ABSTRACT
COVID-19 Associated Coagulopathy (CAC) is one of the complications of corona virus disease in severe infection. The purpose of this study was to identify the distinctive biomarkers of this CAC by performing laboratory differential diagnosis of CAC from other spectrum of coagulopathies. The major impact of this cohort study was on the following: "hematological," "Inflammatory markers," "Coagulative indicators," "Immunologic indices," "Cardiac markers," "platelet," and "COVID-19". The blood samples of 320 candidates were collected and grouped into control, asymptomatic, severe and critically severe for twenty (20) laboratory parameters each with their methods were employed and conducted. The results were analyzed using Statistical Package for Social Sciences (SPSS) version 26 for all the analyses involving descriptive statistics, Independent T-test, Chi-square (χ2 ), Fisher’s Exact test, Binary logistic regression analysis, Correlation analysis of Analysis of variance (ANOVA), Receiver operating characteristic (ROC) Curve and Area under curve (AUC) were used to generate correlation, Mean±standard (quantitative) data, percentage (prevalence) categorical (qualitative) data. The comparison significance between the four groups at 95% confidence limit was (P ˂ 0.05) and P > 0.05 for non-significance. . The Asymptomatic COVID-19 patients had only minor subtle alternations of no significant reports (p > 0.05). However, the hospitalized COVID-19 patients in groups 3 and 4 provided the most important haematological and biochemical findings where CAC occurs. These include the high and significant levels of Lymphocytopenia (17.083 ± .252) (P < 0.004), Neutrophilia (82.805 ± .312) (P < 0.031), NLR (4.81 ± .27) (p < 0.007), and Recticulopenia (0.430 ±.671) (p < 0.006), mild anaemia, and Thrombocytopenia (97.949 ± 12.456) (P < 0.0034) on haematological parameters; while levels of D-Dimer (3.16 ± 0.53 (p < 0.001),Fibrinogen (6.34 ± 1.12) (p < 0.012), Prothrombin Time (31.39 ± 6.99) (0.007), INR (2.42 ± 0.53) (P < 0.002) and moderate APTT (44.33 ± 4.50) (P < 0.051) levels were raised. High serum level of LDH (297.40±25.28) (p < 0.022), AST (44.70 ± 9.38), CRP (16.60 ± 4.11) (p < 0.042), CK (190.99 ± 25.28) (p < 0.004), IL-6 (10.65 ± 2.44) (p < 0.001), IL-1(6.33 ± 1.68) (p < 0.044), TNF-α (97.00 ± 6.24) (P,0.015); and low levels of IgG, HDL and Albumin were seen in these same groups. In severe and critically severe cases, the changes were generally involved moderate anemia, thrombocytopenia (97.12 ± 12.34), raised D-dimer, and inflammatory markers, among others; while marked Neutrophilia, lymphocytopenia, high D-dimer, INR, delayed PT, and raised fibrinogen . Plasma biomarkers such LDH, IL-6, CK, and CRP were significantly higher in the elderly comorbids groups. Univariate comparison statistical analysis showed significant (p < 0.0013) increase in NLR, IL-6, CRP and SOFA score increase ≥8, with the decrease in lymphocyte count (p < 0.001) were related to the aggravation of the elderly comorbids patient's condition with possibility of prognostic CAC and mortality thereby meeting ISTH’s criteria. The unique laboratory parameters of COVID-19 were highlighted as D-dimer, PT, INR, Fibrinogen, NLR, IL-6, CRP, LDL, HDL, HGB, CK, LDH, Thrombocytopenia, Lymphocytopenia, Age and Comorbidity. This study also highlighted that CAC occurs mostly among the ICU critically ill patients and could be differentially diagnosed with its objective biomarkers identified to be inclusive of ISTH- SOFA score, D-dimer, PT, INR, Fibrinogen, PLT, IL-6, CRP, Age, NLR and Comorbidity. Therefore, it is necessary that tracking haematological alterations in conjunction with biochemical indicators in COVID-19 patients can identify those who will require further care and stratify the risk for CAC as the COVID-19 disease progresses.
