Association of Mortality and Raised Inflammatory Markers such as Serum LDH, Serum Ferritin and CRP in Hospitalized Patient with Covid-19 Infection
Syed Sohail Abbas Naqvi1, Abdul Hayee Phulpoto, Abdul Qayoom Memon, Munir Ahmad Channo, Muhammad Rafique Mangi, Asadullah Maher
Objective: The objective of the study was to analyze correlation of serum ferritin, CRP (c-reactive protein) and lactate dehydrogenase with mortality in hospital due to infection caused by covid-19. Also, the aim was to evaluate the best cut off values.
Study Design: It was a cross-sectional study carried out in themedicine department ofCivil Hospital and Khairpur Medical College, Khairpur. The study was done between June to September 2020.
Methodology: Patients that were admitted due to SARS COV-2 which was positive after PCR testing were the part of this study. Patients that had suggestive findings on radiograph but negative PCR test for SARS COV-2, patients with incomplete data or patients that left hospital against medical advice were not included in this study. At the time of admission, serum levels of ferritin, CRP and LDH were tested. The viral load of SARS COV-2 was analyzed through nasopharyngeal swab. WHO guidelines were used to evaluate the disease severity.
Results: In this study, 248 participants were taken with mean age 42.28± 17.84years. 163 patients (65.7%) showed up with mild symptoms, 38 patients (15.32%) revealed moderate while 47 patients (18.95%) were severe cases. 27 patients (10.8%) expired in the hospital. The serum levels of ferritin (124 patients; 50%), CRP (86 patients; 34.67%) and LDH (179 patients; 72.17%) were elevated which was more frequent in patients with moderate or severe conditions and mortality.The 95% confidence interval and the areas in curves associated with receiver operating characteristics for serum levels of ferritin, CRP and LDH were 0.920 (0.840-0.98), 0.91 (0.84-0.95) and 0.87 (0.75-0.92) respectively. CRP (≥45.5 mg/L) had 87.46% sensitivity and 89.10% specificity; ferritin (≥723 ng/ml) had 94.22% sensitivity and 87.60% specificity and the LDH (≥428.5 U/L) had 91.50% sensitivity and 81.65% specificity to predict the mortality.
Conclusion: The levels of inflammatory markers at the time of admission will help predict mortality in Covid-19 patients.
Key Words: Inflammation, Coronavirus, Outcome, mortality, Pakistan