Implications of SARS-CoV-2 infection on the clinical, hematological, and inflammatory parameters in COVID-19 patients: A retrospective cross-sectional study

Abstract

Background: The current coronavirus pandemic (COVID-19) was caused by severe acute respiratory syndrome virus 2 (SARS-CoV-2). COVID-19 is characterized by atypical pneumonia, mild colds, and more severe illnesses, such as severe acute respiratory distress, thrombosis, organ failure, and various secondary bacterial and fungal infections. Notably, the severity of COVID-19 in different age groups is not well known, and the validity of clinical laboratory data remains unclear.

Methods: In this retrospective cross-sectional study, we examined differential regulation of clinical, hematologic, and inflammatory biomarkers in COVID-19 patients. We divided 104 COVID-19 patients into five different groups according to age (0-17, 18-45, 46-65, 66-79, and >80 years). Baseline data (sex, comorbidities, intensive care admission, and medications), hematologic markers, liver, and renal function tests, coagulation, and inflammatory markers were examined in these groups. Receiver operator characteristic (ROC) analysis was used to determine the optimal threshold for predicting COVID-19 biological markers.

Results: We found that the highest percentage (45%) of COVID-19 patients was in the age group of 46-65 years. The hematologic parameters (WBC, HB, and PLT) were normal between the patient groups. The area under the curve in ROC analysis showed significant differences in the levels of creatine, GGT, BUN, CRP, D-dimer, ferritin, AST, and procalcitonin between the patients of age groups 46-65 and 66-79 years. Renal biomarkers were significantly high in most patients, regardless of age. In contrast, the liver biomarkers, did not differ significantly between patient groups.

Conclusion: The main finding of our study is that laboratory parameters such as GGT, creatinine, BUN, CRP, procalcitonin, ferritin and D-dimer were differentially regulated in COVID -19 patients of different age groups. Importantly, these laboratory parameters may help as clinical predictors to assess the severity of the disease in the population. We conclude here that age is an important factor influencing COVID-19 severity.

Keywords: COVID-19; Clinical parameters; Clinical predictors; Hematological parameters; Inflammatory markers; SARS CoV-2.

Fig. 1

The level of LFTs and RFTs among COVID-19 patients. No statistical difference was detected on the levels of AST and GGT. A significant difference was observed between the patients in the age 18-45 and 46-65 years on the GGT, creatine, and BUN levels, and between the age range 18-45 and 66-79 on the BUN level. Mann–Whitney test, where * = P < 0.05, ** = P < 0.01, *** = P < 0.001, n = 104. AST = aspartate aminotransferase, GGT = gamma-glutamyl transferase, BUN = blood urea nitrogen.

Fig. 2

The comparison between the inflammatory and coagulants markers in different age categories of patients with COVID-19. Most of the significant differences were observed in the CRP, procalcitonin, ferritin and D-dimer levels. No statistical difference was detected in the and LDH level. Mann–Whitney test, where * = P < 0.05, ** = P < 0.01, *** = P < 0.001, n = 104. CRP = C-reactive protein, LDH = lactate dehydrogenase.

Fig. 3

ROC curve comparing the different clinical markers to predict the severity of COVID-19 among different patient groups (A): Age-G1, and (B): Age-G2.