Estimation of D-dimer, C-reactive protein and ferritin in Covid-19 survivors in a North Indian Hospital, Lucknow, India.
Abstract
Background: Novel coronavirus disease (COVID-19), the disease caused by SARS-CoV-2, is a highly contagious disease. COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was initially thought to affect only the upper respiratory tract, can affect almost all systems. COVID-19 survivors who are critically ill featured hyper inflammation and the associated biomarkers may be useful for risk stratification.
Objective: We aimed to estimate the levels of several biomarkers, including serum C-reactive protein (CRP), D-dimer, and serum ferritin in Covid-19 survivors to reduce the further disease complication and its-associated mortality.
Method: This case-control study was conducted on COVID-19 survivors and a control group without a history of Covid-19. The D-dimer and Ferritin were determined by using Mini Vidas Immuno assay analyser and CRP was estimated Dimension RXL Siemens autoanalyzer by Particle Enhanced Turbidimetric Immunoassay.
Results: The results indicated that CRP levels were higher in COVID-19 survivors compared to controls (p<0.0001). The mean of D-dimer was found to be elevated in COVID-19 survivors as compared to controls (p<0.0001). Similarly, the ferritin level was also found to be raised in COVID-19 survivors as compared to controls (p<0.0001).
Conclusion: Results revealed that COVID-19 survivors had considerably higher mean levels of CRP, D-dimer, and ferritin than controls.
References
WHO. WHO Virtual press conference on COVID‐19. Press briefing. 2020 Mar 11.
Zhang YZ, Holmes EC. A genomic perspective on the origin and emergence of SARS-CoV-2. Cell. 2020 Apr 16;181(2):223-7. https://doi.org/10.1016/j.cell.2020.03.035
Chowdhury SD, Oommen AM. Epidemiology of COVID-19. Journal of digestive endoscopy. 2020 Mar;11(01):03-7. https://doi.org/10.1055/s-0040-1712187
Fisher D, Heymann D. Q&A: The novel coronavirus outbreak causing COVID-19. BMC medicine. 2020 Dec;18(1):1-3. https://doi.org/10.1186/s12916-020-01533-w
Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time. The Lancet infectious diseases. 2020 May 1;20(5):533-4. https://doi.org/10.1016/S1473-3099(20)30120-1
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DS, Du B. Clinical characteristics of coronavirus disease 2019 in China. New England journal of medicine. 2020 Apr 30;382(18):1708-20. https://doi.org/10.1056/NEJMoa2002032
Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. HLH Across Specialty Collaboration. InCOVID-19: Consider Cytokine Storm Syndromes and Immunosuppression 2019 (Vol. 395, p. 1033). Lancet. https://doi.org/10.1016/S0140-6736(20)30628-0
Stebbing J, Phelan A, Griffin I, Tucker C, Oechsle O, Smith D, Richardson P. COVID-19: combining antiviral and anti-inflammatory treatments. The Lancet Infectious Diseases. 2020 Apr 1;20(4):400-2. https://doi.org/10.1016/S1473-3099(20)30132-8
Tay MZ, Poh CM, Rénia L, MacAry PA, Ng LF. The trinity of COVID-19: immunity, inflammation and intervention. Nature Reviews Immunology. 2020 Jun;20(6):363-74. https://doi.org/10.1038/s41577-020-0311-8
Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, Liu S, Zhao P, Liu H, Zhu L, Tai Y. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet respiratory medicine. 2020 Apr 1;8(4):420-2. https://doi.org/10.1016/S2213-2600(20)30076-X
Wu C, Chen X, Cai Y, Zhou X, Xu S, Huang H, Zhang L, Zhou X, Du C, Zhang Y, Song J. Risk factors associated with acute respiratory distress syndrome and death in COVID-19 survivors with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA internal medicine. 2020 Jul 1;180(7):934-43. https://doi.org/10.1001/jamainternmed.2020.0994
