The Association between oxygen saturation, neutrophil-lymphocyte ratio and D-dimer with mortality based on clinical manifestation of COVID-19 patients

  • Marwan Faculty of Medicine Mulawarman University; Pulmonology Division-Laboratory of Internal Medicine, Abdul Wahab Sjahranie General Hospital
  • Muhammad Rizqan Khalidi Faculty of Medicine Mulawarman University; Laboratory of Anesthesiology Abdul Wahab Sjahranie General Hospital
  • Siti Khotimah Laboratory of Biochemistry Faculty of Medicine Mulawarman University
  • Sri Wahyunie Laboratory of Clinical Pathology Faculty of Medicine Mulawarman University; Abdul Wahab Sjahranie General Hospital
  • Lili Pertiwi Kalalo Laboratory of Clinical Pathology Faculty of Medicine Mulawarman University; Abdul Wahab Sjahranie General Hospital
  • Fanny Gomarjoyo Mulawarman University
DOI: https://doi.org/10.5937/scriptamed52-34641
Keywords: Oxygen saturation, Neutrophil lymphocyte ratio, D-dimer, Clinical manifestations of COVID-19

Abstract


Background / Aim: Coronavirus 2019 (COVID-19) infection is caused by severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). It has become an emergency condition for global public health. Oxygen saturation has important role for diagnosing the patient in the hospital. The neutrophil-lymphocyte ratio (NLR) is a marker for the viral inflammatory reaction to confirm the viral or bacterial infection. The D-dimer is also known as biomarker for severity and prognosis of COVID-19. The aim of the study was to investigate
the risk factors of mortality in COVID-19 patients based on oxygen saturation, neutrophil-lymphocyte ratio and D-dimer.

Methods: Data has been obtained from confirmed cases of COVID-19 in AbdulWahab Sjahranie Hospital from October until November 2020. They were collected and analysed with Chi-squared test by SPSS 22.0 software.
Results: There were 60 patients with SARS-CoV-2 infection in this study, 48 (80 %) patients survived and 12 (20 %) deceased. Peripheral oxygen saturation < 90 % had 13 (21.7 %) and ≥ 90 % had 47 (78.3 %) patients. There were 13 (21.7 %) patients with NLR value < 3.13 and ≥ 3.13 47 (78.3 %) patients. D-dimer value less than 0.5 had 9 (15 %) and ≥ 0.5 had 51 (85 %) patients. The results of statistical analysis have showed that there were relationship between oxygen saturation (p = 0.002) and survival rate of COVID patients.

Conclusion: According to the research that has been conducted, there was correlation between oxygen saturation and mortality of COVID-19 patient. It could be used as biomarker to improve the management of COVID-19 patients.

Author Biographies

Marwan, Faculty of Medicine Mulawarman University; Pulmonology Division-Laboratory of Internal Medicine, Abdul Wahab Sjahranie General Hospital

Faculty of Medicine Mulawarman University; Pulmonology Division-Laboratory of Internal Medicine, Abdul Wahab Sjahranie General Hospital

Muhammad Rizqan Khalidi, Faculty of Medicine Mulawarman University; Laboratory of Anesthesiology Abdul Wahab Sjahranie General Hospital

Faculty of Medicine Mulawarman University; Laboratory of Anesthesiology Abdul Wahab Sjahranie General Hospital

Siti Khotimah, Laboratory of Biochemistry Faculty of Medicine Mulawarman University

Laboratory of Biochemistry Faculty of Medicine Mulawarman University

Sri Wahyunie, Laboratory of Clinical Pathology Faculty of Medicine Mulawarman University; Abdul Wahab Sjahranie General Hospital

Laboratory of Clinical Pathology Faculty of Medicine Mulawarman University; Abdul Wahab Sjahranie General Hospital

Lili Pertiwi Kalalo, Laboratory of Clinical Pathology Faculty of Medicine Mulawarman University; Abdul Wahab Sjahranie General Hospital

Laboratory of Clinical Pathology Faculty of Medicine Mulawarman University; Abdul Wahab Sjahranie General Hospital

