Prognosis of COVID-19: Red Cell Distribution Width, Platelet Distribution Width, and C-Reactive Protein.

Abstract

IntroductionCytokine storm is central in the pathobiology of Coronavirus disease 2019 (COVID-19). The pro-inflammatory state and hypoxia disrupt erythropoiesis leading to alterations in red cell distribution width (RDW) and hematocrit. Platelet production increases alongside its destruction, inviting newly formed immature platelets into the circulation. Thus, the platelet distribution width (PDW) and mean platelet volume (MPV) are also affected. The study's objective is to analyze these indices and C-reactive protein (CRP) to elucidate prognostic insights in COVID-19 patients at the time of admission.MethodologyThis study was a retrospective cross-sectional study conducted at Chigateri General Hospital, attached to JJM Medical College, Davangere, over two months, July and August of 2020. Patients falling under categories B and C according to the interim guidelines issued by the Ministry of Health and Family Welfare, Government of India were enrolled in this study. Patients requiring mechanical ventilation and those with a prior diagnosis of malignancy were excepted from the study.ResultsThe study population comprised a total of hundred patients. Seventy-five patients survived the disease and were discharged; twenty-five patients succumbed to the viral illness. The mean age of survivors (43.0 +/- 13.6 years) was significantly lesser than that of non-survivors (59.1 +/- 11.5 years) (p <0.001). RDW was significantly different among survivors (p=0.002); PDW and CRP were lower among the deceased (p=0.05 and p=0.10, respectively). Cut off values for RDW as 15%, CRP as 67 mg/l, and PDW as 17% were significantly associated with mortality. Hematocrit and MPV were not significantly associated with mortality. RDW has a sensitivity of 92% and a negative predictive value of 95% in predicting mortality.DiscussionRDW showed a significant association with increased mortality. Impaired cell-mediated immunity at the onset of infection is responsible for rapid progression to moderate or even severe COVID disease. Since the investigations in our study were ordered at the time of admission, it may lead us to believe that higher RDW is associated with a better patient outcome.Lower C-reactive protein levels are associated with higher mortality. CRP is a non-specific marker for inflammation. Raised CRP is customarily an indicator of acute inflammation. Notwithstanding, the raised CRP may be an indicator of baseline immune response in early COVID infection.High PDW shows a significant association with increased mortality. The pathobiology of change in platelet indices in COVID-19 patients is presumably multifactorial: infection of the bone marrow; autoimmune platelet destruction; platelet sequestration. ConclusionRed cell distribution width, platelet distribution width, and C-reactive protein are useful early predictive markers of mortality in COVID-19. Although serial investigations would provide a better picture, these indices at admission can gauge the clinical outcome early in the disease. As there is still a lot to be understood about the natural history of COVID-19, our study aims to propose relatively inexpensive indices of mortality that can aid efficient management.