Cheng K, Wei M, Shen H, Wu C, Chen D, Xiong W, et al. Clinical characteristics of 463 COVID-19 survivors with common and severe type coronavirus disease (In Chinese). Shanghai Med J 2020;1-15
Gao Y, Li T, Han M, Li X, Wu D, Xu Y, Zhu Y, Liu Y, Wang X, Wang L. Diagnostic utility of clinical laboratory data determinations for COVID-19 survivors with the severe COVID‐19. Journal of medical virology. 2020 Jul;92(7):791-6. https://doi.org/10.1002/jmv.25770
Qin C, Ziwei MP, Tao SY, Ke PC, Shang MM. Dysregulation of immune response in COVID-19 survivors with COVID-19 in Wuhan, China; Clinical Infectious Diseases; Oxford Academic. Clinical Infectious Diseases. 2020. https://doi.org/10.1093/cid/ciaa248
Luan YY, Yin CH, Yao YM. Update advances on C-reactive protein in COVID-19 and other viral infections. Frontiers in Immunology. 2021:3153. https://doi.org/10.3389/fimmu.2021.720363
Azar MM, Shin JJ, Kang I, Landry M. Diagnosis of SARS-CoV-2 Infection in the Setting of the Cytokine Release Syndrome. Expert Rev MolDiagn (2020) 20:1087-97. https://doi.org/10.1080/14737159.2020.1830760
Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers Associated With COVID-19 Disease Progression. Crit Rev Clin Lab Sci (2020) 57(6):389- 99. https://doi.org/10.1080/10408363.2020.1770685
Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, Xing F, Liu J, Yip CC, Poon RW, Tsoi HW. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. The lancet. 2020 Feb 15;395(10223):514-23. https://doi.org/10.1016/S0140-6736(20)30154-9
McAlpine LS, Zubair AS, Maran I, Chojecka P, Lleva P, Jasne AS, Navaratnam D, Matouk C, Schindler J, Sheth KN, Chun H. Ischemic stroke, inflammation, and endotheliopathy in COVID-19 COVID-19 survivors.
Chen S, Pan C, Zhang P, Tang Y, Tang Z. Clinical characteristics of inCOVID-19 survivors with coronavirus disease 2019 and acute ischemic stroke: from epidemiology to outcomes. Current Neurovascular Research. 2020 Dec 1;17(5):760-4. https://doi.org/10.2174/18755739MTExmMzYl1
Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, et al. D-dimer levels on admission to predict in-hospital mortality in COVID-19 survivors with Covid-19. J ThrombHaemost. (2020) 18:1324-9. https://doi.org/10.1111/jth.14859
Wang ZF, Su F, Lin XJ, Dai B, Kong LF, Zhao HW, Kang J. Serum D-dimer changes and prognostic implication in 2009 novel influenza A (H1N1). Thrombosis research. 2011 Mar 1;127(3):198-201. https://doi.org/10.1016/j.thromres.2010.11.032
Klok FA, Kruip MJ, van der Meer NJ, Arbous MS, Gommers DA, Kant KM. Incidence of thrombotic complications in critically ill ICU COVID-19 survivors with COVID-19.[published online ahead of print, 2020 Apr 10]. ThrombRes2020.:30120-1. https://doi.org/10.1016/j.thromres.2020.04.013
Townsend L, Fogarty H, Dyer A, Martin‐Loeches I, Bannan C, Nadarajan P, Bergin C, O'Farrelly C, Conlon N, Bourke NM, Ward SE. Prolonged elevation of D‐dimer levels in convalescent COVID‐19 COVID-19 survivors is independent of the acute phase response. Journal of thrombosis and haemostasis. 2021 Apr;19(4):1064-70.. https://doi.org/10.1111/jth.15267
Zhou F. Y u T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inCOVID-19 survivors with COVID19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395(10229):1054-62. https://doi.org/10.1016/S0140-6736(20)30566-3
Kell DB, Pretorius E. Serum ferritin is an important inflammatory disease marker, as it is mainly a leakage product from damaged cells. Metallomics. 2014 Apr;6(4):748-73. https://doi.org/10.1039/C3MT00347G
Henry BM, De Oliveira MH, Benoit S, Plebani M, Lippi G. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clinical Chemistry and Laboratory Medicine (CCLM). 2020 Jul 1;58(7):1021-8. https://doi.org/10.1515/cclm-2020-0369
