TO CORRELATE THE ROLE OF SERUM FERRITIN AND D-DIMER AS A PROGNOSTIC BIOMARKER IN COVID-19 DISEASE

Abstract

Covid 19 pandemic is still a threat to public health. According to WHO, since the  start  of this  pandemic,  about  260  million  cases  with  more  than  5 million deaths reported globally. Including Pakistan, more than 200 countries have been affected so far. It is highly contagious disease, commonly spreads between people who are in close contact to each other. According to studies, hyper-inflammation followed by systemic inflammatory response, wide spreadendothelial damage and hypercoagulable state are the main cause of this disease. Therefore, evaluation of inflammatory  state  using  biomarkers  will  be  helpful  in  screening  and  early detection of severe disease.Objective To assess the severity of covid-19 by correlating serum ferritin and D-dimer levels with the clinical outcome of the disease.

Materials and method:It  is a descriptive cross-sectional  study,  conducted in the department  of clinical pathology,  JPMC, with  collaboration  of ZiauddinMedical  university  hospital, during a period of six months with the approval  of IRB.  A total  of 384 covid PCR positive patients were selected from covid wards and ICU and categorized into  mild,  moderate  and  severe  disease  group  on  the  basis  of  WHO  covid-19 disease  severity  classification.  Serum  ferritin  and  D-dimer  levels  was  done  at admission and  repeated after  1 week of hospitalization,  on automated clinical analyzer using principle of immuno-turbidimetry. All the patients were followed throughout the course of their disease. Results were analyzed and corelated with the clinical progression and outcomes of the disease.Results:Our study has shown, male dominance in mild, moderate and severe disease group i.e. we  found  54.5%  (n=12)  males  in  mild  disease  group,  54.8%  males  in moderate disease group and 53.6% males in severe disease group. The mean age of patients with mild to moderate disease was less than 50 years whereas, patients with severe disease had a meanage of more than 50years.

n  mild  disease  group,  mean  serum  ferritin  level  was  80.74  ng/ml  and  mean serum D-dimer level was 444.06 ng/ml, during first week of hospitalization with an  average  of  7  days  of  stay  in  hospital,  no  oxygen  requirement  and  100% survival rate, whereas in moderate disease group, we observe that mean serum ferritin level was 150.42  ng/ml  and  D-dimer  level  was  2676.5  ng/ml  during  first  week  of hospitalization.  About  84.2%  (n=166)  patients  with  moderate  disease  gotsurvived and discharged, but unfortunately 15.7% (n=31) of patients, progresses to  severe  disease  with  complications  and  high  oxygen  requirement,  their  mean serum ferritin level was more than 220 ng/ml and D-dimer levels was more than 2000 ng/ml.In severe disease group, mean serum ferritin level was 333.6 ng/ml and mean D-dimer  level  was  6810.5  ng/ml  during  first  week  of  hospitalization,  with  an average  of  18  days  of  stay  in  hospital,  with  very  high  oxygen  requirement, complications and only 6 % (n=8) survival rate.Conclusion:Our  study  showed  the  importance  of  serum  ferritin  and  D-dimer  levels  as  the primary biomarker which  can help  in  early detection  of  severity of  the  disease, enabling  the  clinicians  to  make  strategic  planning  and  disease  management. These steps would definitely decrease the mortality index and hospital stay.