The association of haematological parameters and disease severity in COVID-19 patients at initial presentation / Munirah Ismail

Coronavirus infection (COVID-19) is a multisystemic disease involving the hematopoietic system, rather than the solely respiratory system. The haematological and coagulation abnormalities are mostly associated with cytokine storm and are usually related to acute respiratory distress syndrome (ARDS)...

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Main Author:	Ismail, Munirah
Format:	Thesis
Language:	English
Published:	2022
Subjects:	Communicable diseases and public health
Online Access:	https://ir.uitm.edu.my/id/eprint/95206/1/95206.PDF
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spelling	my-uitm-ir.952062024-08-21T04:12:57Z The association of haematological parameters and disease severity in COVID-19 patients at initial presentation / Munirah Ismail 2022 Ismail, Munirah Communicable diseases and public health Coronavirus infection (COVID-19) is a multisystemic disease involving the hematopoietic system, rather than the solely respiratory system. The haematological and coagulation abnormalities are mostly associated with cytokine storm and are usually related to acute respiratory distress syndrome (ARDS) and multiorgan failure leading to more severe disease and mortality. Previous studies have reported inconsistent haematological parameters, especially white blood cell differential counts. Lymphopenia, neutrophilia, and thrombocytopenia were commonly reported to be associated with severe COVID-19 disease. Some studies also reported the clinical utility of biological markers such as neutrophil to lymphocyte ratio (NLR), neutrophil to monocyte ratio (NMR) on lymphocyte to monocyte ratio (!,,MR) and platelet to lymphocyte ratio (PLR) in predicting disease. Recent evidence has suggested that patients with COVID-19 may also have abnormal coagulation markers and are at higher risk of thromboembolic complications. However, the trend of coagulation markers in different disease severity remains unclear. Objective: This study aims to determine the association between various hematological parameters and disease severity of COVID-19 at initial presentation. Method: This study is a single-center, retrospective, cross-sectional study conducted at Selayang Hospital, Malaysia, from January 2020 to June 2021. Two hundred and fifty-seven positive COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) subjects with different severity of mild, moderate, severe, and critically ill disease that fulfilled inclusion and exclusion criteria were included. The Pearson Chi-square test (X2) was used to analyse categorical data, and the Kruskal-Wallis test was used to analyse the continuous data across a different group of severity. Results: Of 257 cases, 54 were mild cases, 65 were moderate cases, 116 were severe cases, and 22 were critically ill cases. The values of TWC, absolute neutrophil count (ANC), prothrombin time (PT), activated partial thromboplastin time (APTT), NLR, NMR, and PLR were significantly increased in patients with critically ill disease, while the value for absolute lymphocyte count (ALC) was significantly higher in severe disease presentation (p<0.05). Meanwhile, the value of absolute eosinophil count (AEC) was too low to be detected in severe and critically ill disease presentation. There was no statistically significant value for haemoglobin, platelet count, absolute basophil count (ABC), international normalised ratio {INR), and LMR across the different disease severity groups at initial presentation. Conclusion: Leukocytosis, neutrophilia, lymphopenia, monocytopenia, eosinopenia, increased PT and APTT levels, high NLR, high NMR and high PLR are associated with severe and critically ill COVID-19 disease at initial presentation. Faculty of Medicine 2022 Thesis https://ir.uitm.edu.my/id/eprint/95206/ https://ir.uitm.edu.my/id/eprint/95206/1/95206.PDF text en public masters Universiti Teknologi MARA Faculty of Medicine
institution	Universiti Teknologi MARA
collection	UiTM Institutional Repository
language	English
topic	Communicable diseases and public health
spellingShingle	Communicable diseases and public health Ismail, Munirah The association of haematological parameters and disease severity in COVID-19 patients at initial presentation / Munirah Ismail
description	Coronavirus infection (COVID-19) is a multisystemic disease involving the hematopoietic system, rather than the solely respiratory system. The haematological and coagulation abnormalities are mostly associated with cytokine storm and are usually related to acute respiratory distress syndrome (ARDS) and multiorgan failure leading to more severe disease and mortality. Previous studies have reported inconsistent haematological parameters, especially white blood cell differential counts. Lymphopenia, neutrophilia, and thrombocytopenia were commonly reported to be associated with severe COVID-19 disease. Some studies also reported the clinical utility of biological markers such as neutrophil to lymphocyte ratio (NLR), neutrophil to monocyte ratio (NMR) on lymphocyte to monocyte ratio (!,,MR) and platelet to lymphocyte ratio (PLR) in predicting disease. Recent evidence has suggested that patients with COVID-19 may also have abnormal coagulation markers and are at higher risk of thromboembolic complications. However, the trend of coagulation markers in different disease severity remains unclear. Objective: This study aims to determine the association between various hematological parameters and disease severity of COVID-19 at initial presentation. Method: This study is a single-center, retrospective, cross-sectional study conducted at Selayang Hospital, Malaysia, from January 2020 to June 2021. Two hundred and fifty-seven positive COVID-19 reverse transcriptase-polymerase chain reaction (RT-PCR) subjects with different severity of mild, moderate, severe, and critically ill disease that fulfilled inclusion and exclusion criteria were included. The Pearson Chi-square test (X2) was used to analyse categorical data, and the Kruskal-Wallis test was used to analyse the continuous data across a different group of severity. Results: Of 257 cases, 54 were mild cases, 65 were moderate cases, 116 were severe cases, and 22 were critically ill cases. The values of TWC, absolute neutrophil count (ANC), prothrombin time (PT), activated partial thromboplastin time (APTT), NLR, NMR, and PLR were significantly increased in patients with critically ill disease, while the value for absolute lymphocyte count (ALC) was significantly higher in severe disease presentation (p<0.05). Meanwhile, the value of absolute eosinophil count (AEC) was too low to be detected in severe and critically ill disease presentation. There was no statistically significant value for haemoglobin, platelet count, absolute basophil count (ABC), international normalised ratio {INR), and LMR across the different disease severity groups at initial presentation. Conclusion: Leukocytosis, neutrophilia, lymphopenia, monocytopenia, eosinopenia, increased PT and APTT levels, high NLR, high NMR and high PLR are associated with severe and critically ill COVID-19 disease at initial presentation.
format	Thesis
qualification_level	Master's degree
author	Ismail, Munirah
author_facet	Ismail, Munirah
author_sort	Ismail, Munirah
title	The association of haematological parameters and disease severity in COVID-19 patients at initial presentation / Munirah Ismail
title_short	The association of haematological parameters and disease severity in COVID-19 patients at initial presentation / Munirah Ismail
title_full	The association of haematological parameters and disease severity in COVID-19 patients at initial presentation / Munirah Ismail
title_fullStr	The association of haematological parameters and disease severity in COVID-19 patients at initial presentation / Munirah Ismail
title_full_unstemmed	The association of haematological parameters and disease severity in COVID-19 patients at initial presentation / Munirah Ismail
title_sort	association of haematological parameters and disease severity in covid-19 patients at initial presentation / munirah ismail
granting_institution	Universiti Teknologi MARA
granting_department	Faculty of Medicine
publishDate	2022
url	https://ir.uitm.edu.my/id/eprint/95206/1/95206.PDF
_version_	1811768812639354880

The association of haematological parameters and disease severity in COVID-19 patients at initial presentation / Munirah Ismail

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