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. 2025 Dec;11(1):2540749.
doi: 10.1080/20565623.2025.2540749. Epub 2025 Aug 2.

Assessment of the relationship between hematologic parameters, (CPD), in screening for COVID-19 severity in women

Simone Cristina de Carvalho  1   2 , Sonia Mara Raboni  3   4   5 , Lucas Bochnia Bueno  5 , Bruna Amaral Lapinscki  3 , Sonia Maria Lissa  1   2 , Ludmilla Louise Moreira Amadeu  2 , Ricardo Rasmussen Petterle  6 , Samuel Ricardo Comar  2 , Meri Bordignon Nogueira  1   4
Affiliations

Assessment of the relationship between hematologic parameters, (CPD), in screening for COVID-19 severity in women

Simone Cristina de Carvalho et al. Future Sci OA. 2025 Dec.

Abstract

Aims: This study evaluated hematological parameters and cell population data (CPDs) to assess their ability to discriminate between moderate and severe COVID-19 in hospitalized female patients, and to identify potential markers associated with worse outcomes.

Patients & methods: A retrospective study was conducted on 84 adult female COVID-19 patients hospitalized at CHC-UFPR (Brazil) between March 2020 and July 2021. Patients were stratified into moderate (n = 46) and severe (n = 38) disease groups. A control group included 100 healthy female outpatients. Parameters analyzed included D-dimer, WBC count, neutrophil-to-lymphocyte ratio (NLR), and CPDs (LY-X, LY-Y). RT-qPCR was used for SARS-CoV-2 confirmation and variant identification.

Results: Significant differences (p < 0.05) in LY-X, LY-Y, NLR, and WBC were found between moderate and severe groups. D-dimer was elevated in severe cases. Among deceased patients (n = 17), WBC and NLR were markedly increased. ROC curve analysis confirmed the discriminatory power of these markers. No significant association was found between viral genotype and severity (p = 0.9602).

Conclusions: Hematological parameters, particularly CPDs and NLR, are valuable for early stratification of COVID-19 severity. These automated, rapid, and cost-effective measures can support clinical decision-making. However, CPD usage depends on analyzer availability and lacks standardization across platforms.

Keywords: COVID-19; CPD (cell population data); D-dimer; SARS-CoV-2; moderate disease; severe disease; sysmex XN-3100; women.

Plain language summary

Introduction COVID-19 overview: COVID-19 is a highly transmissible and potentially severe infectious disease caused by SARS-CoV-2, associated with a complex systemic inflammatory response.Relevance of hematological parameters: Traditional biomarkers have shown limitations in disease stratification. Recent evidence supports the use of hematological indicators such as cell population data (CPD) and D-dimer in evaluating disease severity.Study objective: To assess the diagnostic and prognostic potential of CPD parameters, neutrophil-to-lymphocyte ratio (NLR), white blood cell count (WBC), and D-dimer levels in female COVID-19 patients.Methods Design and population: A retrospective analysis was conducted at CHC-UFPR, involving 84 female COVID-19-positive patients (38 with severe and 46 with moderate disease) and 100 female controls without COVID-19.Laboratory procedures: Complete blood count (CBC) and CPDs were analyzed using the Sysmex XN-3100. D-dimer measurements were performed on the Sysmex CS Series. RT-qPCR was used for SARS-CoV-2 variant genotyping.Statistical analysis: Data were evaluated using R software with GCMR package and ROC curves generated with MedCalc. A 5% significance level was adopted.Results Key biomarkers: LY-X and LY-Y (CPDs), NLR, WBC, and D-dimer levels were significantly associated with disease severity (p < 0.05).Prognostic indicators: Elevated NLR and WBC levels were strongly correlated with fatal outcomes.Severity vs. outcome: A statistically significant correlation (p < 0.001) was observed between clinical severity and mortality, reinforcing the value of hematological parameters in predicting outcomes.Variant analysis: Although the Gamma variant predominated among severe cases and deaths, genotyping results did not statistically influence severity (p = 0.9602).ROC performance: LY-X, LY-Y, NLR, and WBC showed statistically significant diagnostic accuracy in distinguishing between moderate and severe disease.Discussion Inflammatory dysregulation: Severe COVID-19 patients exhibited leukocytosis, lymphopenia, and elevated NLR, indicative of systemic immune dysregulation.Lymphocyte markers: LY-X and LY-Y effectively represented lymphocyte depletion and inflammatory activity, correlating with disease progression.NLR as a predictor: NLR values were markedly elevated in severe cases, reinforcing its utility as an accessible inflammatory marker in COVID-19.Role of D-dimer: While elevated in severe cases and useful in early risk assessment, D-dimer showed limited utility in monitoring treatment response.Variant considerations: Despite the predominance of the Gamma variant among severe cases, the sample size limited definitive conclusions on variant-specific outcomes.Final considerations Clinical applicability: Hematological parameters, particularly CPDs and NLR, are promising tools for early severity stratification in COVID-19, providing fast, cost-effective, and minimally invasive support for clinical decision-making.Advantages of CPDs: These parameters offer real-time insights during routine blood analysis, without requiring additional samples or testing time.Limitations and future directions: The need for specialized equipment and the lack of standardization may restrict widespread CPD implementation. Further studies with larger, more diverse populations are warranted.

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Conflict of interest statement

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Figures

Figure 1.
Figure 1.
Flowchart. CPD: cell population data; D-dimer: mg/FEU: milligrams/fibrinogen equivalent units; WBC: white blood cell count expressed as × 1000/mm3; NLR: neutrophil to lymphocyte ratio; LY-X: lymphocyte complexity; LY-Y: lymphocyte fluorescence intensity.
Figure 2.
Figure 2.
COVI-19 severity vs. outcome clinical.
Figure 3.
Figure 3.
Shows the ROC curves for WBC (leukocytes), lymphocyte subpopulation (LY-X and LY-Y), NLR (neutrophil/lymphocyte ratio), and D-dimer.
See this image and copyright information in PMC

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