Estimation of Ferritin and D-Dimer Levels in COVID-19 Patients with Mucormycosis: A Cross-sectional Study

Abstract

Introduction: There are increasing reports of the occurrence of fungal co-infections in Coronavirus disease-2019 (COVID-19) patients resulting in severe morbidity among predisposed individuals. Mucormycosis is an Invasive Fungal Infection (IFI). Early anticipation and identification of fungal co-infections can significantly reduce morbidity rate among COVID-19 infected patients. Aim: To determine quantitatively the levels of ferritin and D-dimer in COVID-19 infected patients with mucormycosis. Materials and Methods: This cross-sectional study was conducted on 84 Real Time Polymerase Chain Reaction (RT-PCR) positive for COVID-19 in oropharyngeal swab patients from June 2021 to August 2021 at Sri Devaraj Urs Medical College, Kolar, Karnataka, India. D-dimer and ferritin levels were measured in the patient’s blood sample using Latex Enhanced Immunoturbidimetric method in Vitros 5.1 FS and Vitros Eci Immunodiagnostics, respectively. Continuous data represented as mean and standard error of mean, Kruskal-Wallis test and Mann-Whitney U test was used to test significance, p-value <0.05 was considered as statistically significant. Results: Of the 84 COVID-19 Infected patients, 40 were included in group 1, 25 patients in group 2 and 19 patients in group 3. A total of 21 patients were aged between 20-40 years, 48 patients between 41-60 years age group and 15 patients were in 61-80 years of age group. The number of male patients was 63 and female patients were 21. The D-dimer levels were 1259.37±258.9, 2632.60±472.6 and 229.53±18.4 (p-value <0.001) in group 1, 2 and 3, respectively and ferritin levels were 528.58±45.03, 511.48±74.4, and 256.89±51.8 (p-value <0.007) in group 1, 2 and 3, respectively. Conclusion: Serum ferritin and plasma D-dimer were significantly elevated in COVID-19 patients with mucormycosis. Mucormycosis in COVID-19 patients without pre-existing co-morbidities may be attributed to the use of steroid therapy in these patients for COVID-19 infection. Thus, serum ferritin and plasma dimer levels may have a significant predictive role in the risk assessment for the development of mucormycosis among COVID-19 infected patients.

Keywords

• acute phase protein
• coronavirus disease-2019
• fibrin degradation products
• fungal disease
• severe acute respiratory syndrome coronavirus-2