COVID-19 laboratory findings: Difference between revisions
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Some other hematological findings in [[COVID-19]] infection include: increase in [[C-reactive protein|C-reactive protein (CRP)]], [[procalcitonin]], [[Aspartate aminotransferase|aspartate aminotransferase (AST)]], [[Alanine aminotransferase|alanine aminotransferase (ALT)]], total [[bilirubin]], cardiac [[Troponin|troponins]], decrease in [[albumin]] and [[leukocytosis]]. | Some other hematological findings in [[COVID-19]] infection include: increase in [[C-reactive protein|C-reactive protein (CRP)]], [[procalcitonin]], [[Aspartate aminotransferase|aspartate aminotransferase (AST)]], [[Alanine aminotransferase|alanine aminotransferase (ALT)]], total [[bilirubin]], cardiac [[Troponin|troponins]], decrease in [[albumin]] and [[leukocytosis]]. | ||
== Other Laboratory Findings == | |||
=== Leukocytosis === | |||
*[[Leukocytosis]] is seen in 11.4% of patients with severe [[COVID-19]] infection compared to 4.8% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623">{{cite journal| author=Lippi G, Plebani M| title=The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks. | journal=Clin Chem Lab Med | year= 2020 | volume= 58 | issue= 7 | pages= 1063-1069 | pmid=32191623 | doi=10.1515/cclm-2020-0240 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32191623 }} </ref> | *[[Leukocytosis]] is seen in 11.4% of patients with severe [[COVID-19]] infection compared to 4.8% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623">{{cite journal| author=Lippi G, Plebani M| title=The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks. | journal=Clin Chem Lab Med | year= 2020 | volume= 58 | issue= 7 | pages= 1063-1069 | pmid=32191623 | doi=10.1515/cclm-2020-0240 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32191623 }} </ref> | ||
*In patients with COVID-19 infection, leukocytosis may be an indication of a bacterial infection or superinfection.<ref name="pmid32191623" /> | *In patients with COVID-19 infection, leukocytosis may be an indication of a bacterial infection or superinfection.<ref name="pmid32191623" /> | ||
=== Increase in C-reactive protein (CRP) === | |||
*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.<ref name="pmid32109013" /><ref name="pmid32191623" /> | *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.<ref name="pmid32109013" /><ref name="pmid32191623" /> | ||
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*In patients with COVID-19 infection, increase in [[CRP]] may be an indication of severe viral infection or [[sepsis]] and [[viremia]].<ref name="pmid32191623" /> | *In patients with COVID-19 infection, increase in [[CRP]] may be an indication of severe viral infection or [[sepsis]] and [[viremia]].<ref name="pmid32191623" /> | ||
=== Increase in procalcitonin === | |||
*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.<ref name="pmid32109013" /><ref name="pmid32191623" /> | *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.<ref name="pmid32109013" /><ref name="pmid32191623" /> | ||
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*In patients with COVID-19 infection, increase in [[procalcitonin]] may be an indication of bacterial infection or [[superinfection]].<ref name="pmid32191623" /> | *In patients with COVID-19 infection, increase in [[procalcitonin]] may be an indication of bacterial infection or [[superinfection]].<ref name="pmid32191623" /> | ||
=== Increase in ferritin === | |||
*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|acute respiratory distress syndrome (ARDS)]] but not death<ref name="pmid32167524">{{cite journal| author=Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S | display-authors=etal| title=Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. | journal=JAMA Intern Med | year= 2020 | volume= | issue= | pages= | pmid=32167524 | doi=10.1001/jamainternmed.2020.0994 | pmc=7070509 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32167524 }} </ref>, while another one reports an association between increase in [[ferritin]] and death in COVID-19 infection<ref name="pmid32171076">{{cite journal| author=Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z | display-authors=etal| title=Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. | journal=Lancet | year= 2020 | volume= 395 | issue= 