Preliminary study to identify severe from moderate cases of COVID-19 using combined hematology parameters

Abstract

Background: The third fatal coronavirus is the novel coronavirus (SARS-CoV-2) that causes novel coronavirus pneumonia (COVID-19) which first broke out in December 2019. Patients will develop rapidly if there is no any intervention, so the risk identification of severe patients is critical. The aim of this study was to investigate the characteristics and rules of hematology changes in patients with COVID-19, and to explore the possibility differentiating moderate and severe patients using conventional hematology parameters or combined parameters.

Methods: The clinical data of 45 moderate and severe type patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in Jingzhou Central Hospital from January 23 to February 13, 2020 were collected. The epidemiological indexes, clinical symptoms, and laboratory test results of the patients were retrospectively analyzed. Those parameters with significant differences between moderate and severe cases were analyzed, and the combination parameters with the best diagnostic performance were selected using the linear discriminant analysis (LDA) method.

Results: Of the 45 patients with the novel 2019 corona virus (COVID-19) (35 moderate and 10 severe cases), 23 were male and 22 were female, with ages ranging from 16 to 62 years. The most common clinical symptoms were fever (89%) and dry cough (60%). As the disease progressed, white blood cell count (WBC), neutrophil count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), red blood cell distribution width-coefficient of variation (RDW-CV), and red cell volume distribution width-standard deviation (RDW-SD) parameters in the severe group were significantly higher than those in the moderate group (P<0.05); meanwhile, lymphocyte count (Lym#), eosinophil count (Eos#), high fluorescent cell percentage (HFC%), red blood cell count (RBC), hemoglobin (HGB), and hematocrit (HCT) parameters in the severe group were significantly lower than those in the moderate group (P<0.05). For NLR parameter, it's area under the curve (AUC), cutoff, sensitivity and specificity were 0.890, 13.39, 83.3% and 82.4% respectively; meanwhile, for PLR parameter, it's AUC, cutoff, sensitivity and specificity were 0.842, 267.03, 83.3% and 74.0% respectively. The combined parameters of NLR and RDW-SD had the best diagnostic efficiency (AUC =0.938), and when the cutoff value was 1.046, the sensitivity and the specificity were 90.0% and 84.7% respectively, followed by the combined parameter NLR&RDW-CV (AUC =0.923). When the cut-off value was 0.62, the sensitivity and the specificity for distinguishing severe type from moderate cases of COVID-19 were 90.0% and 82.4% respectively.

Conclusions: The combined NLR and RDW-SD parameter is the best hematology index. It may help clinicians to predict the severity of COVID-19 patients and can be used as a useful indicator to help prevent and control the epidemic.

Keywords: COVID-19; Neutrophil lymphocyte ratio (NLR); combination parameter; linear discriminant analysis; novel coronavirus (SARS-CoV-2); receiver operating characteristic; red cell volume distribution width-standard deviation (RDW-SD); severe pneumonia.

Figure 1

The comparison of complete blood count (CBC) parameters with significant deviation between moderate and severe type COVID-19 patients. The scatter plots were provided, and the Student’s t-test was employed to compare the differences in CBC parameters between the moderate and the severe COVID-19 cases. “*” standing for significant deviation.

Figure 2

ROC analysis using single and combined parameters in the diagnosis of severe cases of COVID-19. Differentiated diagnosis of moderate and severe COVID-19 patients using different parameters. The positive sample is the blood routine result of the severe patient, and the negative sample is the blood routine result of the moderate patient. Panel A is a ROC plot that uses a single parameter to identify severe from moderate patients. Panel B is a ROC plot that uses the combined parameters of NLR and RDW-SD and NLR and RDW-CV to identify patients; Panels C and D are scatter plots that use the combined parameters for comparison between the two groups; Panel E is a recommendation management strategy for COVID-19 patients. “*” standing for significant deviation.