Early Predictors of Severity in Newly Diagnosed COVID-19 Patients: A Cross-sectional study

Abstract

Introduction: Corona virus disease 2019 (COVID-19) is a pandemic that has claimed many lives and consumed financial resources globally in the recent past. In this context, it is necessary to evaluate the role of different ‘low-cost’ and routine serum biochemistry markers in predicting the severity of illness in patients with COVID-19. There are many studies are available in this regard to assist clinicians to predict the severity of COVID-19, but were from high end laboratories which include costlier markers. Aim: To study the routinely done serum biochemistry markers which are of lower cost to determine their role individually and in combination in the early prediction of on-going severity of diagnosed COVID-19 patients. Materials and Methods: This was a descriptive and cross- sectional study,conducted in Department of Biochemistry and Microbiology at Mehdi Nawaz Jung Institute of Oncology and Regional Cancer Center (MNJIO & RCC), a tertiary cancer care institute at Hyderabad, India for a period of three months during the pandemic second wave, from August to October 2021. A total of 100 subjects of 35 to 75 age group who were Reverse- Transcriptase-Polymerase Chain Reaction (RT-PCR) positive for SARS-COV2 were included in this study. At the same time of swab, venous blood collected for Lactate Dehydrogenase (LDH), Alanine Aminotransferase (ALT), Albumin, C-Reactive Protein (CRP) and Ferritin and electrolytes sodium, potassium were estimated. These subjects were followed for ten days to categorise the severity, whether home quarantined or hospitalised. The numerical data was recorded as master chart in MS Excel spread sheet, and was imported to the free trial software, IBM SPSS Statistics (version 28.0) and analysed. Results: Age and sex did not show any significance (p=0.12&0.62) but smoking, alcoholism and co-morbidities had a significant association with the level of illness (p<0.001). Serum LDH, CRP and Ferritin were qualified as significant (p<0.001) markers to predict the ongoing severity. The relationship between the LDH, Ferritin and CRP and the severity is expressed as Odds Ratios (OR) with 95% confidence intervals. The combined use as markers for these three parameters had 0.99 area under curve with a best predictive efficacy at 100% sensitivity and 80.3% specificity with positive likelihood ratio of 5.07. Conclusion: Routine chemistry parameters are cost-effective as they are readily available, of lower cost and can be used in combination and also time saving investigations helpful in predicting the need for hospitalisation so as to assure the safety of COVID-19 patients.