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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 2  |  Page : 197-199

Evaluation of serum ferritin and D-Dimer levels in COVID-19 patients of an Indian tertiary care setting


1 Department of Biochemistry, Government Erode Medical College, Erode, Tamil Nadu, India
2 Department of Biochemistry, Coimbatore Medical College, Coimbatore, Tamil Nadu, India
3 Department of Physiology, Vinayaka Mission's Research Foundation (Deemed to be University), Salem, Tamil Nadu, India
4 Department of Physiology, Vinayaka Mission's Kirupananda Variyar Medical College and Hospital, Salem, Tamil Nadu, India

Date of Submission29-May-2022
Date of Acceptance11-Jul-2022
Date of Web Publication23-Dec-2022

Correspondence Address:
Dr. Bagavathiammal Periyasamy
Department of Biochemistry, Government Erode Medical College, Perundurai, Erode, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_125_22

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  Abstract 


Background and Aim: Because COVID-19-affected individuals with severe disease are more susceptible to develop acute respiratory distress syndrome, metabolic acidosis, and septic shock, it is currently widely accepted that severe COVID-19 cases have a higher fatality rate than mild instances. Hence, it is very critical to identify between severe and mild disease among the COVID-19-affected individuals at the earliest to prevent the fatal sequelae. The study was done using serum ferritin and D-dimer levels as biomarkers to find a correlation between the severity of lung involvement among COVID-positive patients. Materials and Methods: A cross-sectional study has been conducted between June 2021 and November 2021 for 6 months among the patients who are positive for COVID-19 at the Government Erode Medical College. Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) was detected in all of the patients using a real-time reverse transcription–polymerase chain reaction assay. Results: One hundred and eight COVID-19-affected individuals with lung involvement and 102 COVID-19-affected individuals without lung involvement were included in the current study. Groups A and B had mean ages of 61.72 ± 10.6 years and 54.78 ± 12.4 years, respectively. COVID-19 infection was studied in patients who were both mildly unwell and severely ill, where the findings revealed a link between serum ferritin and D-dimer levels and lung involvement among COVID-positive patients. The group with lung involvement had considerably higher D-dimer levels than the group without the involvement. Conclusion: The levels of D-dimer and ferritin are linked to serious involvement of the lung as indicated by the computed tomography scan. Both these markers of inflammation are useful in determining the severity of SARS-CoV-2 infection among the infected patients.

Keywords: COVID-19, D-dimer, ferritin, lung


How to cite this article:
Raja S, Periasamy D, Periyasamy B, Narayanasamy D, Periaswamy P, Vajiravelu S. Evaluation of serum ferritin and D-Dimer levels in COVID-19 patients of an Indian tertiary care setting. Arch Med Health Sci 2022;10:197-9

How to cite this URL:
Raja S, Periasamy D, Periyasamy B, Narayanasamy D, Periaswamy P, Vajiravelu S. Evaluation of serum ferritin and D-Dimer levels in COVID-19 patients of an Indian tertiary care setting. Arch Med Health Sci [serial online] 2022 [cited 2023 Jan 31];10:197-9. Available from: https://www.amhsjournal.org/text.asp?2022/10/2/197/364950




  Introduction Top


Because COVID-19 (caused by “severe acute respiratory syndrome-coronavirus-2 [SARS-CoV-2]”) exploits the “angiotensin-converting enzyme-2 (ACE-2)” receptor for entry into the host cell, the clinical picture of COVID-19 patients has a respiratory dominance pattern that is dependent on the virus's tropism toward the body's target organs.[1],[2] SARS-CoV-2 virus binds to the ACE-2 with a 10–20-fold higher affinity than the earlier forms of the virus. This receptor is abundantly expressed in a variety of human organs, including the lungs, heart, kidneys, and gastrointestinal tract, which explains the symptoms seen in the disease's prodrome. In moderate COVID, the lungs are usually unaffected, however, in severe COVID, the patient develops fatal sequelae of acute respiratory distress syndrome (ARDS).[3],[4] Because COVID-19-affected individuals with severe disease are more susceptible to develop ARDS, metabolic acidosis, and septic shock, it is currently widely accepted that severe COVID-19 cases have a higher fatality rate than mild instances. As a result, it is very critical to identify between severe and mild disease among the COVID-19-affected individuals at the earliest to prevent the fatal sequelae.[5],[6] Fibrin breakdown produces D-dimer as a by-product. It is widely accepted as a thromboembolism biomarker and a prognostic indicator for critically ill individuals. D-dimer has been explored as a biomarker for predicting disease severity since COVID-19 is a procoagulant condition.[7] When COVID gets serious, the test detects the existence of clots in the body. Many clots grow throughout the body, particularly in the lungs, preventing the lungs from breathing. D-dimer can be detected for up to 8 h after it is formed until it is cleared by the kidney. Serum ferritin is another key indicator for determining the severity of COVID.[8] The abnormal activation of the coagulation and immune systems with the enormous release of pro-inflammatory mediators among the individuals suffering from severe COVID-19 has been shown to elevate ferritin levels resulting from the cytokine storm.[9] Hence, serum ferritin and D-dimer levels can be assessed to estimate the COVID-19 severity and aid in diagnosing severe COVID-19 patients earlier.


