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Research ArticleOriginal Article
Open Access

Routine laboratory parameters predict serious outcome as well as length of hospital stay in COVID-19

Mohammed A. Jeraiby, Majed I. Hakamy, Mohammed B. Albarqi, Rehab I. Areda, Moayad A. Haddad and Johar Iqbal
Saudi Medical Journal November 2021, 42 (11) 1165-1172; DOI: https://doi.org/10.15537/smj.2021.42.11.20210429
Mohammed A. Jeraiby
From the Department of Medical Biochemistry (Jeraiby, Iqbal), Faculty of Medicine, Jazan University, from the Department of Pulmonology (Hakamy, Albarqi, Areda); and from the Department of Laboratory Medicine (Haddad), King Fahad Central Hospital, Jazan, Kingdom of Saudi Arabia.
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Majed I. Hakamy
From the Department of Medical Biochemistry (Jeraiby, Iqbal), Faculty of Medicine, Jazan University, from the Department of Pulmonology (Hakamy, Albarqi, Areda); and from the Department of Laboratory Medicine (Haddad), King Fahad Central Hospital, Jazan, Kingdom of Saudi Arabia.
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Mohammed B. Albarqi
From the Department of Medical Biochemistry (Jeraiby, Iqbal), Faculty of Medicine, Jazan University, from the Department of Pulmonology (Hakamy, Albarqi, Areda); and from the Department of Laboratory Medicine (Haddad), King Fahad Central Hospital, Jazan, Kingdom of Saudi Arabia.
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Rehab I. Areda
From the Department of Medical Biochemistry (Jeraiby, Iqbal), Faculty of Medicine, Jazan University, from the Department of Pulmonology (Hakamy, Albarqi, Areda); and from the Department of Laboratory Medicine (Haddad), King Fahad Central Hospital, Jazan, Kingdom of Saudi Arabia.
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Moayad A. Haddad
From the Department of Medical Biochemistry (Jeraiby, Iqbal), Faculty of Medicine, Jazan University, from the Department of Pulmonology (Hakamy, Albarqi, Areda); and from the Department of Laboratory Medicine (Haddad), King Fahad Central Hospital, Jazan, Kingdom of Saudi Arabia.
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Johar Iqbal
From the Department of Medical Biochemistry (Jeraiby, Iqbal), Faculty of Medicine, Jazan University, from the Department of Pulmonology (Hakamy, Albarqi, Areda); and from the Department of Laboratory Medicine (Haddad), King Fahad Central Hospital, Jazan, Kingdom of Saudi Arabia.
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  • For correspondence: [email protected]
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  • Figure 1
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    Figure 1

    - STROBE chart. COVID-19: coronavirus disease-19, RT-PCR: real-time reverse transcriptase-polymerase chain reaction

  • Figure 2
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    Figure 2

    - Receiver operating characteristic (ROC) curve depicting area under curve (AUC) for c-reactive protein (CRP) and red cell distribution width (RDW). Serious outcome (intensive care unit [ICU] admission) is the dependent variable.

Tables

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    Table 1

    - Average age and levels of routine laboratory analytes of covid-19 patients at the time of admission (N=74).

    VariablesMedian (IQR)
    Age (years), mean±SD50.4±17.2 [19-83]a
    Creatinine (µmol/L)76 (57.2)
    CRP (mg/dL)8.5 (15.6)
    Hb (g/dL), mean±SD12.1±2.2
    MCV (fL), mean±SD83.03±9.10
    MCH (pg/cell), mean±SD26.9±3.5
    MCHC (g/dL), mean±SD32.4±1.9
    RDW14.1 (3.2)
    WBC (109/L)8.1 (8.0)
    Neutrophil (109/L)6.1 (7.9)
    Lymphocyte (109/L)1.4 (1.2)
    Monocyte (109/L)0.6 (0.7)
    Eosinophil (109/L)0.01 (0.1)
    Basophil (109/L)0.02 (0.03)
    Platelet (109/L)210.5 (124.5)
    • CRP: c-reactive protein, Hb: hemoglobin, MCV: mean corpuscular volume, MCH: mean corpuscular hemoglobin, MCHC: mean corpuscular hemoglobin cocentration, RDW: red cell distribution width, WBC: absolute count of leucocytes, IQR: interquartile range. Values are expressed as either mean±standrad or median IQR or a range

    • View popup
    Table 2

    - Levels of routine laboratory analytes, leucocyte ratios, and delta creatinine (Δ Cr) among stable and serious COVID-19 patients.