F.M. Torti, S.V. Torti. Regulation of ferritin genes and protein. Blood, 99 (2002), pp. 3505-3516. https://doi.org/10.1182/blood.V99.10.3505
Mulchandani R, Lyngdoh T, Kakkar AK. Deciphering the COVID‐19 cytokine storm: systematic review and meta‐analysis. European journal of clinical investigation. 2021 Jan;51(1):e13429. https://doi.org/10.1111/eci.13429
Coomes EA, Haghbayan H. Interleukin‐6 in COVID‐19: a systematic review and meta‐analysis. Reviews in medical virology. 2020 Nov;30(6):1-9. https://doi.org/10.1002/rmv.2141
Leisman DE, Ronner L, Pinotti R, Taylor MD, Sinha P, Calfee CS, Hirayama AV, Mastroiani F, Turtle CJ, Harhay MO, Legrand M. Cytokine elevation in severe and critical COVID-19: a rapid systematic review, meta-analysis, and comparison with other inflammatory syndromes. The Lancet Respiratory Medicine. 2020 Dec 1;8(12):1233-44. https://doi.org/10.1016/S2213-2600(20)30404-5
Lin Z, Long F, Yang Y, Chen X, Xu L, Yang M. Serum ferritin as an independent risk factor for severity in COVID-19 COVID-19 survivors. Journal of infection. 2020 Oct 1;81(4):647-79. https://doi.org/10.1016/j.jinf.2020.06.053
Yang X, Yu Y, Xu J, Shu H, Liu H, Wu Y, Zhang L, Yu Z, Fang M, Yu T, Wang Y. Clinical course and outcomes of critically ill COVID-19 survivors with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The lancet respiratory medicine. 2020 May 1;8(5):475-81. https://doi.org/10.1016/S2213-2600(20)30079-5
Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, et al. D-dimer levels on admission to predict in-hospital mortality in COVID-19 survivors with Covid-19. J ThrombHaemost. (2020) 18:1324-9. https://doi.org/10.1111/jth.14859
Wang ZF, Su F, Lin XJ, Dai B, Kong LF, Zhao HW, et al. Serum D-dimer changes and prognostic implication in 2009 novel influenza A(H1N1). Thromb Res. (2011) 127:198-201. https://doi.org/10.1016/j.thromres.2010.11.032
Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. (2020) 382:1708-20. https://doi.org/10.1056/NEJMoa2002032
McAlpine LS, Zubair AS, Maran I, Chojecka P, Lleva P, Jasne AS, et al. Ischemic Stroke, Inflammation, and Endotheliopathy in COVID-19 COVID-19 survivors. Stroke (2021) 52:e233-8. https://doi.org/10.1161/STROKEAHA.120.031971
Kernan KF, Carcillo JA. Hyperferritinemia and inflammation. IntImmunol. 2017;29: 401-9. https://doi.org/10.1093/intimm/dxx031
Mohamed MMB, Lukitsch I, Torres-Ortiz AE, Walker JB, Varghese V, HernandezArroyo CF, et al. Acute kidney injury associated with coronavirus disease 2019 in urban New Orleans. Kidney. 2020;360(1):614-22. https://doi.org/10.34067/KID.0002652020
Chen S, Pan C, Zhang P, Tang Y, Tang Z. Clinical Characteristics of InCOVID-19 survivors With Coronavirus Disease 2019 and Acute Ischemic Stroke: From Epidemiology to Outcomes. CurrNeurovasc Res (2020) 17:760-4. https://doi.org/10.2174/1567202617999201110200410
Hadid T, Kafri Z, Al-Katib A. Coagulation and anticoagulation in COVID-19. Blood Reviews. 2021 May 1;47:100761. https://doi.org/10.1016/j.blre.2020.100761
Kaushal K, Kaur H, Sarma P, Bhattacharyya A, Sharma DJ, Prajapat M, Pathak M, Kothari A, Kumar S, Rana S, Kaur M, Prakash A, Mirza AA, Panda PK, Vivekanandan S, Omar BJ, Medhi B, Naithani M. Serum ferritin as a predictive biomarker in COVID-19. A systematic review, meta-analysis and meta-regression analysis. J Crit Care. 2022 Feb;67:172-181. https://doi.org/10.1016/j.jcrc.2021.09.023
Özdemir İH, Özlek B, Özen MB, Gündüz R, Cetin N, Özlek E, Yıldız BS, Bilge AR. Prognostic value of C-reactive protein/albumin ratio in hypertensive COVID-19 patients. Clinical and Experimental Hypertension. 2021 Oct 3;43(7):683-9. https://doi.org/10.1080/10641963.2021.1937205
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