  Materials and Methods Top


A cross-sectional study has been conducted between June 2021 and November 2021 for 6 months among the patients who are positive for COVID-19 at the Government Erode Medical College, Tamil Nadu. SARS-CoV-2 was detected in all of the patients using a real-time reverse transcription–polymerase chain reaction (RT-PCR) assay. All of the patients had a chest high-resolution computed tomography (CT) scan. COVID-19 patients were separated into two groups based on the presence or lack of lung involvement on the CT scan result. COVID patients with lung involvement were placed in Group A, whereas COVID patients without lung involvement were placed in Group B. Several variables were included in this study including sociodemographic details such as gender, age, and the laboratory parameters such as serum ferritin and D-dimer. Individuals aged >18 years and positive for COVID-19 by RT-PCR testing were included in the study. Individuals with underlying conditions such as liver disease, malignancy, heart disease, and pregnant females were excluded from the study. Serum ferritin and D-dimer levels were estimated by the Dimension EXL 200 Integrated Chemistry System by Siemens. The reference range of serum ferritin is 22–322 ng/ml and for D-dimer is <0.5 mg/L.

Statistical analysis

IBM Corp. Released 2016. IBM SPSS Statistics for Windows, Version 24.0. (Armonk, NY: IBM Corp.) was utilized to analyze the data. Continuous data are shown as mean and standard deviation, whereas categorical data were shown as numbers and percentages. To compare the categorical variables, the Chi-square test was performed. Statistical tests were regarded as significant when the P < 0.05.


  Results Top


There were 108 COVID-19-affected individuals with lung involvement and 102 COVID-19-affected individuals without lung involvement included in the current study. Groups A and B had mean ages of 61.72±0.10.6 years and 54.78 ± 12.4 years, respectively. Fifty-eight percent of the patients were men and 42% were women among the study participants. Fifty-nine percent of the study participants belonging to Group A were males and 44% of the participants belonging to Group B were females. Thirty-three percent of the people from Group A are known cases of diabetes and 21% of the individuals in Group A are known cases of hypertension [Table 1].
Table 1: Sociodemographic distribution of study participants

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The majority of males were affected by COVID-19 according to our findings. The mean serum ferritin concentration was 538.26 ± 412.84 ng/ml among the Group A individuals with lung involvement, which was significantly higher than the mean concentration of 158.64 ± 125.74 ng/ml among the individuals without lung involvement. The mean D-dimer concentration in Group A participants with lung involvement was 4.62 ± 3.28 mg/L, whereas the mean D-dimer level among people without lung involvement was 0.46 ± 1.14 [Table 2].
Table 2: Comparison of serum ferritin and D-dimer levels among the two groups

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  Discussion Top


COVID-19 infection was studied in patients who were both mildly unwell and severely ill, where the findings revealed a link between serum ferritin and D-dimer levels and lung involvement among COVID-positive patients.[10] The group with lung involvement had considerably higher D-dimer levels than the group without the involvement. Serum ferritin was found to be an important biomarker for COVID-positive patients according to this investigation, indicating the serious infection where the ferritin levels were shown to be considerably higher, which was supported by several other studies.[11],[12] A study by Zhou et al. involving patients with COVID-19 looked at ferritin levels and found that patients with a severe and very severe degree of COVID-19 disease had elevated levels of serum ferritin, with the levels being substantially higher among the very severe group.[13] One more study by Burugu et al. with severe COVID-19 patients found that those with severe disease of COVID-19 had considerably higher ferritin levels.[14] A number of studies have found a substantial link between COVID disease and D-dimer levels. This study has observed that having a high D-dimer was linked to a worsening composite outcome, particularly regarding the severe degree of COVID-19 and the mortality. This research backs up the theory that infection with the SARS-CoV-2 might cause hemostatic system failure, resulting in a hypercoagulable state, which is frequent in sepsis.[15] Occlusion and formation of microthrombi in the small arteries of lung among the critically ill individuals with COVID-19 have been seen in the recent evidence of lung pathological dissection. Nevertheless, the etiology of raised blood D-dimer levels is complex, and the best threshold value for elevated D-dimer in COVID-19 patients has yet to be determined.[16] COVID-19-related coagulopathy is clearly deserving of special attention and therapy. A considerably raised blood D-dimer level indicates the enhanced production of thrombin, according to the “International Society on Thrombosis and Hemostasis guidelines.”[17] In spite of the severity of clinical presentation, patients with COVID-19 who have significantly increased D-dimer values may require hospitalization. D-dimer is a fibrin breakdown product that is used to rule out thrombosis as a diagnosis. Raised D-dimer levels are observed in severe COVID-19 diseases with hypercoagulability and microangiopathy.[18]


