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High-value laboratory testing for hospitalized COVID-19 patients: a review
Daniela Cihakova1, Michael B Streiff2, Steven P Menez2
1Department of Pathology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD 21287, USA.
Insights
This review guides clinicians on using lab tests for hospitalized COVID-19 patients. Key markers like IL-6, CRP, and d-dimer can predict severity and guide treatment decisions.
Area of Science:
- Clinical Medicine
- Infectious Diseases
- Laboratory Diagnostics
Background:
- Hospitalized COVID-19 patients require careful monitoring for disease progression and complications.
- Laboratory testing plays a crucial role in assessing inflammation, cardiac function, hematologic status, and co-infections.
- Evidence-based guidelines are needed to optimize laboratory test utilization in this population.
Purpose of the Study:
- To review the utility, timing, and indications for laboratory tests in hospitalized COVID-19 patients.
- To provide clinicians with evidence-based recommendations for managing COVID-19 care.
- To cover key domains including inflammation, cardiology, hematology, nephrology, and co-infection.
Main Methods:
- Evidence-based review of existing literature.
- Analysis of laboratory test utility in predicting COVID-19 severity and outcomes.
- Synthesis of data on inflammatory markers, cardiac biomarkers, hematologic parameters, and co-infection screening.
Main Results:
- Admission levels of IL-6 (Interleukin-6), CRP (C-reactive protein), absolute lymphocyte count, neutrophils, and neutrophil-to-lymphocyte ratio can predict COVID-19 severity.
- Elevated LDH (Lactate dehydrogenase), ferritin, AST (Aspartate aminotransferase), and d-dimer are associated with severe illness and mortality.
- Elevated cardiac troponin and proBNP (pro-Brain Natriuretic Peptide) aid in identifying cardiac complications and differentiating etiologies.
- Co-infection evaluation is generally not needed for non-severe cases but is crucial for severe, ICU, and immunocompromised patients.
Conclusions:
- Specific laboratory tests upon admission can stratify COVID-19 patients by severity risk.
- Biomarkers are essential for early detection of cardiac complications and guiding management.
- Judicious use of co-infection testing is important, particularly in high-risk patient groups.
- Optimized laboratory test selection improves clinical decision-making for hospitalized COVID-19 patients.
Abstract:
We present here an evidence-based review of the utility, timing, and indications for laboratory test use in the domains of inflammation, cardiology, hematology, nephrology and co-infection for clinicians managing the care of hospitalized COVID-19 patients. Levels of IL-6, CRP, absolute lymphocyte count, neutrophils and neutrophil-to-lymphocyte ratio obtained upon admission may help predict the severity of COVID-19. Elevated LDH, ferritin, AST, and d-dimer are associated with severe illness and mortality. Elevated cardiac troponin at hospital admission can alert clinicians to patients at risk for cardiac complications. Elevated proBNP may help distinguish a cardiac complication from noncardiac etiologies. Evaluation for co-infection is typically unnecessary in nonsevere cases but is essential in severe COVID-19, intensive care unit patients, and immunocompromised patients.
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