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Preliminary study to identify severe from moderate cases of COVID-19 using combined hematology parameters.
Ann Transl Med. 2020 May; 8(9):593.AT

Abstract

Background

The third fatal coronavirus is the novel coronavirus (SARS-CoV-2) that causes novel coronavirus pneumonia (COVID-19) which first broke out in December 2019. Patients will develop rapidly if there is no any intervention, so the risk identification of severe patients is critical. The aim of this study was to investigate the characteristics and rules of hematology changes in patients with COVID-19, and to explore the possibility differentiating moderate and severe patients using conventional hematology parameters or combined parameters.

Methods

The clinical data of 45 moderate and severe type patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in Jingzhou Central Hospital from January 23 to February 13, 2020 were collected. The epidemiological indexes, clinical symptoms, and laboratory test results of the patients were retrospectively analyzed. Those parameters with significant differences between moderate and severe cases were analyzed, and the combination parameters with the best diagnostic performance were selected using the linear discriminant analysis (LDA) method.

Results

Of the 45 patients with the novel 2019 corona virus (COVID-19) (35 moderate and 10 severe cases), 23 were male and 22 were female, with ages ranging from 16 to 62 years. The most common clinical symptoms were fever (89%) and dry cough (60%). As the disease progressed, white blood cell count (WBC), neutrophil count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), red blood cell distribution width-coefficient of variation (RDW-CV), and red cell volume distribution width-standard deviation (RDW-SD) parameters in the severe group were significantly higher than those in the moderate group (P<0.05); meanwhile, lymphocyte count (Lym#), eosinophil count (Eos#), high fluorescent cell percentage (HFC%), red blood cell count (RBC), hemoglobin (HGB), and hematocrit (HCT) parameters in the severe group were significantly lower than those in the moderate group (P<0.05). For NLR parameter, it's area under the curve (AUC), cutoff, sensitivity and specificity were 0.890, 13.39, 83.3% and 82.4% respectively; meanwhile, for PLR parameter, it's AUC, cutoff, sensitivity and specificity were 0.842, 267.03, 83.3% and 74.0% respectively. The combined parameters of NLR and RDW-SD had the best diagnostic efficiency (AUC =0.938), and when the cutoff value was 1.046, the sensitivity and the specificity were 90.0% and 84.7% respectively, followed by the combined parameter NLR&RDW-CV (AUC =0.923). When the cut-off value was 0.62, the sensitivity and the specificity for distinguishing severe type from moderate cases of COVID-19 were 90.0% and 82.4% respectively.

Conclusions

The combined NLR and RDW-SD parameter is the best hematology index. It may help clinicians to predict the severity of COVID-19 patients and can be used as a useful indicator to help prevent and control the epidemic.

Authors+Show Affiliations

Department of Laboratory Medicine, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou 434023, China.Pediatric Medical Center, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou 434023, China.Hematology Application and Research Department, Shenzhen Mindray Bio-Medical Electronic Co., Ltd, Shenzhen 518057, China.Department of Laboratory Medicine, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou 434023, China.Hematology Application and Research Department, Shenzhen Mindray Bio-Medical Electronic Co., Ltd, Shenzhen 518057, China.Department of Intensive Care Unit (ICU), Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou 434023, China.Hematology Application and Research Department, Shenzhen Mindray Bio-Medical Electronic Co., Ltd, Shenzhen 518057, China.Department of Respiratory Medicine, Jingzhou Infectious Disease Hospital, Jingzhou 434023, China.Hematology Application and Research Department, Shenzhen Mindray Bio-Medical Electronic Co., Ltd, Shenzhen 518057, China.Department of Laboratory Medicine, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou 434023, China.Department of Laboratory Medicine, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou 434023, China.Medical Academic Department (IVD), Shenzhen Mindray Bio-Medical Electronic Co., Ltd, Shenzhen 518057, China.Department of Laboratory Medicine, Jingzhou Central Hospital, The Second Clinical Medical College, Yangtze University, Jingzhou 434023, China.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32566620