  Conclusion Top


The levels of D-dimer and ferritin are linked to serious involvement of the lung as indicated by the CT scan. Both these markers of inflammation are useful in determining the severity of SARS-CoV-2 infection among the infected patients. Abnormal concentrations of serum ferritin and D-dimer show that early initiation of antiviral and anticoagulant therapy may be required and is beneficial in reducing morbidity and death in COVID-positive patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Suvvari TK, Kutikuppala LV, Babu GK, Jadhav MJ. Understanding the unusual viral outbreak: Coronavirus disease 2019. Curr Res Sci Med 2020;6:3-10.  Back to cited text no. 1
    
2.
Lu R, Qin J, Wu Y, Wang J, Huang S, Tian L, et al. Epidemiological and clinical characteristics of COVID-19 patients in Nantong, China. J Infect Dev Ctries 2020;14:440-6.  Back to cited text no. 2
    
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Polak SB, Van Gool IC, Cohen D, Jan H, van Paassen J. A systematic review of pathological findings in COVID-19: A pathophysiological timeline and possible mechanisms of disease progression. Mod Pathol 2020;33:2128-38.  Back to cited text no. 3
    
4.
Farasani A. Biochemical role of serum ferratin and D-dimer parameters in COVID 19 diagnosis. Saudi J Biol Sci 2021;28:7486-90.  Back to cited text no. 4
    
5.
Gao Y, Li T, Han M, Li X, Wu D, Xu Y, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol 2020;92:791-6.  Back to cited text no. 5
    
6.
Berger JS, Kunichoff D, Adhikari S, Ahuja T, Amoroso N, Aphinyanaphongs Y, et al. Prevalence and outcomes of D-dimer elevation in hospitalized patients with COVID-19. Arterioscler Thromb Vasc Biol 2020;40:2539-47.  Back to cited text no. 6
    
7.
He X, Yao F, Chen J, Wang Y, Fang X, Lin X, et al. The poor prognosis and influencing factors of high D-dimer levels for COVID-19 patients. Sci Rep 2021;11:1830.  Back to cited text no. 7
    
8.
Lalueza A, Ayuso B, Arrieta E, Trujillo H, Folgueira D, Cueto C, et al. Elevation of serum ferritin levels for predicting a poor outcome in hospitalized patients with influenza infection. Clin Microbiol Infect 2020;26:1557.e9- 1557.e15.  Back to cited text no. 8
    
9.
Melo AK, Milby KM, Caparroz AL, Pinto AC, Santos RR, Rocha AP, et al. Biomarkers of cytokine storm as red flags for severe and fatal COVID-19 cases: A living systematic review and meta-analysis. PLoS One 2021;16:e0253894.  Back to cited text no. 9
    
10.
Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost 2020;18:1094-9.  Back to cited text no. 10
    
11.
Gandini O, Criniti A, Ballesio L, Giglio S, Galardo G, Gianni W, et al. Serum ferritin is an independent risk factor for acute respiratory distress syndrome in COVID-19. J Infect 2020;81:979-97.  Back to cited text no. 11
    
12.
Bozkurt FT, Tercan M, Patmano G, Bingol Tanrıverdi T, Demir HA, Yurekli UF. Can ferritin levels predict the severity of illness in patients with COVID-19? Cureus 2021;13:e12832.  Back to cited text no. 12
    
13.
Zhou B, She J, Wang Y, Ma X. Utility of ferritin, procalcitonin, and C-reactive protein in severe patients with 2019 novel coronavirus disease. Res Sq 2020.  Back to cited text no. 13
    
14.
Burugu HR, Kandi V, Kutikuppala LVS, Suvvari TK. Activities of serum ferritin and treatment outcomes among COVID-19 patients treated with vitamin C and dexamethasone: An uncontrolled single-center observational study. Cureus 2020;12:e11442.  Back to cited text no. 14
    
15.
Rostami M, Mansouritorghabeh H. D-dimer level in COVID-19 infection: A systematic review. Expert Rev Hematol 2020;13:1265-75.  Back to cited text no. 15
    
16.
Yao Y, Cao J, Wang Q, Shi Q, Liu K, Luo Z, et al. D-dimer as a biomarker for disease severity and mortality in COVID-19 patients: A case control study. J Intensive Care 2020;8:49.  Back to cited text no. 16
    
17.
Du RH, Liang LR, Yang CQ, Wang W, Cao TZ, Li M, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: A prospective cohort study. Eur Respir J 2020;55:2000524.  Back to cited text no. 17
    
18.
Zhang L, Yan X, Fan Q, Liu H, Liu X, Liu Z, et al. D-dimer levels on admission to predict in-hospital mortality in patients with COVID-19. J Thromb Haemost 2020;18:1324-9.  Back to cited text no. 18
    



 
 
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  [Table 1], [Table 2]



 

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