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Abstract

Background: Corona virus disease 2019 (COVID-19) is an ongoing global pandemic. It is a systemic infection with a significant impact on the hematopoietic and the immune system. In this study we aimed to evaluate the different inflammatory markers and indexes of systemic inflammatory response in predicting the mortality in patients with COVID-19.

Methods: In this cross sectional study, various inflammatory markers like D-dimer, CRP, serum ferritin, LDH and CBC derived indexes of inflammation were analyzed in predicting mortality in COVID-19 infection.

Results: We enrolled 302 COVID-19 patients who had a mean age of 54.51 ± 15.39 yrs. with 210 (69.5%) males. Among them 21% were asymptomatic and fever was the commonest among symptomatic patients. Majority of patients (66.7%) had no comorbidities and 20% had multiple comorbidities. On analyzing different hematological variables, survivors had statistically significant higher hemoglobin count, lymphocytes, monocytes, eosinophil and platelet count and lower leukocyte, neutrophil count. Inflammatory markers D-dimer, serum ferritin and LDH were significantly elevated among non survivors. Among the indexes of inflammation, only NLR showed significant higher values among non survivors.

All the inflammatory markers were able to predict mortality among the COVID-19 infected cases with a sensitivity and specificity of 85% and 65% for D dimer levels, 85% and 72% for serum ferritin, 85% and 72% for LDH, 85% and 51% for CRP levels respectively. Among the indexes of inflammation, validity of NLR was best in predicting mortality with 85% sensitivity and 51% specificity.

Conclusion: Abnormalities in peripheral blood parameters and increase in inflammatory markers are common findings in COVID-19 infection. NLR was best at predicting mortality followed by D-dimer and serum ferritin levels.

Keywords: Coronavirus; COVID-19; D dimer; Inflammatory markers; Neutrophil lymphocyte ratio; Systemic inflammation index