Abstract
Elderly with comorbidities have shown a higher rate of fatal outcomes when suffering coronavirus disease 2019 (COVID-19). However, a delineation of clinical significances of hematologic indices and underlying comorbidities in the progression and outcome of COVID-19 remains undefined. Six hundred two COVID-19 patients with established clinical outcomes (discharged or deceased) from Hankou Hospital of Wuhan, China between January 14, 2020 and February 29, 2020 were retrospectively analyzed. Of the 602 patients with COVID-19, 539 were discharged and 63 died in the hospital. The deceased group showed higher leukocyte and neutrophil counts but lower lymphocyte and platelet counts. Longer activated partial thromboplastin time (APTT) and prothrombin time (PT), as well as higher D-dimer and C-reactive protein levels, were found in non-survivors. Our observations suggest that these parameters could serve as potential predictors for the fatal outcome and in the discharged group. A higher neutrophil count and D-dimer level but lower lymphocyte were associated with a longer duration of hospitalization. A multivariable Cox regression analysis showed that higher neutrophil count, prolonged PT, and low lymphocyte count were risk factors for patients with COVID-19. Also, we found an association of lower lymphocyte count and higher C-reactive protein levels with the elderly group and those with cardiovascular-related comorbidities. The significantly different hematologic profiles between survivors and non-survivors support that distinct hematologic signatures in COVID-19 patients will dictate different outcomes as a prognostic marker for recovery or fatality. Lymphopenia and aggressive inflammatory response might be major causes for fatal outcomes in the elderly male and especially those with cardiovascular-related comorbidities.
Highlights
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) emerged and is a worldwide health threat [1]
These results indicated that higher inflammatory conditions that manifested as higher levels of leukocytes, neutrophils, C-reactive protein (CRP), and D-dimer and lower lymphocyte count were the main factors associated with the poorer outcome of male patients
Hematologic biomarkers associated with the progression of COVID-19 were investigated, and some novel findings were documented
Summary
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) emerged and is a worldwide health threat [1]. Up to December 2020, tens of thousands of patients are still diagnosed with the coronavirus disease 2019 (COVID-19) every day all over the world. Clinical studies have detected a cytokine storm in critical patients with COVID-19 [5], which is considered to be one of the major causes of acute respiratory distress syndrome (ARDS) and multiple-organ failure at the beginning of the SARS-COV-2 outbreak [6]. Thrombotic complications in patients with COVID-19 are common and contribute to organ failure and mortality [7, 8], which suggests that platelet hyperreactivity is associated with SARS-CoV-2 infection and participating in COVID-19 pathophysiology [9]. Many clinical studies have been done on COVID-19, laboratory indices to predict disease progression and prognosis are not well-established yet [15]
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