Haematological, Clinical and Radiological Prognostic Markers in Young COVID19 Patients during the Second Wave: A Prospective Cohort Study

Abstract

Introduction: The devastating outbreak of the second wave of Coronavirus Disease-2019 (COVID-19), resulting in numerous deaths among young individuals, has been the deadliest pandemic witnessed in this century. It caught us off guard by affecting young people and those without any underlying health conditions, leaving profound psychological and economic scars. Aim: To investigate various prognostic markers (haematological and clinicoradiological) in young COVID-19 patients during the second wave. Materials and Methods: This prospective, cohort study was conducted at a tertiary care centre in Karnataka, India from May 1st, 2021, to June 30th, 2021. All COVID-19 patients between the ages of 18 and 45, regardless of their pre-existing health status, who tested positive on Real-time Reverse TranscriptasePolymerase Chain Reaction (RT-PCR)/Rapid Antigen Test (RAT) or showed typical Computed Tomography (CT) changes, were included. Patients with COVID-19 symptoms but negative RT-PCR/RAT results and without typical CT changes were excluded. Clinical, haematological, and radiological parameters were compared between the survivor group and non survivor group, and the results were analysed using measures of central tendency (mean, median, and mode), Chi-square test, and Independent t-test Statistical Package for Social Sciences (SPSS) version 21.0. Results: A total of 624 cases aged between 18 and 45 were included in the study. Among them, 481 (77.08%) patients survived, while 143 (22.92%) patients were dead. Of the 624 cases, 376 (60.26%) were males, 247 (39.58%) were females, and 1 (0.16%) was transgender. Factors associated with increased mortality included older age (>40 years), presentation with cough (119 patients, 83.2%) and dyspnoea (120 patients, 83.9%), asthma (7 patients, 1.1%), clinical classification based on respiratory rate, oxygen saturation, CT changes, and requirement for mechanical ventilation (78 patients, 54.5% in the Severe category and 54 patients, 37.8% in the Critical category), increased white blood cell count (mean μ=9685.8±5470.9), increased neutrophils (μ=8216±4986.9), elevated levels of CRP (μ=96.7±65.84 mg/dL), serum ferritin (μ=571.4±353.15 ng/ mL), LDH (μ=1268.7±835 U/L), D-dimer (μ=74.87±527), serum globulin, ALT (μ=67.6±58.5 U/L), AST (μ=76.4±62 U/L), ALP (μ=120±89 U/L), urea, creatinine, decreased levels of albumin, total protein, haemoglobin, and lymphopenia (μ=1096.1±795.9). Additionally, a CT score >15 was associated with increased mortality. Conclusion: The aforementioned clinical, haematological, and radiological predictive biomarkers were associated with poor outcomes in young COVID-19 patients. Therefore, prompt and intensive management should be implemented to improve the prognosis of these patients.

Keywords

• biomarkers
• cough
• dyspnoea
• ferritin
• lymphopenia
• mortality