Role of D-Dimer and LDH in Assessment of Severity of Covid-19

Assessment of Severity of Covid-19

Abstract

Background: COVID-19 disease due to coronavirus 2 (SARS-CoV-2) infection has been widely spread in India and worldwide. Laboratory investigation values are mainly attributed to the increased inflammatory biomarkers, tissue injury indicators and coagulation parameters. Hence we aimed to investigate D-Dimer and serum LDH and to correlate them amongst non- ARDS cases and ARDS cases which may help to predict severity and outcome of COVID-19. Subjects and Methods: Total number of 100 cases enrolled for the study, admitted on priority basis. Consecutive blood tests that included D-Dimer and serum LDH in the study period were reviewed. Patients diagnosed with SARS-CoV-2 infection, diagnosed by RT-PCR and CORAD scaling, in whom, CBC, platelet count, RFT, LFT, RBS, serum D-Dimer and serum LDH had been analysed at the time of admission were selected. For assessment of severity and behaviour of the factors to be analysed the COVID-19
patients were grouped into Non-ARDS (mild) and ARDS (severely ill) cases, factors analysed in both groups and correlated. Results: For Non-ARDS patients, the median age was 48 years and for ARDS patients, 60 years. Out of 42 ARDS cases 28 are diabetic (66.7%) p<0.001. Out of 39 ARDS cases 35 had mild to severe dyspnea which accounts for 83.3% with p value <0.001. Lymhocyte count and platelet counts are drastically decreased in ARDS cases (Mean=10; 6-14 p<0.001 and Mean=1.6X103cells/cu.mm p<0.001 respectively). There is decrease in the. ESR is raised in most of the covid cases, a significant increase in ARDS patients (Mean=36; 31.8-42.3 p<0.05). In LFT, Bilirubin levels raised significantly (Mean=1.8 and 0.8 p<0.001 respectively) along with SGPT significantly increased (Mean=40.3 p< 0.001). In all ARDS cases there is significant increase in D-Dimer and serum LDH values (100% and 97.6%). Also in ARDS cases the association between D-Dimer and
serum LDH and correlation between these two factors with routine investigations is stronger. Conclusion: In summary, this study showed that D-Dimer and LDH could be identified as powerful predictive factors for early recognition of thrombosis and organ injury and thus can predict the severity of COVID-19. Lymphopenia, Thrombocytopenia, with more prominent laboratory abnormalities may be a potential indicator for diagnosis. Older age, high number of comorbidities were associated with severe patients.