Laboratory Biomarkers in Assessing the Severity of COVID-19 at Referral Hospital in Indonesia

Abstract

Introduction: The COVID-19 pandemic is challenging due to its high transmissibility and mortality rates. COVID-19 patients can rapidly deteriorate, underscoring the need to identify lab biomarkers for high-risk categorization. This study aims to explore the role and correlation of various laboratory parameters, including Neutrophil-to-Lymphocyte Ratio (NLR), Ferritin, Prothrombin (PT), D-Dimer, C-reactive protein (CRP), and Procalcitonin (PCT), in distinguishing between severe and non-severe cases of COVID-19. Materials and methods: This retrospective cross-sectional study was carried out at Sulianti Saroso Infectious Disease Hospital in Jakarta with approval from the ethics committee. The inclusion criteria for subjects consist of patients confirmed with COVID-19 through PCR test results, adults aged over 18 years, and those with relevant laboratory parameter results. The exclusion criteria include pregnant patients, patients who arrive in a state of death on arrival (DOA), and patients with incomplete data. A sample of 1,598 adult COVID-19 patients was analysed. Laboratory data were extracted from electronic medical records (SIMINTRO) from March 2020 to December 2022. The significance of the means was assessed through the independent Mann-Whitney test, with a p-value <0.05 regarded as statistically significant. After constructing the ROC (receiver-operating characteristic) curve, threshold values were identified based on Youden's index (J). Result: There are differences in the severe and non-severe groups based on age, gender, transmission risk factors, symptoms, and comorbidities (p<0.05). Severe COVID-19 patients show markedly elevated levels of (NLR, Ferritin, Prothrombin, D-Dimer, CRP, and Procalcitonin) compared to non-severe ones, and the statistical cut-off values between severe and non-severe groups according to parameters (NLR, Ferritin, PT, D-Dimer, CRP, and PCT) are significant (p<0.001). Conclusion: Besides clinical findings, biochemical parameters are valuable predictors for assessing COVID-19 severity.