Role of Inflammatory Markers in Predicting Severity and Outcome in COVID-19 Patients Attending a Tertiary Care Institute of Tamil Nadu

Vrinda Vijayakumari; Kaliyannan Mayilananthi; Sudha Prashanth Reddy; Kunal Kumar; Vidya  Vijayakumari; Durga Krishnan

Vrinda Vijayakumari Assistant Professor, Department of General Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Kancheepuram, Tamilnadu, India.
Kaliyannan Mayilananthi Professor, Department of General Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Kancheepuram, Tamilnadu, India.
Sudha Prashanth Reddy Post Graduate Resident, Department of General Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Kancheepuram, Tamilnadu, India.
Kunal Kumar Post Graduate Resident, Department of General Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Kancheepuram, Tamilnadu, India.
Vidya Vijayakumari Assistant Professor, Post Graduate and Research, Department of Zoology, Sanantana Dharma College, Alappuzha, Kerala, India.
Durga Krishnan Professor, Department of General Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Kancheepuram, Tamilnadu, India.

Keywords: COVID 19, SARS COV2, D-Dimer, C-reactive protein, IL-6, serum ferritin, Lactate dehydrogenase

Abstract

Background: Severe acute respiratory syndrome Coronavirus 2 (SARS-COV 2) infection elicits an inflammatory response which is responsible for severe clinical manifestations, disease progression and, poor outcomes.
Objectives: This study aims to assess the pattern of elevation of inflammatory markers in COVID-19 and to determine their association with clinical, radiological severity and outcome of COVID 19.

Methodology: This is a retrospective single-center cross-sectional study conducted at Chettinad Hospital and Research Institute, a tertiary care Hospital in Tamil Nadu, India, encompassing a cohort of 1220 patients. The source population was all cases of COVID-19 admitted at the hospital with a confirmed diagnosis of COVID-19 using RT PCR. The data was obtained from the patientâ€™s case sheets and laboratory investigations and from the electronic data management system. The patientâ€™s clinical severity on admission, baseline characteristics, co-morbid illnesses, presenting complaints, vitals, and inflammatory markers like D-dimer, C-reactive protein IL-6, Serum ferritin, and Lactate dehydrogenase were collected. The data for radiological severity and outcome were coded and analysed.

Results: Diabetes and hypertension were found to be the most common comorbidities in the study population; females more affected than males. Fever and cough are the most common presenting symptoms. The clinical severity of patients was found to have a significant association with radiological severity. D-dimer is having a strong correlation with disease severity and outcome at any point in time. IL-6, CRP, Serum ferritin also showed a strong correlation with outcome in COVID-19.

Conclusion: Our study suggests D-dimer at any point of time in a hospitalized COVID-19 patient as a promising marker for the same. IL-6 is the next best inflammatory marker followed by CRP and Serum ferritin. LDH is the least significant one among these.

How to cite this article:
Vijayakumari V, Mayilananthi K, Reddy SP, Kumar K, Vijayakumari V, Krishnan D. Role of Inflammatory Markers in Predicting Severity and Outcome in COVID-19 Patients Attending a Tertiary Care Institute of Tamil Nadu. Special Issue - COVID-19 & Other Communicable Disease. 2022;186-194.

DOI: https://doi.org/10.24321/0019.5138.202230

Author Biographies

Vrinda Vijayakumari, Assistant Professor, Department of General Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Kancheepuram, Tamilnadu, India.

Assistant Professor ,

Department of General Medicine,

Chettinad Hospital and Research Institute ,

Chettinad Academy of Research and Education

Kelambakkam-603103 , Kancheepuram, Tamilnadu , India

Kaliyannan Mayilananthi, Professor, Department of General Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Kancheepuram, Tamilnadu, India.

Professor ,

Department of General Medicine,

Chettinad Hospital and Research Institute ,

Chettinad Academy of Research and Education

Kelambakkam-603103 , Kancheepuram, Tamilnadu , India

Sudha Prashanth Reddy, Post Graduate Resident, Department of General Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Kancheepuram, Tamilnadu, India.

Post Graduate Resident,

Department of General Medicine,

Chettinad Hospital and Research Institute ,

Chettinad Academy of Research and Education,

Kelambakkam-603103 , Kancheepuram, Tamilnadu , India

Kunal Kumar, Post Graduate Resident, Department of General Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Kancheepuram, Tamilnadu, India.