Citation

Wang, Changzheng, et al. "Preliminary Study to Identify Severe From Moderate Cases of COVID-19 Using Combined Hematology Parameters." Annals of Translational Medicine, vol. 8, no. 9, 2020, p. 593.
Wang C, Deng R, Gou L, et al. Preliminary study to identify severe from moderate cases of COVID-19 using combined hematology parameters. Annals of translational medicine. 2020;8(9):593.
Wang, C., Deng, R., Gou, L., Fu, Z., Zhang, X., Shao, F., Wang, G., Fu, W., Xiao, J., Ding, X., Li, T., Xiao, X., & Li, C. (2020). Preliminary study to identify severe from moderate cases of COVID-19 using combined hematology parameters. Annals of Translational Medicine, 8(9), 593. https://doi.org/10.21037/atm-20-3391
Wang C, et al. Preliminary Study to Identify Severe From Moderate Cases of COVID-19 Using Combined Hematology Parameters. Annals of translational medicine. 2020;8(9):593. PubMed PMID: 32566620.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preliminary study to identify severe from moderate cases of COVID-19 using combined hematology parameters. AU - Wang,Changzheng, AU - Deng,Rongrong, AU - Gou,Liyao, AU - Fu,Zhongxiao, AU - Zhang,Xiaomei, AU - Shao,Feng, AU - Wang,Guanzhen, AU - Fu,Weiyang, AU - Xiao,Jianping, AU - Ding,Xiao, AU - Li,Tao, AU - Xiao,Xiulin, AU - Li,Chengbin, PY - 2020/6/23/entrez PY - 2020/6/23/pubmed PY - 2020/6/23/medline KW - COVID-19 KW - Neutrophil lymphocyte ratio (NLR) KW - combination parameter KW - linear discriminant analysis KW - novel coronavirus (SARS-CoV-2) KW - receiver operating characteristic KW - red cell volume distribution width-standard deviation (RDW-SD) KW - severe pneumonia SP - 593 EP - 593 JF - Annals of translational medicine VL - 8 IS - 9 N2 - Background: The third fatal coronavirus is the novel coronavirus (SARS-CoV-2) that causes novel coronavirus pneumonia (COVID-19) which first broke out in December 2019. Patients will develop rapidly if there is no any intervention, so the risk identification of severe patients is critical. The aim of this study was to investigate the characteristics and rules of hematology changes in patients with COVID-19, and to explore the possibility differentiating moderate and severe patients using conventional hematology parameters or combined parameters. Methods: The clinical data of 45 moderate and severe type patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in Jingzhou Central Hospital from January 23 to February 13, 2020 were collected. The epidemiological indexes, clinical symptoms, and laboratory test results of the patients were retrospectively analyzed. Those parameters with significant differences between moderate and severe cases were analyzed, and the combination parameters with the best diagnostic performance were selected using the linear discriminant analysis (LDA) method. Results: Of the 45 patients with the novel 2019 corona virus (COVID-19) (35 moderate and 10 severe cases), 23 were male and 22 were female, with ages ranging from 16 to 62 years. The most common clinical symptoms were fever (89%) and dry cough (60%). As the disease progressed, white blood cell count (WBC), neutrophil count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), red blood cell distribution width-coefficient of variation (RDW-CV), and red cell volume distribution width-standard deviation (RDW-SD) parameters in the severe group were significantly higher than those in the moderate group (P<0.05); meanwhile, lymphocyte count (Lym#), eosinophil count (Eos#), high fluorescent cell percentage (HFC%), red blood cell count (RBC), hemoglobin (HGB), and hematocrit (HCT) parameters in the severe group were significantly lower than those in the moderate group (P<0.05). For NLR parameter, it's area under the curve (AUC), cutoff, sensitivity and specificity were 0.890, 13.39, 83.3% and 82.4% respectively; meanwhile, for PLR parameter, it's AUC, cutoff, sensitivity and specificity were 0.842, 267.03, 83.3% and 74.0% respectively. The combined parameters of NLR and RDW-SD had the best diagnostic efficiency (AUC =0.938), and when the cutoff value was 1.046, the sensitivity and the specificity were 90.0% and 84.7% respectively, followed by the combined parameter NLR&RDW-CV (AUC =0.923). When the cut-off value was 0.62, the sensitivity and the specificity for distinguishing severe type from moderate cases of COVID-19 were 90.0% and 82.4% respectively. Conclusions: The combined NLR and RDW-SD parameter is the best hematology index. It may help clinicians to predict the severity of COVID-19 patients and can be used as a useful indicator to help prevent and control the epidemic. SN - 2305-5839 UR - https://www.unboundmedicine.com/medline/citation/32566620/Preliminary_study_to_identify_severe_from_moderate_cases_of_COVID_19_using_combined_hematology_parameters_ L2 - https://doi.org/10.21037/atm-20-3391 DB - PRIME DP - Unbound Medicine ER -
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