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Haematological and biochemical pathology markers for a predictive model for ITU admission and death from COVID-19: A
Anuja Rasarathnam1,2, Terrence Haynes-Smith1, Wassif S Wassif3
1Haematology and Blood Transfusion Bedfordshire Hospitals NHS Foundation Trust Bedford UK.
Insights
Hematological and biochemical markers like neutrophil-to-lymphocyte ratio (NLR) can predict COVID-19 patient outcomes. Elevated NLR, age, and specific biochemical changes are linked to mortality and intensive therapy unit (ITU) admission.
Area of Science:
- Clinical Medicine
- Hematology
- Biochemistry
Background:
- Coronavirus disease (COVID-19) has caused a global pandemic, with significant impacts on patient health.
- Understanding the pathological findings and disease progression in COVID-19 patients is crucial for effective management.
- Hematological and biochemical alterations are increasingly recognized as important indicators of COVID-19 severity.
Purpose of the Study:
- To identify pathological findings in COVID-19 patients at Bedford Hospital.
- To analyze laboratory parameters as potential markers for predicting disease outcomes.
- To investigate the association between admission laboratory tests and intensive therapy unit (ITU) admission or survival.
Main Methods:
- Study included COVID-19 positive patients admitted to Bedford Hospital between March-July 2020.
- Clinical and laboratory data were collected via the ICE system.
- Hematological and biochemistry biomarkers were analyzed using univariate and multivariate logistic regression.
Main Results:
- Elevated neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein were common in COVID-19 patients.
- Lymphopenia and neutrophilia were prevalent, contributing to elevated NLR.
- Increased mortality was associated with older age, elevated NLR, alkaline phosphatase, and hyperkalemia.
- Admission to ITU correlated with increased serum albumin and potassium, and decreased serum calcium, sodium, and prothrombin time.
Conclusions:
- Admission laboratory measurements of hematological and biochemical markers can predict COVID-19 patient outcomes, including survival and ITU admission.
- NLR, age, and specific biochemical markers are valuable predictors of mortality.
- Serum electrolyte levels and albumin show association with ITU admission, aiding in early risk stratification.
Abstract:
Coronavirus disease (COVID-19) caused by SARS-CoV-2 has affected over 227 countries. Changes in haematological and biochemical characteristics in patients with COVID-19 are emerging as important features of the disease. This study aims to identify the pathological findings of COVID-19 patients at Bedford Hospital by analysing laboratory parameters that were identified as significant potential markers of COVID-19. Patients who were admitted to Bedford Hospital from March-July 2020 and had a positive swab for COVID were selected for this study. Clinical and laboratory data were collected using ICE system. Multiple haematological and biochemistry biomarkers were analysed using univariate and multivariate logistic regression to predict intensive therapy unit (ITU) admission and/or survival based on admission tests. Neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein were elevated in most patients, irrespective of ITU status, representing a common outcome of COVID-19. This was driven by lymphopenia in 80% and neutrophilia in 42% of all patients. Multivariate logistic regression identified an increase in mortality associated with greater age, elevated NLR, alkaline phosphatase activity and hyperkalaemia. With the area under the receiver operating characteristic (ROC) curve of 0.706 +/- 0.04117, negative predictive value (NPV) 66.7% and positive predictive value (PPV) 64.9%. Analysis also revealed an association between increases in serum albumin and potassium concentrations and decreases in serum calcium, sodium and in prothrombin time, with admission to ITU. The area under the ROC curve of 0.8162 +/- 0.0403, NPV 63.3% and PPV 80.5%. These data suggest that using admission (within 4 days) measurements for haematological and biochemical markers, that we are able to predict outcome, whether that is survival or ITU admission.
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