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Luma A. Yasir Aseel M. Hameed Zaizafoon Nabeel Nasif Najlaa Qassim Muftin

Abstract

Coronavirus disease 2019 (COVID-19) is a systemic inflammatory disorder affects both hematopoietic system and haemostasis process. The better understanding the natural history of COVID-19 would open the fields of treatment and prevention of this disease. COVID-19 patients suffer a mild to severe failing in the respiratory system after short period upon infection. Our study is focused on the early prediction of inflammatory status and respiratory impairment through the usage of inflammatory markers in COVID-19 patients. The current clinical study has included 60 COVID-19 patients and the results were controlled with 30 healthy people. The parameters of this case-control study was included white blood cells (WBCs), lymphocytes percentage (LYM %), D-dimer, interleukine-6 (IL-6), ferritin, hepcidin, vitamin D3 (Vit D), prothrombin time, and INR. The study was also included the IgG and IgM antibodies detection of COVID-19, and the other variables were statistically compared according to the quartiles of these antibodies, which enables a better elucidation for each parameter from onset of the disease up to the severe conditions, then down to the recovery. The predominant decrease was observed significantly in Vit D and non-significantly in LYM%. Areas under (AUC) the receiver operating characteristic (ROC) curve of WBCs, D-dimer, IL-6, Ferritin, PT, INR, Hepcidin, Vit D, LYM% and PTT had been analyzed. ROC analysis identified that Hepcidin and D-dimer has the excellent sensitivity and specificity (100%) with AUC value =1; cut off values were (72.28 and 53.37, respectively). Results appeared that there was a significant variation in the levels of D-dimer, IL-6, Hepcidin in four divided groups depend on IgM classification, on other direction, IgM shows a significant variation between four groups depend on IgG classification with non-significant changes in the other parameters. This study also confirmed that IgG titers in severe COVID-19 patients were significantly higher than those in non-severe patient’s post-symptom onset, and showed that Q2 group according to IgG was the worst case among other groups depend on hematological and immunological tests, whereas the Q4 group was the worst according to IgM. Pearson correlation coefficient (r) revealed the following results: there was a significant negative correlation between LYM% and WBC (r=-0.413), Hepcidin and VitD (r=-0.387), IL-6 and LYM% (r=-0.419), PT and LYM% (r=-0.465), INR and LYM% (r=-0.458), as well as, a significant positive correlation between IL-6 and INR (r=0.433), PT and INR (r=0.957), PT and PTT (r=0.623), Hepcidin and D-dimer (r=0.537), IL-6 and WBC (r=0.579 ), ferritin and VitD (r= 0.370). In conclusion, COVID-19 is accompanied with inflammatory increasing from the moment of onset to its severity influences, yet the inflammatory status remains elevated a while post-recovery and does not decrease in fast rhythm.

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