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Chapanduka ZC, Abdullah I, Allwood B, Koegelenberg CF, Irusen E, Lalla U, Zemlin AE, Masha TE, Erasmus RT, Jalavu TP, Ngah VD, Yalew A, Sigwadhi LN, Baines N, Tamuzi JL, McAllister M, Barasa AK, Magutu VK, Njeru C, Amayo A, Wanjiru Mureithi MW, Mungania M, Sono-Setati M, Zumla A, Nyasulu PS. Haematological predictors of poor outcome among COVID-19 patients admitted to an intensive care unit of a tertiary hospital in South Africa. PLoS One 2022; 17:e0275832. [PMID: 36331976 PMCID: PMC9635707 DOI: 10.1371/journal.pone.0275832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 09/25/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Studies from Asia, Europe and the USA indicate that widely available haematological parameters could be used to determine the clinical severity of Coronavirus disease 2019 (COVID-19) and predict management outcome. There is limited data from Africa on their usefulness in patients admitted to Intensive Care Units (ICUs). We performed an evaluation of baseline haematological parameters as prognostic biomarkers in ICU COVID-19 patients. METHODS Demographic, clinical and laboratory data were collected prospectively on patients with confirmed COVID-19, admitted to the adult ICU in a tertiary hospital in Cape Town, South Africa, between March 2020 and February 2021. Robust Poisson regression methods and receiver operating characteristic (ROC) curves were used to explore the association of haematological parameters with COVID-19 severity and mortality. RESULTS A total of 490 patients (median age 54.1 years) were included, of whom 237 (48%) were female. The median duration of ICU stay was 6 days and 309/490 (63%) patients died. Raised neutrophil count and neutrophil/lymphocyte ratio (NLR) were associated with worse outcome. Independent risk factors associated with mortality were age (ARR 1.01, 95%CI 1.0-1.02; p = 0.002); female sex (ARR 1.23, 95%CI 1.05-1.42; p = 0.008) and D-dimer levels (ARR 1.01, 95%CI 1.002-1.03; p = 0.016). CONCLUSIONS Our study showed that raised neutrophil count, NLR and D-dimer at the time of ICU admission were associated with higher mortality. Contrary to what has previously been reported, our study revealed females admitted to the ICU had a higher risk of mortality.
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Affiliation(s)
- Zivanai C. Chapanduka
- Division of Haematological Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University & NHLS Tygerberg Hospital, Cape Town, South Africa
| | - Ibtisam Abdullah
- Division of Haematological Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University & NHLS Tygerberg Hospital, Cape Town, South Africa
| | - Brian Allwood
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University & Tygerberg Hospital, Cape Town, South Africa
| | - Coenraad F. Koegelenberg
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University & Tygerberg Hospital, Cape Town, South Africa
| | - Elvis Irusen
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University & Tygerberg Hospital, Cape Town, South Africa
| | - Usha Lalla
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University & Tygerberg Hospital, Cape Town, South Africa
| | - Annalise E. Zemlin
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University & NHLS Tygerberg Hospital, Cape Town, South Africa
| | - Tandi E. Masha
- Faculty of Health & Wellness Sciences, Peninsula University of Technology Bellville Campus, Cape Town, South Africa
| | - Rajiv T. Erasmus
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University & NHLS Tygerberg Hospital, Cape Town, South Africa
| | - Thumeka P. Jalavu
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University & NHLS Tygerberg Hospital, Cape Town, South Africa
| | - Veranyuy D. Ngah
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anteneh Yalew
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Statistics, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- National Data Management Centre for Health, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Lovemore N. Sigwadhi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nicola Baines
- Division of Pulmonology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University & Tygerberg Hospital, Cape Town, South Africa
| | - Jacques L. Tamuzi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Marli McAllister
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Anne K. Barasa
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Valerie K. Magutu
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Caroline Njeru
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Angela Amayo
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | | | - Mary Mungania
- Department of Laboratory Medicine, Kenyatta National Hospital, Nairobi, Kenya
| | - Musa Sono-Setati
- Department of Public Health Medicine, Department of Health, Limpopo, South Africa