Post Graduate Resident,

Department of General Medicine,

Chettinad Hospital and Research Institute ,

Chettinad Academy of Research and Education,

Kelambakkam-603103 , Kancheepuram, Tamilnadu , India

Vidya Vijayakumari, Assistant Professor, Post Graduate and Research, Department of Zoology, Sanantana Dharma College, Alappuzha, Kerala, India.

Assistant Professor

Post graduate and Research Department of Zoology,

Sanantana Dharma College, Alappuzha, Kerala India.

Durga Krishnan, Professor, Department of General Medicine, Chettinad Hospital and Research Institute, Chettinad Academy of Research and Education, Kelambakkam, Kancheepuram, Tamilnadu, India.

Professor,

Department of General Medicine,

Chettinad Hospital and Research Institute ,

Chettinad Academy of Research and Education,

Kelambakkam-603103 , Kancheepuram,, Tamilnadu , India.

References

WHO [Internet]. Emergencies/Coronavirus Disease (COVID-19)/India Situation Report; [cited 2022 Jan 2]. Available from: https://www.who.int/india/emergencies/coronavirus-disease-(covid-19)/india-situation-report.

Zaim S, Chong JH, Sankaranarayanan V, Harky A. COVID-19 and Multiorgan Response. Curr Probl Cardiol. 2020 Aug;45(8):100618. [PubMed] [Google Scholar]

Jin JM, Bai P, He W, Wu F, Liu XF, Han DM, Liu S, Yang JK. Gender differences in patients with COVID-19: focus on severity and mortality. Front Public Health. 2020 Apr;8:152. [PubMed] [Google Scholar]

Izcovich A, Ragusa MA, Tortosa F, Lavena Marzio MA, Agnoletti C, Bengolea A, Ceirano A, Espinosa F, Saavedra E, Sanguine V, Tassara A, Cid C, Catalano HN, Agarwal A, Foroutan F, Rada G. Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review. PLoS One. 2020 Nov;15(11):e0241955. [PubMed] [Google Scholar]

Leulseged TW, Hassen IS, Ayele BT, Tsegay YG, Abebe DS, Edo MG, Maru EH, Zewde WC, Naylor LK, Semane DF, Dresse MT, Tezera BB. Laboratory biomarkers of COVID-19 disease severity and outcome: Findings from a developing country. PLoS One. 2021 Mar;16(3):e0246087. [PubMed] [Google Scholar]

Nath R, Gupta NK, Jaswal A, Gupta S, Kaur N, Kohli S, Saxena A, Ish P, Kumar R, Tiwari P, Kumar M, Kishore J, Yadav G, Marwein F, Gupta N. Mortality among adult hospitalized patients during the first wave and second wave of COVID-19 pandemic at a tertiary care center in India. Monaldi Arch Chest Dis. 2021 Oct 11. [PubMed] [Google Scholar]

Lim S, Bae JH, Kwon HS, Nauck MA. COVID-19 and diabetes mellitus: from pathophysiology to clinical management. Nat Rev Endocrinol. 2021 Jan;17(1):11-30. [PubMed] [Google Scholar]

Clark CE, McDonagh STJ, McManus RJ, Martin U. COVID-19 and hypertension: risks and management. A scientific statement on behalf of the British and Irish Hypertension Society. J Hum Hypertens. 2021 Apr;35(4):304-7. [PubMed] [Google Scholar]

Capoferri G, Osthoff M, Egli A, Stoeckle M, Bassetti S. Relative bradycardia in patients with COVID-19. Clin Microbiol Infect. 2021 Feb;27(2):295-6.[PubMed] [Google Scholar]

Chatterjee NA, Jensen PN, Harris AW, Nguyen DD, Huang HD, Cheng RK, Savla JJ, Larsen TR, Gomez JMD, Du-Fay-de-Lavallaz JM, Lemaitre RN, McKnight B, Gharib SA, Sotoodehnia N. Admission respiratory status predicts mortality in COVIDâ€19. Influenza Other Respir Viruses. 2021 Sep;15(5):569-72.[PubMed] [Google Scholar]

Rees EM, Nightingale ES, Jafari Y, Waterlow NR, Clifford S, B Pearson CA, Group CW, Jombart T, Procter SR, Knight GM. COVID-19 length of hospital stay: a systematic review and data synthesis. BMC Med. 2020 Sep;18(1):270. [PubMed] [Google Scholar]

