Review on biochemical alterations in COVID-19 patients

Abstract

Coronavirus Disease 2019 (COVID-19) pandemic is leading to a Public Health Emergency of International Concern (PHEIC) across the globe. COVID-19 has been found to be associated with the dysfunction of several vital organs in addition to respiratory failure. Though biochemical findings among COVID-19 patients have been partially characterized in some case studies, published systematic reviews with consolidated biochemical findings of COVID-19 are not yet available. The role of biochemical monitoring in the screening of COVID-19 cases has not been definitely established. Hence, the significance of laboratory parameters in assessing the severity and prognosis of COVID-19 cases is discussed with a focus on various hematological, biochemical, and metabolic alterations in patients suffering from COVID-19 infection. We conclude that biochemical monitoring of COVID-19 patients helps in identifying critically ill patients even earlier, aiming to reduce mortality and improve the recovery rate.

Review on the Systemic Damage and Biochemical Alterations Associated with COVID-19 Infection

“…Hematological profile of severe COVID 19 patients showed increased WBC count and neutrophil count, decreased lymphocyte, platelet, eosinophil count, and hemoglobin levels (Jayasri et al, 2020).…”

“…According to the severity of the disease, the clinical course of COVID-19 can be classified into three stages (Figure . 1), namely "early infection", "pulmonary phase", and "hyperinflammation phase", each one characterized by specific biochemical alterations (Siddiqi and Mehra, 2020). Biochemical changes (Figure 2) like leukocytosis, neutrophilia, lymphopenia, cytokine storm, decreased albumin, increase in alanine transaminase (ALT), total bilirubin, lactate dehydrogenase (LDH), and procalcitonin levels were significant predictors of ICU admitted COVID-19 patients (Jayasri et al, 2020). Biochemical findings in COVID-19 (Table 1) patients include higher levels of AST, ALT, total bilirubin, BUN, creatinine, creatinine kinase, lactate dehydrogenase, myoglobin, creatinine kinase MB, cardiac troponin I .…”

“…COVID-19 is a systemic infection with cardiovascular, pulmonary, gastrointestinal, neurological, and hematological manifestations (Araya et al, 2021). Common complications observed more frequently in deceased patients included acute respiratory distress, sepsis, acute cardiac injury, heart failure, alkalosis, acute kidney injury, and hypoxic encephalopathy (Jayasri et al, 2020).…”

“…Lymphocyte percentages of COVID-19 patients indicate that the lymphocyte count is reduced with increased severity of the disease and lymphopenia is reported to be a predictor of poor prognosis in COVID-19 patients (Tan et al, 2020). A research conducted on COVID-19 patients indicated that, leukocytosis was present in 50% patients who died and 4% who recovered and the 91% of the patients were developed lymphopenia (Jayasri et al, 2020). The mechanisms leading to lymphocyte deficiency expected to be, lymphocytes express the ACE2 receptor on their cellular membrane, the virus might directly destroy lymphatic organs and pro-inflammatory cytokines, such as IL-6 and TNF-alpha, could induce lymphocyte deficiency (Marcello and…”

“…Thrombocytopenia has been described in COVID-19 patients and associated with the progression and prognosis of the disease (Marcello and Luisa, 2020). A meta-analysis of 1725 COVID-19 cases with 375 severe cases revealed that significantly lower platelet count in patients was associated with over fivefold enhanced risk of severity and mortality and thus, it can serve as a clinical indicator of worsening illness during hospitalization (Lippi et al, 2020).Thrombocytopenia is observed in critically ill COVID-19 patients and suggests serious organ malfunction or physiologic decompensation as opposed to primary hematologic etiology as well as the development of intravascular coagulopathy, often evolving towards disseminated intravascular coagulation (Jayasri et al, 2020)…”