10229 | pages= 1054-1062 | pmid=32171076 | doi=10.1016/S0140-6736(20)30566-3 | pmc=7270627 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32171076 }} </ref>. | *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|acute respiratory distress syndrome (ARDS)]] but not death<ref name="pmid32167524">{{cite journal| author=Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S | display-authors=etal| title=Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. | journal=JAMA Intern Med | year= 2020 | volume= | issue= | pages= | pmid=32167524 | doi=10.1001/jamainternmed.2020.0994 | pmc=7070509 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32167524 }} </ref>, while another one reports an association between increase in [[ferritin]] and death in COVID-19 infection<ref name="pmid32171076">{{cite journal| author=Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z | display-authors=etal| title=Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. | journal=Lancet | year= 2020 | volume= 395 | issue= 10229 | pages= 1054-1062 | pmid=32171076 | doi=10.1016/S0140-6736(20)30566-3 | pmc=7270627 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32171076 }} </ref>. | ||
=== Increase in aspartate aminotransferase (AST) === | |||
*Increase in [[Aspartate transaminase|AST]] is seen in 39.4% of patients with severe [[COVID-19]] infection compared to 18.2% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623" /> | *Increase in [[Aspartate transaminase|AST]] is seen in 39.4% of patients with severe [[COVID-19]] infection compared to 18.2% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623" /> | ||
*In patients with [[COVID-19]] infection, increase in [[aminotransferases]] may indicate injury to the [[liver]] or multi-system damage.<ref name="pmid32191623" /> | *In patients with [[COVID-19]] infection, increase in [[aminotransferases]] may indicate injury to the [[liver]] or multi-system damage.<ref name="pmid32191623" /> | ||
=== Increase in alanine aminotransferase (ALT) === | |||
*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.<ref name="pmid32109013" /><ref name="pmid32191623" /> | *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.<ref name="pmid32109013" /><ref name="pmid32191623" /> | ||
| Line 43: | Line 43: | ||
*In patients with [[COVID-19]] infection, increase in [[aminotransferases]] may indicate injury to the liver or multi-system damage.<ref name="pmid32191623" /> | *In patients with [[COVID-19]] infection, increase in [[aminotransferases]] may indicate injury to the liver or multi-system damage.<ref name="pmid32191623" /> | ||
=== Increase in lactate dehydrogenase (LDH) === | |||
* Increase in [[Lactate dehydrogenase|LDH]] is seen in 58.1% of patients with severe [[COVID-19]] infection compared to 37.2% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623" /> | * Increase in [[Lactate dehydrogenase|LDH]] is seen in 58.1% of patients with severe [[COVID-19]] infection compared to 37.2% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623" /> | ||
| Line 49: | Line 49: | ||
*In patients with COVID-19 infection, increase in [[Lactate dehydrogenase|LDH]] may indicate injury to the lungs or multi-system damage.<ref name="pmid32191623" /> | *In patients with COVID-19 infection, increase in [[Lactate dehydrogenase|LDH]] may indicate injury to the lungs or multi-system damage.<ref name="pmid32191623" /> | ||
=== Increase in monocyte volume distribution width (MDW) === | |||
*MDW was found to be increased in all patients with COVID-19 infection, particularly in those with the worst conditions.<ref name="pmid32191623" /> | *MDW was found to be increased in all patients with COVID-19 infection, particularly in those with the worst conditions.<ref name="pmid32191623" /> | ||
=== Increase in total bilirubin === | |||
*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.<ref name="pmid32109013" /><ref name="pmid32191623" /> | *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.<ref name="pmid32109013" /><ref name="pmid32191623" /> | ||
| Line 59: | Line 59: | ||
*In patients with COVID-19 infection, increase in total bilirubin may indicate injury to the liver.<ref name="pmid32191623" /> | *In patients with COVID-19 infection, increase in total bilirubin may indicate injury to the liver.<ref name="pmid32191623" /> | ||
=== Increase in creatinine === | |||
