Investigating The Role of Inflammatory Markers at Admission in Defining the Severity of Moderate-to-Critical COVID-19: A Cross-Sectional Analysis.

Background and aims: The spectrum of Coronavirus disease-2019 (COVID-19) has been clinically defined from asymptomatic carriers to critical illness. Different inflammatory markers have been used to account for the severity and outcomes of this disease in different settings. Our study aims to investigate the role of these inflammatory markers in defining COVID-19 severity. Methods: This cross-sectional study included 200 confirmed cases of COVID-19. Inflammatory markers including lymphocyte count, D-Dimers, Ferritin, CRP, LDH were noted at admission. The moderate-to-critical disease was defined according to the WHO criteria. Descriptive statistics were applied. Mann-Whitney U-test was applied to compare the difference of markers between moderate-severe and critical patients. ROC was plotted to determine the cut-off values of these markers. Binary logistics regression analysis was used to assess which markers significantly predict the severity of COVID-19. Results: A D-dimer value of >775 ng/ml and LDH >495 U/L had a sensitivity of 72.9% and 79.2% and specificity of 57.9% and 53.6% respectively for critical COVID-19 illness. CRP levels of >100.5 mg/dl has a sensitivity of 66.7%. All inflammatory markers were significantly higher in a critical group of patients (p < 0.05) except for lymphopenia. Binary logistics regression analysis shows that LDH levels and D-dimers were only significant predictors of severity in COVID-19 patients. Conclusion: Inflammatory markers at admission are very useful in defining the severity of COVID-19 in addition to the clinical criteria. This is also useful in predicting adverse outcomes.