    VariablesIsolation (stable)ICU (serious)
    Male (n=23)Female (n=21)Total (n=44)Male (n=16)Female (n=14)Total (n=30)
    Median [range]
    Age (years), mean±SD48.5±15.650.0±19.349.2±17.350.9±20.753.5±12.452.1±17.1
    Creatinine (μmol/L)89 [38-1015]64.0 [28-838]71.0 [28-1015]99.0 [52-983]74.5 [49-649]85.0 [49-983]
    CRP (mg/dL)8.4 [0.36-38]a1.5 [0.3-48]4.3 [0.3-48]12.6 [0.3-112]16.3 [1-57.1]13.2 [0.3-112]e
    Hb (g/dL), mean±SD12.9±2.711.6±1.512.3±2.311.6±2.311.8±1.511.7±1.9
    MCV (fL), mean±SD84±882±783±783±1180±1082±10
    MCH (pg/cell), mean±SD27±326±327±327±425±326±3
    MCHC (g/dL), mean±SD32±1.831.7±1.732.3±1.932.9±1.931.7±1.732.3±1.8
    RDW (%)13.2 [11.7-23.1]c14.1 [11.8-18.2]13.5 [11.7-23.1]14.5 [12.7-33]16.3 [12.7-19.9]15.2 [12.7-33]d
    WBC (109/L)7.8 [3.0-18.5]7.0 [2.5-22.4]7.8 [2.5-22.4]12.6 [4.4-35.1]7.9 [1.3-31.8]9.4 [1.3-35.1]
    Neutrophils (109/L)5.6 [1.3-14.9]4.2 [1.3-18.6]4.7 [1.3-18.6]10.2 [2.4-26.4]c5.9 [0.5-27.7]6.6 [0.5-27.7]b
    Lymphocytes (109/L)1.3 [0.25-3.2]c1.6 [0.6-4.1]1.5 [0.25-4.1]0.9 [0.3-3]1.4 [0.4-2.4]1.2 [0.3-3]
    NLR4.6 [0.8-36.3]a1.9 [0.5-23.3]4.0 [0.5-36.3]10.6 [2.6-45.5]c4.1 [1.4-14.2]6.3 [1.4-44.5]b
    Monocytes (109/L)0.6 [0-1.8]0.6 [0.12-2.24]0.6 [0-2.2]0.7 [0.2-6.5]0.6 [0.03-1.4]0.6 [0.03-6.5]
    MLR0.5 [0-2.8]0.3 [0.08-1.5]0.4 [0-2.8]0.8 [0.3-2.2]c0.4 [0.08-1.2]0.6 [0.08-2.2]b
    Platelet count (109/L)183.0 [49-419]c242.0 [104-467]192.0 [49-467]272.0 [159-685]205.5 [116-351]237 [116-685]
    PLR178.8 [15.5-736]95.1 [68.9-608.2]151 [15.5-736]268 [103-865.5]a143 [83-494.5]194 [83-865.5]b
    ∆ Cr (μmol/L)0.0 [-31-190]-4.0 [-174-218]-1.0 [-174-218]-6.5 [-279-248]-3.5 [-127-221]-3.5 [-279-248]
    % ∆ Cr0.0 [-49.2-150.6]-2.6 [-34.3-42.4]-1.6 [-49.2-150.6]-9.6 [-45.1-61.6]-5.1 [-44.4-156.2]-5.1 [-45.1-156.2]
    • COVID-19: coronavirus disease-19, ICU: intensive care unit, SD: standard deviation, CRP: c-reactive protein, Hb: hemoglobin, MCV: mean corpuscular volume, MCH: mean corpuscular hemoglobin, MCHC: mean corpuscular hemoglobin cocentration, RDW: red cell distribution width, WBC: absolute count of leucocytes, NLR: neutrophil lymphocyte ratio, MLR: monocyte to lymphocyte ratio, PLR: platelet to lymphocyte ratio. Significantly different from a females or b stable (total) at p<0.05; significantly different from c females or d stable (total) at p<0.01; significantly different from e stable (total) at p<0.001

    • View popup
    Table 3

    - Univariate analysis: binary logistic for serious outcome in COVID-19 infection and linear regression for length of hospital stay.

