Association of Inflammatory Biomarkers with COVID-19 Disease Severity at Tertiary Care Hospital, Mumbai, India

Abstract

Introduction: After originating from China in 2019, the novel Coronavirus Disease 2019 (COVID-19) pandemic has badly affected most of the world and now India is witnessing second wave of COVID-19 cases posing a severe threat to public health in the country. The single-stranded Ribonucleic Acid (RNA) virus belongs to beta coronavirus family and is defined as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). The inflammatory response caused by COVID-19 infection can play a critical role in progression of disease to severe level. Aim: This study aimed to explore the association of inflammatory biomarkers with COVID-19 disease severity. Materials and Methods: In this single centre retrospective observational study, 103 confirmed COVID-19 patients were included and divided into non severe and severe groups based upon their clinical features. Information about age, gender, comorbidity and inflammatory biomarkers (serum interleukin-6, serum ferritin and plasma D-dimer) was collected for patients admitted between 1st June 2020 to 30th June 2020. The study was conducted at the Department of Biochemistry, Seth GS Medical College and King Edward Memorial (KEM) Hospital, Mumbai, Maharashtra, India. Comparison of biochemical parameters between non severe and severe group was done using independent t-test and correlation analysis was done using Pearson’s correlation test. Results: Out of total 103 patients, 67 (65%) had one or more co-morbidities. Total 53 (51.4%) patients were on various types of oxygen support. Mean serum IL-6, serum ferritin and plasma D-dimer levels were significantly higher in severe COVID-19 group (IL-6-1561.0±6015.0, ferritin- 2386±5051, and D-dimer4.1±4.4) (p<0.0001) compared to non severe COVID-19 group (IL-6-26.7±46.6, ferritin- 513.0±419.9, and D-dimer-1.1±1.4). The best cut-off point for serum IL-6 was 20.2 pg/mL; sensitivity 91% and specificity 70.2%). For serum ferritin best cut-off point was 566.5 ng/mL; sensitivity 78.5% and specificity 70.2%. For plasma D-dimer best cut-off point was 0.9 pg/mL; sensitivity 72.2% and specificity 70.2%. Conclusion: Serum IL-6, serum ferritin and plasma D-dimer can be helpful in monitoring of COVID-19 patients for early identification of severe cases and reducing mortality.

Keywords

• coronavirus disease 2019
• d-dimer
• ferritin
• interleukin-6