Serum Ferritin and C - Reactive Protein as Prognostic Factors in Patients with Novel Coronavirus 2019

Prognostic Factors in Patients with Novel Coronavirus 2019

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in Coronavirus disease 2019 (COVID-19) which has been widely spread in India and worldwide. We have aimed to investigate serum ferritin and CRP along with routine investigations 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 taken for study, admitted on priority basis. Consecutive blood tests that included ferritin and CRP in the study period were reviewed. Patients diagnosed with SARS-CoV-2 infection in whom, CBC, platelet count, RFT, LFT, RBS, serum ferritin and CRP 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 72% were men. For ARDS patients, 60 years, and 74% were men. Out of 42 ARDS cases 28 are diabetic (66.7%) as compared to 11 cases being diabetic in total 58 Non-ARDS cases (19%) 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 is drastically decreased in ARDS cases (Mean=10; 6-14 p<0.001). 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, T.Bilirubin and D.Bilirubin raised significantly (Mean=1.8 and 0.8 p<0.001 respectively) along with SGPT significantly increased (Mean=40.3 p< 0.001). Also, there is drastic decrease in platelet counts in these ARDS cases (Mean=1.6X103cells/cu.mm p<0.001) suggesting thrombotic storm and inflammatory signs in ARDS cases. In all ARDS cases there is significant increase in serum ferritin and CRP values (100%) whereas in
Non-ARDS cases these values were raised in 84.5% of cases. we found that in COVID-19 patients the association between ferritin levels and CRP levels was stronger. Conclusion: Detailed investigation of 100 hospitalized COVID-19 cases suggests that the serum ferritin test and CRP test should be used for screening in patients with COVID-19 to evaluate the severity and to predict the prognosis and mortality in hospitalized COVID-19 patients. 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.