Association of Baseline Levels of C-Reactive Protein and Neutrophil to Lymphocyte Ratio in Assessing Severity and Mortality among COVID-19 Patients in Three Waves: A Cross-sectional Study
Published: July 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/62910.18271
Umalakshmi Annavarapu, Suhas Dhulipala, Shailaja Alapaty, Mangala Sirsikar, Jyothi A Natikar, Deepthi Mahendrakar
1. Associate Professor, Department of Biochemistry, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India.
2. Junior Resident, Department of Pulmonology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India.
3. Professor, Department of Biochemistry, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India.
4. Associate Professor, Department of Biochemistry, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India.
5. Assistant Professor, Department of Biochemistry, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India.
6. Assistant Professor, Department of Biochemistry, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India.
Correspondence
Dr. Umalakshmi Annavarapu,
FB 199, Hal Central Township, Near Borewell Bus Stop, Marathahalli, Bangalore-560037, Karnataka, India.
E-mail: lakshmiannavarapu18@gmail.com
Introduction: The Coronavirus Disease 2019 (COVID-19) infection has experienced three peaks in India, with possibilities of reinfections and future peaks. A comprehensive understanding of the disease, particularly in terms of inflammatory markers, is crucial. Neutrophil-to-Lymphocyte Ratio (NLR) and C-Reactive Protein (CRP) have been established as markers of disease severity in COVID-19 during the first wave, but limited data exists regarding these markers in the second and third waves.
Aim: This study aims to investigate the association between baseline levels of CRP and NLR with disease severity and mortality among COVID-19 patients in three waves.
Materials and Methods: A cross-sectional study was conducted at a tertiary care hospital in Bangalore from March 2020 to March 2022. The study included clinical data from 1485 patients with COVID-19. CRP and NLR levels were measured on the day of hospital visit, and their association with severity and mortality was assessed. Continuous variables were compared using independent t-test, one-way analysis of variance (ANOVA), or Kruskal-Wallis test as appropriate. Categorical variables were compared using the Chi-square test.
Results: Wave 1 demonstrated a significant increase in CRP and NLR values among patients with critical illness (mean±SD: 11.96±11.9, 12.41±13.7) compared to other categories. The values of these two parameters in other categories of wave 1 were as follows: asymptomatic (2.28±6.0, 3.17±2.0), mild (1.67±3.4, 2.41±2.7), moderate (1.07±1.7, 3.71±2.4), and severe (6.47±7.2, 4.39±4.3). In wave 2, critical illness (10.52±8.9 and 10.73±7.8) showed elevated values compared to other categories (0.957±1.1, 2.61±1.7), (4.90±5.9, 4.27±4.1), (4.84±4.8, 4.03±2.4), (7.35±6.7, 7.10±6.7). In wave 3, the two parameters in critical cases (15.0±17.3 and 16.47±7.6) were elevated compared to other categories (3.67±2.9, 16.44±10.3), (3.3 and 13.9), (3.7±5.9, 19.10±1.6).
Conclusion: CRP and NLR were found to be useful early markers for assessing disease severity and mortality in COVID-19 patients across all three waves.
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