Hematological and biochemical parameter changes among healthy individuals infected with COVID-19 according to sex and age: A hospital based study
More details
Hide details
Department of Clinical Laboratory, The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, CHINA
Department of Medical Analysis, Princess Aisha Bint Al-Hussein College of Nursing and Medical Sciences. Al-Hussein Bin Talal University, Ma’an 71111, JORDAN
Faculty of Public Health & Health Informatics, Umm Al Qura University, Makkah, SAUDI ARABIA
Online publication date: 2023-07-09
Publication date: 2023-09-01
Electron J Gen Med 2023;20(5):em527
Numerous studies have linked COVID-19 to a range of human health problems, including high blood pressure, diabetes, and heart disease. Only a few research have focused on the specific effects of COVID-19 on healthy people. Consequently, this study was designed to investigate the effects of COVID-19 on hematological and biochemical markers among healthy people infected with COVID-19 patients according to sex, and age.

Materials and methods:
This study is a retrospective cross-sectional study conducted on 2,640 healthy people infected with COVID-19 in Jordan for the period from January 2021 to March 2022. Independent t-test and one-way ANOVA tests were used to compare the means of different groups.

In the present study, only 271 out of 2,640 COVID-19 cases met the criteria and were assessed according to sex and age. The average age of the study population was 57.90 years. The findings of this study revealed that statistically significant increases were noticed only in the levels of WBC, K, and ferritin of males compared with females. Similarly, statistically significant increases across various age groups were observed in WBC, MCV, MCH, PT, INR, and D-dimer levels. Moreover, statistically significant increases in FBS, creatinine, AST, CPK, CK-MB, ferritin, and LDH were seen when comparing the biochemical parameters across age groups.

Patients infected with COVID-19 should be screened for all these studied hematological and biochemical parameters because the findings of the present study suggest that COVID-19 could lead to disturbances in, WBC, PT, APTT, d-dimer, INR, FBS, CR, urea, K, AST, ALT, ALP, LDH, CPK, CK-MB, and ferritin. We recommend clinical physicians to monitor patients’ conditions immediately by evaluating all of these parameters in order to prevent patients from deteriorating into life-threatening situations.

