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Objective: Coronavirus Disease 2019 (COVID-19) is characterized by high fever, sudden developing respiratory distress, and radiological findings failing to respond to conventional treatments. The purpose of this study is to identify the association of D-dimer levels and lymphocyte counts with poor prognosis and to predict the clinical course in patients with COVID-19.
Methods: A total of 118 hospitalized adult patients diagnosed with COVID-19 were included in the study. According to the National Institutes of Health (NIH) COVID-19 treatment guidelines, patients were divided into two groups with severe disease (n= 26) and non-severe (n= 92) disease. Detected at the time of diagnosis, D-dimer levels and lymphocyte counts were compared between severe and non-severe COVID-19 patient groups. Distinctive performance analysis of these values was performed, and cut-off values were determined.
Results: The mean age of patients was 62 ± 7 years (range 42-80 years), and 63 (53.4 %) were female. The lymphocyte count was lower (p <0.001), and D-dimer was higher in patients with severe COVID-19 compared to non-severe patients (p <0.001). D-dimer's cut-off point when the sum of specificity and sensitivity is maximized was 2 mg/L (sensitivity, 0.731; specificity, 0.913), and 1500/mm3 was for lymphocyte count (sensitivity, 0.692; specificity, 0.609). Lymphocyte count and D-dimer had a significant discrimination power (AUC: 0.745 [95 CI: 0.644 - 0.846 ], AUC: 0.928 [95% CI: 0.879 - 0.978] respectively, p <0.0001).
Conclusion: The lymphocyte value of ≤ 1500/mm3 and D-dimer value of ≥ 2 mg/L can be used in the early determination of patients with poor prognosis in COVID-19. Using these cut-off values for D-dimer and lymphocyte count will help predict prognosis and make rapid treatment decisions in patients with COVID-19.
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2. Gorbalenya AE, Baker SC, Baric RS, Groot RJ, Drosten C, Gulyaeva AA et al. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nat Microbiol. 2020;(5), 536–44 .
3. Hsu LY, Chia PY, Lim JF. The Novel Coronavirus (SARS-CoV-2) Pandemic . Ann Acad Med Singap. 2020;105-7.
4. Chan JWM, Ng CK, Chan YH, Mok TY, Lee S, Chu SY et al. Short term outcome and risk factors for adverse clinical outcomes in adults with severe acute respiratory syndrome (SARS). Thorax 2003;58(8), 686-9.
5. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395(10223):507-13.
6. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M et al.The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315(8):801-10.
7. Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020;135(23):2033-40.
8. Arachchillage DR, Laffan M. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J ThrombHaemost. 2020;18(5):1233-4.
9. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020;395(10229):1033-4.
10. National Institutes of Health. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines.Availablefrom:https://covid19treatmentguidelines.nih.gov
11. Panigada M, Bottino N, Tagliabue P, Grasselli G, Novembrino C, Chantarangkul V et al. Hypercoagulability of COVID‐19 patients in ICU. A report of thromboelastography findings and other parameters of hemostasis. J ThrombHaemos. 2020;18:1738-42.
12. Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID‐19. J ThrombHaemost. 2020;18:1559-61.
13. Li Y, Zhao K, Wei H, Chen W, Wang W, Jia L et al. Dynamic relationship between D‐dimer and COVID‐19 severity. Br J Haematol. 2020;190:24-7.
14. Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y et al. Dysregulation of immune response in patients with Coronavirus 2019 (COVID-19) in Wuhan, China. Clin Infect Dis. 2020;71(15):762-8.
15. Tan L, Wang Q, Zhang D, Ding J, Huang Q, Tang YQ et al. Lymphopenia predicts disease severity of COVID-19: a descriptive and predictive study. Signal Transduct Target Ther. 2020;5(1):1-3.
16. Wang L, He W, Yu X, Hu D, Bao M, Liu H et al. Coronavirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80:639-45.
17. Huang C, Wang Y, Li X,Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395(10223):497-506.
18. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420-2.
19. Aksoy E, Azkur AK. Schmallenberg virus induces apoptosis in Vero cell line via extrinsic and intrinsic pathways in a time and dose dependent manner. J Vet Med Sci. 2019 Feb 9;81(2):204-12.
20. Chen R-F, Chang J-C, Yeh W-T, Lee C-H, Liu J-W, Eng H-L et al. Role of vascular cell adhesion molecules and leukocyte apoptosis in the lymphopenia and thrombocytopenia of patients with severe acute respiratory syndrome (SARS). Microbes Infect. 2006;8(1):122-7.
21. Azkur AK, Akdis M, Azkur D, Sokolowska M, Veen W, Brüggen M-C et al. Immune response to SARS‐CoV‐2 and mechanisms of immunopathological changes in COVID‐19. Allergy 2020;75:1564-81.
22. Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020;63(3):364-74.
23. Guan W-j, Ni Z-y, Hu Y, Liang WH, Ou CQ, He JX et al., for the China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20.
24. Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z et al. D‐dimer levels on admission to predict in‐hospital mortality in patients with Covid‐19. J ThrombHaemost. 2020;18(6):1324-9.
25. Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J et al.Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Transl Res. 2020;220:1-13.
26. Vicenzi M, Di Cosola R, Ruscica M, Ratti A, Rota I, Rota F et al. The liaison between respiratory failure and high blood pressure: evidence from COVID-19 patients.EurRespir J. 2020 Jul 30;56(1):2001157.
27. Gupta N, Zhao Y-Y, Evans CE. The stimulation of thrombosis by hypoxia. Thromb Res. 2019;181:77-83.
28. Subramaniam S, Scharrer I. Procoagulant activity during viral infections. Front Biosci. (Landmark Ed) 2018;23:1060-81.
29. Van Gorp E, Suharti C, Ten Cate H,Dolmans WM, van der Meer JW, ten Cate JW et al. Infectious diseases and coagulation disorders. J Infect Dis. 1999;180(1):176-86.
30. Yu Y, Shen Y, Li J, Liu J, Liu S, Song H. Viral infection related venous thromboembolism: potential mechanism and therapeutic targets. Ann Palliat Med. 2020;9(3):1257-63.
31. Ng K, Wu A, Cheng V, Tang BS, Chan CY, Yung CY et al. Pulmonary artery thrombosis in a patient with severe acute respiratory syndrome. Postgrad Med J. 2005;81(956):e3.
32. Al-Abdallat MM, Payne DC, Alqasrawi S, Rha B, Tohme RA, Abedi GR et al., for the Jordan MERS-CoV Investigation Team. Hospital-associated outbreak of Middle East respiratory syndrome coronavirus: a serologic, epidemiologic, and clinical description. Clin Infect Dis. 2014;59(9):1225-33.
33. Ding Y, Wang H, Shen H, Li Z, Geng J, Han H et al. The clinical pathology of severe acute respiratory syndrome (SARS): a report from China. J Pathol. 2003;200(3):282-9.
34. Giannis D, Ziogas IA, Gianni P. Coagulation disorders in coronavirus infected patients: COVID-19, SARS-CoV-1, MERS-CoV and lessons from the past. J ClinVirol. 2020:104362.
35. Algaissi A, Agrawal AS, Han S, Peng B-H, Luo C, Li F et al. Elevated human dipeptidyl peptidase 4 expression reduces the susceptibility of hDPP4 transgenic mice to Middle East respiratory syndrome coronavirus infection and disease. J Infect Dis. 2019;219(5):829-35.