COVID-19 laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shakiba Hassanzadeh, MD[2]

Synonyms and keywords:

Overview

Some other hematological findings in COVID-19 infection include: increase in C-reactive protein (CRP), procalcitonin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total bilirubin, cardiac troponins, decrease in albumin and leukocytosis.

COVID-19-Associated Hematologic Findings

• Leukocytosis
• Increase in C-reactive protein (CRP)
• Increase in procalcitonin
• Increase in ferritin
• Increase in aspartate aminotransferase (AST)
• Increase in alanine aminotransferase (ALT)
• Increase in lactate dehydrogenase (LDH)
• Increase in monocyte volume distribution width (MDW)
• Increase in total bilirubin
• Increase in creatinine
• Increase in cardiac troponins
• Decrease in albumin
• Increase in interleukin-6 (IL-6)
• Thrombocytosis

Pathophysiology and Causes

• CRP is an acute phase reactant that increases in conditions with inflammation.
• In sepsis, the activation and adherence of monocytes increase procalcitonin, therefore procalcitonin in a biomarker for sepsis and septic shock.
• ALT is produced by liver cells and is increased in liver conditions.
• LDH is expressed in almost all cells and an increase in LDH could be seen in damage to any of the cell types.
• Bilirubin  is produced by liver cells and increases in liver and biliary conditions.
• Creatinin is produced in the liver and excreted by the kidneys; creatinine increases when there is decrease in glomerular filtration rate.
• Increase in cardiac troponins are used for diagnosing myocardial infarction and acute coronary syndrome .
• Albumin may be decreased in many conditions such as sepsis, renal disease or malnutrition.

Epidemiology

• Leukocytosis is seen in 11.4% of patients with severe COVID-19 infection compared to 4.8% of patients with non-severe infection.
• Increase in CRP is seen in 81.5% of patients with severe COVID-19 infection compared to 56.4% of patients with non-severe infection.
• Increase in procalcitonin is seen in 13.7% of patients with severe COVID-19 infection compared to 3.7% of patients with non-severe infection.
• Increase in AST is seen in 39.4% of patients with severe COVID-19 infection compared to 18.2% of patients with non-severe infection.
• Increase in ALT is seen in 28.1% of patients with severe COVID-19 infection compared to 19.8% of patients with non-severe infection.
• Increase in LDH is seen in 58.1% of patients with severe COVID-19 infection compared to 37.2% of patients with non-severe infection.
• MDW was found to be increased in all patients with COVID-19 infection, particularly in those with the worst conditions.
• Increase in total bilirubin is seen in 13.3% of patients with severe COVID-19 infection compared to 9.9% of patients with non-severe infection.
• Increase in creatinine is seen in 4.3% of patients with severe COVID-19 infection compared to 1% of patients with non-severe infection.
• Thrombocytosis has been reported in 4% of patients with COVID-19 infection.

Clinical Significance

Laboratory findings in COVID-19 infection may indicated clinical abnormalities, including:

• In patients with COVID-19 infection, leukocytosis may be an indication of a bacterial infection or superinfection.
• In patients with COVID-19 infection, increase in CRP may be an indication of severe viral infection or sepsis and viremia.
• In patients with COVID-19 infection, increase in procalcitonin may be an indication of bacterial infection or superinfection.
• There have been different reports regarding the association of increase in ferritin with death in COVID-19 infection; for example, there has been a report that increase in ferritin is associated with acute respiratory distress syndrome (ARDS) but not death, while another one reports an association between increase in ferritin and death in COVID-19 infection
• In patients with COVID-19 infection, increase in aminotransferases may indicate injury to the liver or multi-system damage.
• In patients with COVID-19 infection, increase in aminotransferases may indicate injury to the liver or multi-system damage.
• In patients with COVID-19 infection, increase in LDH may indicate injury to the lungs or multi-system damage.
• In patients with COVID-19 infection, increase in total bilirubin may indicate injury to the liver.
• In patients with COVID-19 infection, increase in creatinine may indicate injury to the kidneys.
• In patients with COVID-19 infection, increase in cardiac troponins may indicate cardiac injury.
• In patients with COVID-19 infection, decrease in albumin may indicate liver function abnormality.
• Increase in IL-6 has been reported to be associated with death in COVID-19 infection.

References

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