*Increase in [[creatinine]] is seen in 4.3% of patients with severe [[COVID-19]] infection compared to 1% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623" /> | *Increase in [[creatinine]] is seen in 4.3% of patients with severe [[COVID-19]] infection compared to 1% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623" /> | ||
| Line 65: | Line 65: | ||
*In patients with COVID-19 infection, increase in [[creatinine]] may indicate injury to the kidneys.<ref name="pmid32191623" /> | *In patients with COVID-19 infection, increase in [[creatinine]] may indicate injury to the kidneys.<ref name="pmid32191623" /> | ||
=== Increase in cardiac troponins === | |||
*In myocardial infarction and [[Acute coronary syndromes|acute coronary syndrome]] are used for diagnosis.<ref name="pmid32311826" /> | *In myocardial infarction and [[Acute coronary syndromes|acute coronary syndrome]] are used for diagnosis.<ref name="pmid32311826" /> | ||
*In patients with COVID-19 infection, increase in cardiac troponins may indicate cardiac injury.<ref name="pmid32191623" /> | *In patients with COVID-19 infection, increase in cardiac troponins may indicate cardiac injury.<ref name="pmid32191623" /> | ||
=== Decrease in albumin === | |||
*[[Albumin]] may be decreased in many conditions such as [[sepsis]], renal disease or [[malnutrition]].<ref name="pmid32311826" /> | *[[Albumin]] may be decreased in many conditions such as [[sepsis]], renal disease or [[malnutrition]].<ref name="pmid32311826" /> | ||
*In patients with COVID-19 infection, decrease in [[albumin]] may indicate liver function abnormality.<ref name="pmid32191623" /> | *In patients with COVID-19 infection, decrease in [[albumin]] may indicate liver function abnormality.<ref name="pmid32191623" /> | ||
=== Increase in interleukin-6 (IL-6) === | |||
*Increase in [[IL-6]] has been reported to be associated with death in COVID-19 infection.<ref name="pmid32167524" /> | *Increase in [[IL-6]] has been reported to be associated with death in COVID-19 infection.<ref name="pmid32167524" /> | ||
| Line 82: | Line 82: | ||
[[Thrombocytosis]] has been reported in 4% of patients with [[COVID-19]] infection.<ref name="pmid32007143">{{cite journal| author=Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y | display-authors=etal| title=Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. | journal=Lancet | year= 2020 | volume= 395 | issue= 10223 | pages= 507-513 | pmid=32007143 | doi=10.1016/S0140-6736(20)30211-7 | pmc=7135076 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32007143 }} </ref> | [[Thrombocytosis]] has been reported in 4% of patients with [[COVID-19]] infection.<ref name="pmid32007143">{{cite journal| author=Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y | display-authors=etal| title=Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. | journal=Lancet | year= 2020 | volume= 395 | issue= 10223 | pages= 507-513 | pmid=32007143 | doi=10.1016/S0140-6736(20)30211-7 | pmc=7135076 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32007143 }} </ref> | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
Revision as of 16:25, 28 June 2020
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.
Other Laboratory Findings
Leukocytosis
- Leukocytosis is seen in 11.4% of patients with severe COVID-19 infection compared to 4.8% of patients with non-severe infection.[1][2]
- In patients with COVID-19 infection, leukocytosis may be an indication of a bacterial infection or superinfection.[2]
Increase in C-reactive protein (CRP)
- 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.[1][2]
- CRP is an acute phase reactant that increases in conditions with inflammation.[3]
- In patients with COVID-19 infection, increase in CRP may be an indication of severe viral infection or sepsis and viremia.[2]
Increase in procalcitonin
- 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.[1][2]
- In sepsis, the activation and adherence of monocytes increase procalcitonin, therefore procalcitonin in a biomarker for sepsis and septic shock.[4]
- In patients with COVID-19 infection, increase in procalcitonin may be an indication of bacterial infection or superinfection.[2]
Increase in ferritin
- 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[5], while another one reports an association between increase in ferritin and death in COVID-19 infection[6].
