Clinical and laboratory manifestations in critically ill patients with COVID-19 and deceased people

Abstract

This article provides a review of the literature on the symptoms, laboratory blood values of critically ill patients who recovered and those who died of the new coronavirus disease COVID-19. Physicians should consider the following when predicting the course of the disease: in the first 3 days after admission, patients who recovered were slightly more likely to have leukocytosis and leukopenia, normal and increased lymphocyte counts; there were more individuals with increased number of band neutrophils, and patients who subsequently died were more likely to have normocytosis, granulocytosis, lymphopenia, thrombocytopenia, and higher erythrocyte sedimentation rate. The evaluation of laboratory indices in dynamics is of great importance for the prognosis: patients who recovered, on day 4–6 had a less pronounced growth of leukocytes and subsequently, on the contrary, their reduction; on day 4–6 of hospital stay, there was a decrease in the number of lymphocytes with subsequent growth; high creatine phosphokinase values at the beginning of hospitalization decreased significantly from day 7–9 to reference values; from the time of hospitalization, there was a decrease in lactate dehydrogenase content; the average prothrombin index tended to decrease, but within normal limits. Patients who died later, already from day 4–6 had an increase in leukocyte count, a decrease in lymphocyte level; thrombocytopenia was registered more often, which persisted with time and decreased significantly, especially after 9 days; in all periods of observation, erythrocyte sedimentation rate was higher (median of 30–40 mm/h); from day 7, there were significant fluctuations in maximum creatine phosphokinase values with their significant increase; at the beginning of hospitalization, these patients had higher lactate dehydrogenase levels compared to the first group and maintained their advantages during all periods of observation with significant fluctuations of maximal values; when comparing these patients by observation periods, there were slight fluctuations in the prothrombin index, which most often registered in about 80 % of patients with a subsequent increase after day 9, but within normal limits; also, at the beginning of hospitalization, there were significant fluctuations in the minimum prothrombin index towards very low rates.