    VariablesSerious outcomeLength of hospital stay
    OR95% CIP-valueßR2FP-value
    Age1.0100.983-1.0380.484-0.0010.0040.3070.581
    Gender0.9580.378-2.4280.9290.1550.0655.0080.028
    Creatinine1.0000.998-1.0020.8040.0000.0453.4100.069
    CRP1.0531.016-1.0910.0050.0060.19317.23<0.001
    CRPxcreatinine1.0001.000-1.0000.1151.016x10-50.16714.39<0.001
    Creatinine/CRP0.9880.977-0.9990.037-0.0010.0332.4930.119
    Hb0.8760.703-1.0910.236-0.0430.0987.8320.007
    MCV0.9810.931-1.0340.4710.0000.0000.0010.976
    MCH0.9610.841-1.0980.558-0.0110.0161.1440.288
    MCHC1.0090.787-1.2920.946-0.0430.0755.8080.019
    RDW1.2521.030-1.5230.0240.0140.0251.8510.178
    WBC1.0790.999-1.1650.0540.0110.0614.6590.034
    Neutrophils1.0931.004-1.1890.0400.0150.0836.4800.013
    Lymphocytes0.6820.380-1.2230.199-0.0140.0020.1210.729
    NLR1.0430.985-1.1040.1480.0100.0856.7050.012
    MLR2.2250.875-5.6590.0930.1630.0826.4060.014
    PLR1.0021.000-1.0050.1030.0000.0513.8470.054
    ∆ Cr0.9980.992-1.0040.580-0.0010.0655.0170.028
    % ∆ Cr1.0020.988-1.0150.813-0.0030.0846.6050.012
    • COVID-19: coronavirus disease-19, OR: odds ratio, CI: confidence interval, CRP: c-reactive protein, Hb: hemoglobin, MCV: mean corpuscular volume, MCH: mean corpuscular hemoglobin, MCHC: mean corpuscular hemoglobin cocentration, RDW: red cell distribution width, WBC: absolute count of leucocytes, NLR: neutrophil lymphocyte ratio, MLR: monocyte to lymphocyte ratio, PLR: platelet to lymphocyte ratio. Values are expressed as either OR at 95% CI for logistic regression or unstandardized regression coefficient (ß), unadjusted R2 and F-value for linear regression.

    • View popup
    Table 4

    - Multivariable logistic regression for serious outcome in COVID-19 patients in adjusted and unadjusted models.

    VariablesUnadjusted modelAdjusted model
    OR95% CIP-valueOR95% CIP-value
    CRP1.0521.014-1.0910.0071.0481.006-1.0900.024
    RDW1.2181.010-1.4700.0401.2861.035-1.5960.023
    • COVID-19: coronavirus disease-19, CRP: c-reactive protein, RDW: red cell distribution width, OR: odds ratio, CI: confidence interval

    • View popup
    Table 5

    - Multiple regression analysis for length of hospital stay (LOS) in various unadjusted and adjusted models.

    VariablesUnadjustedAdjusted
    1A2A
    CoefficientP-valueCoefficientP-value
    CRP0.006<0.0010.0040.003
    MCHC-0.0290.065-0.0440.007
    NLR0.0090.0080.0040.213
    % ∆ Cr-0.0030.002-0.0020.021
     1B2B
    CRP0.005<0.0010.0040.004
    MCHC-0.0340.028-0.0470.003
    MLR0.1700.0020.1240.026
    % ∆ Cr-0.0030.001-0.0020.014
     1C2C
    CRP0.006<0.0010.0040.003
    MCHC-0.0270.096-0.0430.009
    PLR0.0000.0510.0000.250
    % ∆ Cr-0.0030.002-0.0020.024
    • CRP: c-reactive protein, MCHC: mean corpuscular hemoglobin cocentration, NLR: neutrophil lymphocyte ratio, MLR: monocyte to lymphocyte ratio, PLR: platelet to lymphocyte ratio. Values are expressed as unstandardized regression coefficient. Model 1A and 2A includes NLR, 1B and 2B includes MLR, 3A and 3B includes PLR. Models 1A, 1B and 1C are unadjusted; models 2A, 2B and 2C are adjusted

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Routine laboratory parameters predict serious outcome as well as length of hospital stay in COVID-19
Mohammed A. Jeraiby, Majed I. Hakamy, Mohammed B. Albarqi, Rehab I. Areda, Moayad A. Haddad, Johar Iqbal
Saudi Medical Journal Nov 2021, 42 (11) 1165-1172; DOI: 10.15537/smj.2021.42.11.20210429

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Routine laboratory parameters predict serious outcome as well as length of hospital stay in COVID-19
Mohammed A. Jeraiby, Majed I. Hakamy, Mohammed B. Albarqi, Rehab I. Areda, Moayad A. Haddad, Johar Iqbal
Saudi Medical Journal Nov 2021, 42 (11) 1165-1172; DOI: 10.15537/smj.2021.42.11.20210429
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Keywords

  • coronavirus
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  • C-reactive protein
  • mean corpuscular hemoglobin concentration
  • neutrophil-lymphocyte-ratio
  • red cell distribution width

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