Increase in aspartate aminotransferase (AST)
- 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.[1][2]
- In patients with COVID-19 infection, increase in aminotransferases may indicate injury to the liver or multi-system damage.[2]
Increase in alanine aminotransferase (ALT)
- 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.[1][2]
- ALT is produced by liver cells and is increased in liver conditions.[3]
- In patients with COVID-19 infection, increase in aminotransferases may indicate injury to the liver or multi-system damage.[2]
Increase in lactate dehydrogenase (LDH)
- 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.[1][2]
- LDH is expressed in almost all cells and an increase in LDH could be seen in damage to any of the cell types.[3]
- In patients with COVID-19 infection, increase in LDH may indicate injury to the lungs or multi-system damage.[2]
Increase in monocyte volume distribution width (MDW)
- MDW was found to be increased in all patients with COVID-19 infection, particularly in those with the worst conditions.[2]
Increase in total bilirubin
- 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.[1][2]
- Bilirubin is produced by liver cells and increases in liver and biliary conditions.[3]
- In patients with COVID-19 infection, increase in total bilirubin may indicate injury to the liver.[2]
Increase in creatinine
- Increase in creatinine is seen in 4.3% of patients with severe COVID-19 infection compared to 1% of patients with non-severe infection.[1][2]
- Creatinin is produced in the liver and excreted by the kidneys; creatinine increases when there is decrease in glomerular filtration rate.[3]
- In patients with COVID-19 infection, increase in creatinine may indicate injury to the kidneys.[2]
Increase in cardiac troponins
- In myocardial infarction and acute coronary syndrome are used for diagnosis.[3]
- In patients with COVID-19 infection, increase in cardiac troponins may indicate cardiac injury.[2]
Decrease in albumin
- Albumin may be decreased in many conditions such as sepsis, renal disease or malnutrition.[3]
- In patients with COVID-19 infection, decrease in albumin may indicate liver function abnormality.[2]
Increase in interleukin-6 (IL-6)
Thrombocytosis
Thrombocytosis has been reported in 4% of patients with COVID-19 infection.[7]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 Invalid
<ref>tag; no text was provided for refs namedpmid32109013 - ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 2.15 2.16 2.17 2.18 Lippi G, Plebani M (2020). "The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks". Clin Chem Lab Med. 58 (7): 1063–1069. doi:10.1515/cclm-2020-0240. PMID 32191623 Check
|pmid=value (help). - ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 Frater JL, Zini G, d'Onofrio G, Rogers HJ (2020). "COVID-19 and the clinical hematology laboratory". Int J Lab Hematol. 42 Suppl 1: 11–18. doi:10.1111/ijlh.13229. PMC 7264622 Check
|pmc=value (help). PMID 32311826 Check|pmid=value (help). - ↑ Meisner M (2014). "Update on procalcitonin measurements". Ann Lab Med. 34 (4): 263–73. doi:10.3343/alm.2014.34.4.263. PMC 4071182. PMID 24982830.
- ↑ 5.0 5.1 Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S; et al. (2020). "Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China". JAMA Intern Med. doi:10.1001/jamainternmed.2020.0994. PMC 7070509 Check
|pmc=value (help). PMID 32167524 Check|pmid=value (help). - ↑ Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z; et al. (2020). "Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study". Lancet. 395 (10229): 1054–1062. doi:10.1016/S0140-6736(20)30566-3. PMC 7270627 Check
|pmc=value (help). PMID 32171076 Check|pmid=value (help). - ↑ Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y; et al. (2020). "Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study". Lancet. 395 (10223): 507–513. doi:10.1016/S0140-6736(20)30211-7. PMC 7135076 Check
|pmc=value (help). PMID 32007143 Check|pmid=value (help).