Saeed GA, Gaba W, Shah A, Al Helali AA, Raidullah E, Al Ali AB, Elghazali M, Ahmed DY, Al Kaabi SG, Almazrouei S. Correlation between chest CT severity scores and the clinical parameters of adult patients with COVID-19 pneumonia. Radiol Res Pract. 2021 Jan;2021:6697677. [PubMed] [Google Scholar]

Yu HH, Qin C, Chen M, Wang W, Tian DS. D-dimer level is associated with the severity of COVID-19. Thromb Res. 2020 Nov;195:219-25. [PubMed] [Google Scholar]

Paudel N, Shrestha S, Marasine NR, Khanal P, Aryal S, Erku D, Poudel A. D-dimer as a biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19. PLoS One. 2021 Aug;16(8):e0256744. [PubMed] [Google Scholar]

Conte G, Cei M, Evangelista I, Colombo A, Vitale J, Mazzone A, Mumoli N. The Meaning of D-Dimer value in COVID-19. Clin Appl Thromb Hemost. 2021 Jan-Dec;27:10760296211017668. [PubMed] [Google Scholar]

Thachil J, Longstaff C, Favaloro EJ, Lippi G, Urano T, Kim PY; SSC Subcommittee on Fibrinolysis of the International Society on Thrombosis and Haemostasis. The need for accurate D-dimer reporting in COVID-19: Communication from the ISTH SSC on fibrinolysis. J Thromb Haemost. 2020 Sep;18(9):2408-11. [PubMed] [Google Scholar]

Grifoni E, Valoriani A, Cei F, Lamanna R, Gelli AMG, Ciambotti B, Vannucchi V, Moroni F, Pelagatti L, Tarquini R, Landini G, Vanni S, Masotti L. Interleukin-6 as prognosticator in patients with COVID-19. J Infect. 2020 Sep;81(3):452-82. [PubMed] [Google Scholar]

Santa Cruz A, Mendes-Frias A, Oliveira AI, Dias L, Matos AR, Carvalho A, Capela C, Pedrosa J, Gil Castro A, Silvestre R. IL-6 is a biomarker for the development of fatal SARS-CoV-2 pneumonia. Front Immunol. 2021;12:263. [Google Scholar]

Sabaka P, KoÅ¡ÄÃ¡lovÃ¡ A, Straka I, Hodosy J, LiptÃ¡k R, KmotorkovÃ¡ B, KachlÃkovÃ¡ M, KuÅ¡nÃrovÃ¡ A. Role of interleukin 6 as a predictive factor for a severe course of Covid-19: retrospective data analysis of patients from a long-term care facility during Covid-19 outbreak. BMC Infect Dis. 2021 Mar;21(1):308.[PubMed] [Google Scholar]

Bhandari S, Rankawat G, Singh A, Wadhwani D, Patel B. Evaluation of interleukin-6 and its association with the severity of disease in COVID-19 patients. Indian J Medi Spec. 2020;11(3):132. [Google Scholar]

Ali N. Elevated level of C-reactive protein may be an early marker to predict risk for severity of COVID-19. J Med Virol. 2020 Nov;92(11):2409-11. [PubMed] [Google Scholar]

Luan Y, Yin C, Yao YM. Update advances on C-reactive protein in COVID-19 and other viral infections. Front Immunol. 2021 Aug;12:720363. [PubMed] [Google Scholar]

Vargas-Vargas M, CortÃ©s-Rojo C. Ferritin levels and COVID-19. Rev Panam Salud Publica. 2020 Jun;44:e72. [PubMed] [Google Scholar]

Carubbi F, Salvati L, Alunno A, Maggi F, Borghi E, Mariani R, Mai F, Paoloni M, Ferri C, Desideri G, Cicogna S, Grassi D. Ferritin is associated with the severity of lung involvement but not with worse prognosis in patients with COVID-19: data from two Italian COVID-19 units. Sci Rep. 2021 Mar;11(1):4863. [PubMed] [Google Scholar]

Szarpak L, Ruetzler K, Safiejko K, Hampel M, Pruc M, Kanczuga-Koda L, Filipiak KJ, Jaguszewski MJ. Lactate dehydrogenase level as a COVID-19 severity marker. Am J Emerg Med. 2021 Jul;45:638-9. [PubMed] [Google Scholar]