A combination of inflammatory and hematological markers is strongly associated with the risk of death in both mild and severe initial disease in unvaccinated individuals with COVID-19 infection

Parul Chopra, Tushar Sehgal, Ranjan Yadav, Suneeta Meena, Souvik Maitra, Kapil Dev Soni, Arulselvi Subramanian, Shyam Prakash, Purva Mathur, Sandeep Mittan, Sooyun Tavolacci, Ajeet Kaushik, Kiran Gulia, Ebrahim Mostafavi, Abhishek Gupta, Anjan Trikha, Ritu Gupta, Kunzang Chosdol, Anant Mohan, Kalaivani ManiSubrata Sinha, Sudip Kumar Datta

Research output: Contribution to journalArticlepeer-review


Background Inflammatory and hematological markers are used extensively for early prognostication and monitoring in COVID-19. We aimed to determine whether routinely prescribed laboratory markers can predict adverse outcome at presentation in COVID-19. Methods This retrospective observational study was performed on 401 samples collected between July to December 2020 from COVID-19 positive subjects, admitted at All India Institute of Medical Sciences, Delhi, India. Clinical details and laboratory investigations within 3 days of COVID-19 positivity were obtained. Clinical outcomes were noted from patient medical records, till discharge or death. Laboratory parameters, with individually defined cut-offs, were used, either singly or in combination to distinguish survival and death for those having severe and non-severe disease at initial presentation. Findings Total Leukocyte count, Absolute neutrophil count, Neutrophil to Lymphocyte ratio, C-Reactive Protein (CRP), Interleukin-6 (IL-6), Lactate Dehydrogenase, Ferritin and Lymphocyte to CRP ratio (LCR) were significantly altered at presentation in severe COVID-19 as compared to non-severe cases; and, also in those who died due to COVID-19 compared to those who survived. A combination of four markers, CRP (≥3.9mg/dL); IL-6 (≥45.37pg/ml); Ferritin (≥373ng/ mL); 1/LCR ≥0.405 was found to strongly predict mortality in cases with non-severe presentation as also in severe cases. Conclusion and Interpretation The combination of routinely used markers, CRP, IL-6, Ferritin and 1/LCR can be used to predict adverse outcomes, even in those presenting with mild to moderate disease. This would identify subset of patients who would benefit from closer monitoring than usual for non-severe disease.

Original languageEnglish (US)
Pages (from-to)42-56
Number of pages15
JournalElectronic Journal of the International Federation of Clinical Chemistry and Laboratory Medicine
Issue number1
StatePublished - 2023

All Science Journal Classification (ASJC) codes

  • Clinical Biochemistry
  • Biochemistry, medical

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