Role of inflammatory and liver function markers in assessing the prognosis of patients with COVID‑19

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) caused Coronavirus disease 2019 (COVID‑19) in early December, 2019. The disease begins as a respiratory disease with varied outcomes, from complete recovery to long‑standing complications, such as respiratory distress, heart ailments and stroke. The present study was undertaken to identify the derangements in liver function and inflammatory status which may be used to diagnose the severity and thus assess the prognosis of patients with COVID‑19 infection. The present study was conducted at a tertiary care teaching hospital. The study population included 456 patients with COVID‑19, confirmed by the reverse transcription‑PCR of nasopharyngeal swabs for SARS‑CoV‑2. Data were collected from patient files. The study was approved by the institutional ethics committee. Data are expressed based on the normality of distribution. Variables were compared and correlation analyses were performed. Receiver operating characteristics and the Youden index were applied to obtain cut‑off values. The results revealed an increase in C‑reactive protein (CRP), ferritin, D‑dimer, lactate dehydrogenase (LDH), aspartate aminotransferase (AST) and total bilirubin levels. In addition, there was evidence of leukocytosis, neutrophilia, lymphopenia and an increased neutrophil‑to‑lymphocyte ratio (NLR). The NLR exhibited an area under the curve of 0.77, with a cut‑off value of 2.23 mg/l. Collectively, the findings of the present study demonstrate that the CRP, LDH, neutrophil and eosinophil counts along with the total leucocyte counts and absolute lymphocyte counts, NLR, erythrocyte sedimentation rate, D‑dimer, ferritin and AST levels serve to predict the severity and prognosis of patients with COVID‑19. AST appears to be a more sensitive marker than alanine aminotransferase. However, the De Ritis ratio, although not as sensitive as AST, may provide insight towards morbidity.