Study of Haematological and Biochemical Parameters of COVID-19 Patients in ICU and in Ward

Introduction: Covid-19 is 65 nm to 125 nm in diameter and contains single-stranded RNA as nuclei content. Covid-19's global scale transmission, frequent occurrence, large number of deaths, infection and mortality among care providers, and multiplicative impact in vulnerable or sensitive groups are all major causes of concern. The clinical presentations of coronavirus disease are diverse, ranging from asymptomatic carriers to manifestations of respiratory collapse requiring mechanical ventilation and ICU support, as well as multi-organ and systemic symptoms such as sepsis, septic shock, and multiple organ dysfunction syndromes (MODS). Aim: Comparison of Haematological and Biochemical Parameters of Covid-19 Patients in ICU and in Ward. Original Research Article Bankar et al.; JPRI, 33(58A): 442-448, 2021; Article no.JPRI.71257 443 Materials and Methods: 25 patients were ICU and 25 patients were ward. Patients went directly to the Observed Treatment in the Dept. of Medicine and Dept. of Respiratory. Datta Meghe Medical College and Shalinitai Meghe Hospital and Research Centre. Results: Serum urea and creatinine significantly raised in ICU patients as compare to ward patients while sodium, potassium and chloride were insignificantly increased in ICU patients. Table 1 shows the D-dimer was also increased in ICU patients (3.45±2.76) as compare to the ward patients (1.49±2.13). D-Dimer is significantly increased in ICU patients (P=0.0071). As we can see in above table the level of Pro-BNP were highly significantly raised in ICU patients as compare to the ward patients (P = 0.0001). While level of Trop T insignificantly increased in ICU patients (P=0.8732). Conclusion: Several indicators, such as elevated leukocyte and CRP, LDH, and deranged urea/creatinine, were identified to be most likely correlated factors with disease incidence and mortality in our study. So are lower bicarbonate levels. However, acute liver and kidney injury are more common in COVID-19 patients.


INTRODUCTION
The coronavirus disease-2019 (COVID- 19) epidemic first surfaced at the end of December in a Hunan seafood market in Wuhan, China, and was quickly proclaimed an international public health emergency by the World Health Organization [1].
It's an infectious disease caused by the coronavirus-2 that causes extreme acute respiratory syndrome SARS-CoV-2 is phylogenetic ally related to SARS viruses, according to genomic studies, and bats may be the primary vector. While the virus's intermediate point of origin and spread to humans is unknown, it has been shown that it is capable of rapid human-to-human transmission. The virus was primarily transmitted from person to person by physical interaction. Coughing, sneezing, and laughing cause droplets. Cardiovascular damage, respiratory failure, acute respiratory distress syndrome, and even death may occur in severe situations [2,3].
Covid-19 is 65 nm to 125 nm in diameter and contains single-stranded RNA as nuclei content. Covid-19's global scale transmission, frequent occurrence, large number of deaths, infection and mortality among care providers, and multiplicative impact in vulnerable or sensitive groups are all major causes of concern [4].
The clinical presentations of coronavirus disease are diverse, ranging from asymptomatic carriers to manifestations of respiratory collapse requiring mechanical ventilation and ICU support, as well as multi-organ and systemic symptoms such as sepsis, septic shock, and multiple organ dysfunction syndromes (MODS) [5].
Lymphocytopenia (82.3%), thrombocytopenia (36.2%), and leukopenia (33.7%) were seen in the majority of COVID-19 disease patients. The majority of patients had elevated levels of Creactive protein (CRP), while high levels of alanine transaminase (ALT), aspartate aminotransferase (AST), creatinine kinase (CK), and D-dimer were less common. In the majority of patients, computed tomography scans (CT-Scan) reveal ground-glass opacity (65%), illdefined margins (81%), smooth or irregular interlobular septal thickening (35%), air bronchogram (47%), wild paving pattern (10%), and thickening of adjacent pleura (32%). Since there have been no conclusive antivirals or vaccines for novel coronavirus disease  in recent intervals, preventive treatment, which includes broadspectrum antibiotics, antivirals, corticosteroids, oxygen therapy, artificial ventilation, and convalescent plasma, is a popular regimen in the present scenario [9]. The aim of the research was to explain both clinical and biochemical features of COVID-19 patients, as well as to identify markers that indicate a poor prognosis and mortality in COVID-19 patients.
In this study researcher focused on admission of patients, laboratory investigations with disease severity, and it is the first of its kind in this field, to our knowledge [10].

Comparison of Haematological and Biochemical Parameters of Covid-19 Patients in ICU and in
Ward.

MATERIALS AND METHODS
The study conducted Department of Biochemistry this study included 50Covid positive patients of age 40 -55 years who were admitted in ICU and Ward to Shalinitai Meghe hospital and Research centre, consequently, 25 patients were ICU and 25 patients were ward. Patients went directly to the Observed Treatment in the Dept. of Medicine and Dept. of Respiratory, DMMC and SMHRC, Nagpur.

Sample Collection
5ml of each patient's blood sample was taken and separated in two tubes EDTA and plain tube. The sample was used to estimate the levels of Liver function test, Ferritin, LDH, CRP and CBC.

