Role of Inflammatory Markers and Computed Tomography Severity Score in Predicting the Severity and Clinical Outcome in Patients with COVID-19

Abstract

Background and objective Several inflammatory markers such as C-reactive protein CRP lactic dehydrogenase LDH serum ferritin D- dimer and interleukin IL-6 have been linked to play a role in the causation of severe disease and mortality of patients with COVID-19. The present study was carried out to correlate the clinical severity with inflammatory markers and CT Computed tomography severity score CTSS in both survivors and non-survivors.Methods It was a hospital-based retrospective study conducted based on data obtained from the records of 100 patients with a laboratory-confirmed COVID-19 for a period of two months 15th April to 14th June 2021. All patients aged over 18 years were included for the study. The pregnant women or breast-feeding mothers and patients suffering from other inflammatory conditions were excluded from the study. Inflammatory markers used were serum CRP serum ferritin LDH D-dimer and IL-6. High resolution computed tomography HRCT of thorax was used for assessing disease severity score.Results In our study 100 patients were grouped as survivors 67 and non-survivors 33 and there was a male predominance 60 over female 40. Among survivors the mean age of the patients was 50.33 years while in non-survivors it was 52.78 years. All non-survivors had comorbidities compared to survivors in whom 41 patients did not have any comorbidities. In both hypertension 24 was the most common comorbidity followed by diabetes 14. The mean C- reactive protein was 60.22plusmn45.1mgdL among survivors and 144.8plusmn94.7 mgdL among non- survivors. The mean ferritin level among survivors was 376plusmn578 ngmL and that among non-survivors was 738.8plusmn581.4 ngmL. The LDH among survivors and non-survivors was 462.4plusmn276 and 819.5plusmn503.6 UL respectively. The mean IL-6 of survivors was 103.3plusmn278.7 and non-survivors was 145.1plusmn179.2 pgmL. The mean D-dimer was 604.3 plusmn 508.8 ngmL in the survivor group and 1346plusmn1002 ngmL in non-survivors. The CTSS was 12.3plusmn4.9 among survivors and 15.96plusmn6.5 among non-survivors with p value 0.0037. All the inflammatory markers were elevated in both survivors and non-survivors but were markedly elevated in non-survivors. C- reactive protein and D-dimer elevation were highly significant with p value lt0.0001.Conclusion The disease severity of COVID-19 correlated with D-dimer and CRP levels. CTSS was also significant in diagnosing severity of the disease. They had the diagnostic accuracy in predicting the severity of disease and mortality. The patients with severe form of COVID-19 also had raised levels of IL-6 LDH and ferritin. Patients with co-morbidities had higher levels of inflammatory markers which exhibited more severe disease. D-dimer CRP and CTSS are recommended to predict the severity and mortality in patients with COVID-19 infection.nbsp