| Abstract |
Corona virus disease is a global pandemic. One of the key issues has been the very high volume of patients presenting to health centres or hospitals during the outbreak. It clearly overwhelms the human and mechanistic capacities available. Therefore, early and effective predictors of clinical outcomes are required for risk stratification.
Material: This is hospital based retrospective study on patients who were admitted in Covid wards/ICU at IGGMC. Patients were divided into 3 groups- mild-moderate; severe; and critical based on their clinical presentation on admission. Several biomarkers like WBC, platelets, N/L, CRP, LDH, S. ferritin, d-dimer, CPK-MB, Serum creatinine, BUL, SGOT, SGPT, Serum albumin were analysed before and after treatment.
Observation: 110 patients were enrolled in this study, 36 were classified into mild-moderate, 56 into severe and 18 into critical. As all of mild-moderate patients were discharged and majority of critical patients expired, biomarkers were compared between severe patients who were discharged vs severe patients who died. Out of these biomarkers, CRP was significantly decreased during course of treatment in severe patients who were discharged (p = 0.004) in comparison to severe patients who died where CRP was significantly increased (p = 0.001) (p value of difference being 0.00001). There was also significant change in ferritin levels (p = 0.006), while other biomarkers like WBC (p = 0.07), platelets (p = 0.066), N/L (p = 0.3), LDH (p = 0.06), d-dimer (p = 0.1), CPK-MB (p = 0.49), serum creatinine (p = 0.05), urea (p = 0.06), S. albumin (p= 0.3), SGOT (p =0.07), SGPT (p=0.25) did not show promising results. In addition, various treatment protocols were analysed by comparing CRP before and after treatment. Severe patients were divided into 2 groups, who took injection Remdesivir along with antibiotics, LMWH, systemic steroids vs who didn't, and CRP level were compared, but the difference was not significant (p = 0.06). Pre and post treatment CRP was also compared for Tocilizumab, Fevipiravir, Hydroxychloroquine, Doxycyline, but none of them were able to decrease CRP significantly (p > 0.05) in the severe or critical group but these drugs were effective in reducing CRP significantly (p<0.05) when given in mild-moderate group or if the treatment was started early.
Conclusion: Increment in CRP and ferritin could effectively predict clinical outcome and could be used for risk stratification but no available drug is effective in reducing these biomarkers significantly in severe or critical group.
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