Biochemical Analysis
EDTA samples were used for the CBC count was estimated on 3 parts coulter counter. The sample was used to estimate the levels of Liver function test, Renal function test, CRP, ferritin, LDH, Trop-I, D-dimer, Pro-BNP were estimated on AU480 Analyser. Serum urea and creatinine significantly raised in ICU patients as compare to ward patients while sodium, potassium and chloride were insignificantly increased in ICU patients. Table 1 shows the D-dimer was also increased in ICU patients (3.45±2.76) as compare to the ward patients (1.49±2.13). D-Dimer is significantly increased in ICU patients (P=0.0071).

RESULTS
As we can see in above table the level of Pro-BNP were highly significantly raised in ICU patients as compare to the ward patients (P = 0.0001). While level of Trop T insignificantly increased in ICU patients (P=0.8732).

DISCUSSION
Abnormal LFT is common in COVID- 19, and it appears in combination with elevated heart and muscle enzymes. It returns to normal without affecting any liver-related morbidity or mortality.
COVID-19 Aminotransferase elevation may also be due to myositis, which is common in people who have had a lot of flu [8]. According to a recent study, SARS-CoV-2 is thought to bind directly to cholangiocytes, demonstrating the Angiotensin Converting Enzyme 2 (ACE) receptor and causing liver damage [11]. This clarifies how the SARSCoV-2 virus caused our patient's liver dysfunction [12] Patients with abnormal LFT results, particularly hepatocyte at the time or during the hospitalization, had higher risk of progression to sever than those with standard liver tests. Exacerbation of pneumonia to mild pneumonia is a crucial health result that suggests a higher mortality risk and necessitates admission to the intensive care unit (ICU) or mechanical ventilation. Previous research has established age, race, and underlying conditions as risk factors for extremeCOVID-19. This is one of the first studies to show a correlation between pathological liver testing and severe disease. Our results support the hypothesis that the SARS-CoV-2 virus is not only highly transmissible but also capable of inducing severe multi-organ dysfunction in humans [13,14].
Lymphocytopenia, leukopenia, thrombocytopenia, deranged liver function enzyme levels, elevated CRP, and D-dimers were observed in our sample population, which corresponded to the findings of multiple studies [15].
In our research, hemoglobin levels in patients with COVID-19 admitted to the wards and those who survived were marginally different (Increased) from patients admitted to intensive care units (ICU) and those who died, which corresponded to results from minimal studies [16].
Renal parameter creatinine was found to be within normal ranges in patients admitted to wards with moderate disease or patients who survived, but dramatically elevated creatinine was found in patients admitted to ICU and those who died, according to our findings, which are compatible with numerous reports. The sodium levels in our sample size of patients were shown to be within normal limits in moderate vs. mild cases non-serious, in comparison to another study that found a drop in sodium levels in patients admitted to intensive care units, contradicting our results, even though severe patients in our study developed significantly elevated sodium levels during their hospital stay.
Potassium levels were shown to be elevated but within normal range in ICU and deceased patients as compared to those admitted to the ward or recovered, a result that matched that of another study. In our sample, patients in intensive care units and the deceased had higher urea and chloride levels, as well as lower serum bicarbonate levels, which correlated with the results of negligible tests [17,18].
Patients in intensive care units and others who died had elevated levels of alanine transaminase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT), as well as mildly elevated levels of overall bilirubin, as opposed to patients in wards or those who survived -results that matched the findings of other tests. In patients admitted to the ICU, elevated levels of inflammatory markers such as C-reactive protein (CRP), lactate dehydrogenase (LDH), D-dimer, and erythrocyte sedimentation rate (ESR), ferritin, and procalcitonin (PCT) were found, with findings correlating with multiple reports [19][20][21].
Our research had a few drawbacks, including a smaller sample size than previous Chinese studies and a retrospective analysis, which indicates that not all laboratory parameters were consistently monitored in every patient. Another drawback is that the only radiological investigation used was a chest radiograph, with no CT scan done to validate the radiological result, as further screening tests for Covid-19 have been proposed. Finally, follow-up labs were not readily accessible for all patients, including those who were sent home for isolation [11,[22][23][24][25]].

CONCLUSION
A single-centre analysis of 50 COVID-19 positive hospitalized patients in a developing world found a variety of factors related to disease incidence and mortality, as well as complex improvements in laboratory investigations during hospitalization that influenced prognosis. While several broad center prospective surveys are required to investigate the results demonstrated, the clinical history and characteristics of patients, as well as comparing levels of many biomarkers, can be used to forecast disease incidence and mortality. Several indicators, such as elevated leukocyte and CRP, LDH, and deranged urea/creatinine, were identified to be most likely correlated factors with disease incidence and mortality in our study. So are lower bicarbonate levels.
However, acute liver and kidney injury are more common in COVID-19 patients.
The literature considers the deranged values of liver function enzymes in Covid-19 to be of less concern, while our study shows a connection between liver enzymes and the increased number of ICU admissions as well as prognostic markers, necessitating further research in this area to document the derangements of liver enzymes during hospitalization and their relationship to clinical outcomes.

DISCLAIMER
The products used for this research are commonly and predominantly use products in our area of research and country. There is absolutely no conflict of interest between the authors and producers of the products because we do not intend to use these products as an avenue for any litigation but for the advancement of knowledge. Also, the research was not funded by the producing company rather it was funded by personal efforts of the authors.

CONSENT
As per international standard or university standard, patients' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
As per international standard or university standard written ethical approval has been collected and preserved by the author(s).