| | - Alimuddin Zumla
- Center for Clinical Microbiology, Division of Infection and Immunity, University College London, NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, United Kingdom
| | - Peter S. Nyasulu
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Abdullah I, Cornelissen HM, Musekwa E, Zemlin A, Jalavu T, Mashigo N, Chetty C, Nkosi N, Chapanduka ZC. Hematological findings in adult patients with SARS CoV‐2 infection at Tygerberg Hospital Cape Town South Africa. Health Sci Rep 2022; 5:e550. [PMID: 35509400 PMCID: PMC9059219 DOI: 10.1002/hsr2.550] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 01/08/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID‐19) is associated with hematological abnormalities of variable severity. The full blood count (FBC) and leukocyte differential count (DIFF) could facilitate the prediction of disease severity and outcome in COVID‐19. This study aimed to assess the hematological parameters in early severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and their correlation with disease outcome. Methods A retrospective cross‐sectional descriptive study was performed. Adults with a FBC and positive SARS‐CoV‐2 polymerase chain reaction results between March 1, and June 31, 2020 were reviewed. Basic hematological parameters (FBC, DIFF) and human immunodeficiency virus (HIV) status were recorded. Outcome measures were admission to a general ward or intensive care unit (ICU), recovery or death. Results Six hundred and eighty‐five cases median age 51 years, were analyzed. Forty‐four percent were males and fourteen percent were HIV‐positive with no association between death and/or ICU admission (p = 0.522 and p = 0.830, respectively). Leucocytosis was predictive of ICU admission (odds ratio [OR]: 2.4, confidence interval [CI]: 1.77–3.8186) and neutrophilia, of both mortality (OR: 1.5, CI: 1.0440–2.0899) and ICU admission (OR: 4, CI: 2.5933–6.475). Median lymphocyte count was decreased and d‐dimer raised, showing no significant association with outcome. Raised neutrophil‐to‐lymphocyte‐ratio (NLR) was associated with increased odds of mortality (OR: 2.5, CI: 1.3556–3.2503) and ICU admission (OR: 4.8, CI: 2.4307–9.5430) as was monocyte‐to‐lymphocyte‐ratio (MLR) (OR: 2, CI: 1.3132–2.9064) and (OR: 2.3, CI: 1.0608–1.9935), respectively. Hospital admission and older age were significantly associated with mortality (p = 0.0008 and p < 0.0001), respectively. Conclusion Evidence‐based interpretation of routine laboratory parameters, readily available in resource‐constrained settings, may identify patients at increased risk of mortality. The FBC, DIFF, NLR, and MLR should form part of the early COVID‐19 investigation.
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Affiliation(s)
- Ibtisam Abdullah
- Division of Haematological Pathology, Faculty of Medicine and Health Sciences Stellenbosch University and National Health Laboratory Service (NHLS) Tygerberg Hospital Cape Town Western Cape Province South Africa
| | - Helena M. Cornelissen
- Division of Haematological Pathology, Faculty of Medicine and Health Sciences Stellenbosch University and National Health Laboratory Service (NHLS) Tygerberg Hospital Cape Town Western Cape Province South Africa
| | - Ernest Musekwa
- Division of Haematological Pathology, Faculty of Medicine and Health Sciences Stellenbosch University and National Health Laboratory Service (NHLS) Tygerberg Hospital Cape Town Western Cape Province South Africa
| | - Annalise Zemlin
- Division of Chemical Pathology, Faculty of Medicine and Health Sciences, Tygerberg Hospital Stellenbosch University and National Health Laboratory Service (NHLS) Cape Town Western Cape South Africa
| | - Thumeka Jalavu
- Division of Chemical Pathology, Faculty of Medicine and Health Sciences, Tygerberg Hospital Stellenbosch University and National Health Laboratory Service (NHLS) Cape Town Western Cape South Africa
| | - Nomusa Mashigo
- Division of Haematological Pathology, Faculty of Medicine and Health Sciences Stellenbosch University and National Health Laboratory Service (NHLS) Tygerberg Hospital Cape Town Western Cape Province South Africa
| | - Carissa Chetty
- Division of Haematological Pathology, Faculty of Medicine and Health Sciences Stellenbosch University and National Health Laboratory Service (NHLS) Tygerberg Hospital Cape Town Western Cape Province South Africa
| | - Nokwazi Nkosi
- Division of Virology, Faculty of Medicine and Health Sciences, Tygerberg Hospital Stellenbosch University and National Health Laboratory Service (NHLS) Cape Town Western Cape South Africa
| | - Zivanai C. Chapanduka
- Division of Haematological Pathology, Faculty of Medicine and Health Sciences Stellenbosch University and National Health Laboratory Service (NHLS) Tygerberg Hospital Cape Town Western Cape Province South Africa
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