of the Creative Commons Attribution License 4.0.

Abstract

The new disease COVID-19 was recently diagnosed because of many cases of pneumonia with unknown etiology. The pathogenic agent is a betacoronavirus: severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This virus causes an excessive immune response in the host called a “cytokine storm,” followed by extensive tissue damage, dysfunctional coagulation, and thrombotic complications. Patients with COVID-19 can be asymptomatic or have mild or severe symptoms. In some cases, COVID-19 worsens very rapidly; initially being asymptomatic or showing only mild symptoms, patients may quickly need intensive care to help them with acute respiratory distress syndrome (ARDS), septic shock, and/or multiple organ failure. COVID-19 thrombosis, an early complication, could be diagnosed at the time of hospitalization or within 24 hours after hospitalization. Evaluation of ferritin, interleukin 6 (IL-6), troponin I, and lactate dehydrogenase (LDH) with D dimer provides more information on the severity of COVID-19. In such a condition, we need to evaluate several criteria to make a rapid diagnosis and to prescribe appropriate treatment. In our study, we observed that medical history, including cardiovascular diseases, thrombosis, and obesity, was important in evaluating COVID-19 patients. The combination of old age (over 65 years) and a history of thrombosis was also a significant predictor of a fatal outcome. The use of a predictive venous thromboembolism (VTE) scale, such as the Geneva risk score for VTE or the Padua prediction score for VTE risk, was important in identifying groups at risk of thrombotic complications. The neutrophil-lymphocyte ratio (NLR), ferritin, C reactive protein (CRP), and LDH were general model matching statistics for independent variables that predicted a fatal outcome in COVID-19 patients. Moreover, COVID-19 patients who at the onset presented with pneumonia had a higher NLR than patients without pneumonia. The presence of D-dimers was strongly correlated with CRP and procalcitonin. Deficiency in protein S was probably important in a cytokine storm, as patients with a low level of protein S had a high level of IL-6. These preliminary results need to be validated by a larger cohort as well as by comparative data obtained during patients’ follow-up.

Keywords: COVID-19, Neutrophil-Lymphocytes Ratio, D-Dimers, Protein S, Pneumonia