References

1. Coronavirus disease (COVID-19) Situation Report-128. [Internet]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. [Cited: 24-Dec-2020].
2. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020 Apr 7;323(13):1239-42.
3. Kementerian Kesehatan RI. Pedoman Pencegahan dan Pengendalian CORONAVIRUS DISEASE (COVID-19). [Internet]. Available from: https://covid19.go.id/p/protokol/pedoman-pencegahan-dan-pengendalian-coronavirus-disease-covid-19-revisi-ke-5. [Cited: 24-Dec-2020]. Indonesian.
4. Shenoy N, Luchtel R, Gulani P. Considerations for target oxygen saturation in COVID-19 patients: are we under-shooting? BMC Med 2020;18:260. doi.org/10.1186/s12916-020-01735-2.
5. Mercier J, Voutsadakis IA. The platelets-neutrophils to lymphocytes ratio: a new prognostic marker in metastatic colorectal cancer. J Gastrointest Oncol 2018 Jun;9(3):478-86.
6. Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol 2017 Jul;39(5):529-39.
7. Hess K, Grant PJ. Inflammation and thrombosis in diabetes. Thromb Haemost 2011 May;105 Suppl 1:S43-54.
8. Kemenkes RI. Pedoman Pencegahan dan Pengendalian Coronavirus Disease (COVID-19) Revisi ke-4. [Internet]. Available from: https://infeksiemerging.kemkes.go.id/download/REV-04_Pedoman_P2_COVID-19__27_Maret2020_TTD1.pdf. [Cited: 24-Dec-2020]. Indonesian.
9. Susilo A, Rumende CM, Pitoyo CW, Santoso WD, Yulianti M, Herikurniawan, et al. [Coronavirus disease 2019: review of current literature]. J Penyakit Dalam Indones 2020;7(1):45-67. Indonesian.
10. Centers for Disease Control and Prevention. Interim US guidance for risk assessment and public health management of persons with potential coronavirus disease 2019 (COVID-19) exposures: geographic risk and contacts of laboratory-confirmed cases. [Internet]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/php/risk-assessment.html. [Cited: 24-Dec-2020].
11. Fuad M, Oehadian A, Prihatni D, Marthoenis. Neutrophil-to-Lymphocyte Ratio and Covid-19 symptom-based severity at admission. AMJ 2021;8(1):1–6.
12. Dashraath P, Wong JLJ, Lim MXK, Lim LM, Li S, Biswas A, et al. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol 2020 Jun;222(6):521-31.
13. de Wit E, van Doremalen N, Falzarano D, Munster VJ. SARS and MERS: recent insights into emerging coronaviruses. Nat Rev Microbiol 2016 Aug;14(8):523-34.
14. 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 Feb 15;395(10223):507-13.
15. 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 Feb 15;395(10223):497-506.
16. Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. J Transl Med 2020 May 20;18(1):206. doi: 10.1186/s12967-020-02374-0.
17. Yu HH, Qin C, Chen M, Wang W, Tian DS. D-dimer level is associated with the severity of COVID-19. Thromb Res 2020 Nov;195:219-25.
18. Gu H, Xie Z, Li T, Zhang S, Lai C, Zhu P, et al. Angiotensin-converting enzyme 2 inhibits lung injury induced by respiratory syncytial virus. Sci Rep 2016 Jan 27;6:19840. doi: 10.1038/srep19840.
19. Hamming I, Timens W, Bulthuis ML, Lely AT, Navis G, van Goor H. Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis. J Pathol 2004 Jun;203(2):631-7.
20. Yeo AJ, Henningham A, Fantino E, Galbraith S, Krause L, Wainwright CE, et al. Increased susceptibility of airway epithelial cells from ataxia-telangiectasia to S. pneumoniae infection due to oxidative damage and impaired innate immunity. Sci Rep 2019 Feb 22;9(1):2627. doi: 10.1038/s41598-019-38901-3.
21. Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol 2020 Jul;84:106504. doi: 10.1016/j.intimp.2020.106504.
22. Soylu K, Gedikli O, Eksi A, Avcioglu Y, Soylu AI, Yuksel S, et al. Neutrophil-to-lymphocyte ratio for the assessment of hospital mortality in patients with acute pulmonary embolism. Arch Med Sci 2016;12(1):95–100.
23. Wong JP, Viswanathan S, Wang M, Sun LQ, Clark GC, D'Elia RV. Current and future developments in the treatment of virus-induced hypercytokinemia. Future Med Chem 2017 Feb;9(2):169-78.
24. Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020 May;18(5):1094-9.

 

 

Published
2021/12/31
Issue
Vol. 52 No. 4 (2021): Q4/December
Section
Original article
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