The İmportance of Hematological Parameters in the Prognosis of Patients with Severe COVID‑19, A Single‑center Retrospective Study

Abstract

Background: Inflammation biomarkers known as acute phase reactants (APRs) show significant variations in serum concentrations  during inflammation brought on by both viral and noninfectious diseases. The erythrocyte sedimentation rate (ESR), the C-reactive  protein (CRP), the lactate dehydrogenase (LDH), the ferritin, the fibrinogen, the procalcitonin, the D-dimer, and the troponin I are all  significant APRs. During inflammation, the serum levels of each of these positive APRs rise. The sensitivity and specificity of hematologic  parameters and indices are as high as the inflammatory biomarkers mentioned above for monitoring disease severity and treatment  response.

Aim: We aimed to evaluate the differences in hematological parameters and indices, and to reveal their treatment and  prognostic values, especially in deceased patients with COVID-19.

Materials and Methods: The hemogram parameters of 169 critical patients with COVID-19 (125 males and 44 females) who received inpatient treatment at …. between 1 March 2020 and 31 December 2021  were analyzed retrospectively. The patients were divided into two groups—deceased (77) and surviving (92)—noting demographic data  such as age and gender. All analyses were performed using SPSS 25.0.

Results: Analyses of the hematological parameters used during  the treatment processes revealed statistically significant differences between the two patient groups. White blood cell (WBC), neutrophil,  and neutrophil‑to‑lymphocyte ratio (NLR) values were significantly higher (P = 0.019, P = 0.000 and P = 0.000, respectively) for deceased  subjects, while lymphocyte, platelet and plateletcrit (PCT) values were significantly lower (for all values, P = 0.000). Platelet volume (MPV)  and platelet distribution width (PDW), as well as MPV/PLT, PDW/PLT, MPV/PCT, and PDW/PCT, levels were significantly higher in deceased  subjects (P = 0.000). Particularly in our deceased cases, receiver operating characteristic analyses were performed to reveal the  importance of such analyses in prognostic status evaluation in COVID‑19 since the hematological parameters are quite different. Cut‑off  values were determined for each parameter, and sensitivity and specificity ratios were calculated. While the sensitivities of MPV/PLT,  PDW/PLT, MPV/PCT, and PDW/PCT indices are over 80%, neutrophil and white blood cell sensitivities were found to be lower (74%, 68.8%,  respectively).

Conclusion: In addition to NLR, which is an important biomarker, the hematological indices MPV/PLT, PDW/PLT, MPV/PCT,  and PDW/ PCT can be used to determine the risk of death in patients with severe COVID-19.