Rachman A, Iriani A, Irawan C, et al. Complete blood count derived inflammatory biomarkers and the level of anti-SARS-CoV-2 NAb and S-RBD IgG among cancer survivors receiving COVID-19 vaccines. Electron J Gen Med. 2023;20(2):em456. https://doi.org/10.29333/ejgm/....
Al-Tammemi AB. The battle against COVID-19 in Jordan: An early overview of the Jordanian experience. Front Public Health. 2020;8:188. https://doi.org/10.3389/fpubh.... PMid:32574291 PMCid:PMC7220996.
Jimenez‐Sotomayor MR, Gomez‐Moreno C, Soto‐Perez‐de‐Celis E. Coronavirus, ageism, and Twitter: An evaluation of tweets about older adults and COVID‐19. J Am Geriatr Soc. 2020;68(8):1661-5. https://doi.org/10.1111/jgs.16... PMid:32338787 PMCid:PMC7267430.
Tomer V, Gupta S, Manwal M, Singh D. How statistics of world health index react against COVID-19. Mater Today Proc. 2021;46:11267-73. https://doi.org/10.1016/j.matp... PMid:33816130 PMCid:PMC7997708.
Al-Nimer MS, Merza TA, Mohammed YMKY, Mohammed HA. Blood cells indices are determinants of the COVID-19 outcome: A cross-sectional study from Kurdistan Region-Iraq. Electron J Gen Med. 2021;18(5):em304. https://doi.org/10.29333/ejgm/....
WHO. Coronavirus disease (COVID-2019) situation reports. World Health Organization; 2021. Available at: https://www.who.int/emergencie... (Accessed: 1 April 2023).
Tummers J, Catal C, Tobi H, Tekinerdogan B, Leusink G. Coronaviruses and people with intellectual disability: An exploratory data analysis. J Intellect Disabil Res. 2020;64(7):475-81. https://doi.org/10.1111/jir.12... PMid:32307762 PMCid:PMC7264798.
Chavda VP, Mishra T, Vuppu S. Immunological studies to understand hybrid/recombinant variants of SARS-CoV-2. Vaccines. 2022;11(1):45. https://doi.org/10.3390/vaccin... PMid:36679891 PMCid:PMC9867374.
Bianchi F, Bianchi G, Song D. The long-term impact of the COVID-19 unemployment shock on life expectancy and mortality rates. J Econ Dyn Control. 2022;146:104581. https://doi.org/10.1016/j.jedc... PMid:36506795 PMCid:PMC9721190.
Jain U. Effect of COVID-19 on the organs. Cureus. 2020;12(8):e9540. https://doi.org/10.7759/cureus....
Zaim S, Chong JH, Sankaranarayanan V, Harky A. COVID-19 and multiorgan response. Curr Probl Cardiol. 2020;45(8): 100618. https://doi.org/10.1016/j.cpca... PMid:32439197 PMCid:PMC7187881.
Merad M, Martin JC. Pathological inflammation in patients with COVID-19: A key role for monocytes and macrophages. Nat Rev Immunol. 2020;20(6):355-62. https://doi.org/10.1038/s41577... PMid:32376901 PMCid:PMC7201395.
Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417-8. https://doi.org/10.1016/S0140-... PMid:32325026.
Haberman R, Axelrad J, Chen A, et al. COVID-19 in immune-mediated inflammatory diseases–case series from New York. N Engl J Med. 2020;383(1):85-8. https://doi.org/10.1056/NEJMc2... PMid:32348641 PMCid:PMC7204427.
Bikdeli B, Madhavan MV, Jimenez D, et al. COVID-19 and thrombotic or thromboembolic disease: Implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. J Am Coll Cardiol. 2020; 75(23):2950-73. https://doi.org/10.1016/j.jacc... PMid:32311448 PMCid:PMC7164881.
Wang K, Chen W, Zhang Z, et al. CD147-spike protein is a novel route for SARS-CoV-2 infection to host cells. Signal Transduct Target Ther. 2020;5(1):283. https://doi.org/10.1038/s41392... PMid:33277466 PMCid:PMC7714896.
Wang M, Xiong H, Chen H, Li Q, Ruan XZ. Renal injury by SARS-CoV-2 infection: A systematic review. Kidney Dis. 2021;7(2):100-10. https://doi.org/10.1159/000512... PMid:33821207 PMCid:PMC7705946.
Saghir SA, AlGabri NA, Alagawany MM, et al. Chloroquine and hydroxychloroquine for the prevention and treatment of COVID-19: A fiction, hope or hype? An updated review. Ther Clin Risk Manag. 2021;17:371. https://doi.org/10.2147/TCRM.S... PMid:33953559 PMCid:PMC8092643.
Glasheen WP, Cordier T, Gumpina R, Haugh G, Davis J, Renda A. Charlson comorbidity index: ICD-9 update and ICD-10 translation. Am Health Drug Benefits. 2019;12(4):188.
Bairwa M, Kumar R, Beniwal K, Kalita D, Bahurupi Y. Hematological profile and biochemical markers of COVID-19 non-survivors: A retrospective analysis. Clin Epidemiol Glob Health. 2021;11:100770. https://doi.org/10.1016/j.cegh... PMid:33997479 PMCid:PMC8106521.
Huyut MT, Huyut Z, Ilkbahar F, Mertoglu C. What is the impact and efficacy of routine immunological, biochemical and hematological biomarkers as predictors of COVID-19 mortality? Int Immunopharmacol. 2022;105:108542. https://doi.org/10.1016/j.inti... PMid:35063753 PMCid:PMC8761578.
Dufrusine B, Valentinuzzi S, Bibbò S, et al. Iron dyshomeostasis in COVID-19: Biomarkers reveal a functional link to 5-lipoxygenase activation. Int J Mol Sci. 2023;24(1):15. https://doi.org/10.3390/ijms24... PMid:36613462 PMCid:PMC9819889.
Yuan X, Huang W, Ye B, et al. Changes of hematological and immunological parameters in COVID-19 patients. Int J Hematol. 2020;112:553-9. https://doi.org/10.1007/s12185... PMid:32656638 PMCid:PMC7354745.
Kumar R, Singh V, Mohanty A, Bahurupi Y, Gupta PK. Corona health-care warriors in India: Knowledge, attitude, and practices during COVID-19 outbreak. J Educ Health Promot. 2021;10:44. https://doi.org/10.4103/jehp.j... PMid:34084791 PMCid:PMC8057180.
Lu J, Hu S, Fan R, et al. ACP risk grade: A simple mortality index for patients with confirmed or suspected severe acute respiratory syndrome coronavirus 2 disease (COVID-19) during the early stage of outbreak in Wuhan, China. MedRxiv. 2020:2020.02.20.20025510. https://doi.org/10.1101/2020.0....
Wajahat M, Muhammad J, Ali SS, et al. COVID-19 Impact on hematological and biochemical parameters on outcomes of admitted patients. Int J Health Sci. 2022;6(S7):6864-74. https://doi.org/10.21203/rs.3.....
Anani M, Amer SA, Kishk RM, Hassan A, Hassan S, Attia F. Evaluation of blood and biochemical parameters of COVID-19 patients in Suez Canal University Hospital: A retrospective study. J Infect Dev Ctries. 2022;16(04):592-9. https://doi.org/10.3855/jidc.1... PMid:35544618.
Liu Y, Yang Y, Zhang C, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020;63:364-74. https://doi.org/10.1007/s11427... PMid:32048163 PMCid:PMC7088566.
Liao D, Zhou F, Luo L, et al. Haematological characteristics and risk factors in the classification and prognosis evaluation of COVID-19: A retrospective cohort study. The Lancet Haematol. 2020;7(9):e671-8. https://doi.org/10.1016/S2352-... PMid:32659214.
Chen J, Wu C, Wang X, Yu J, Sun Z. The impact of COVID-19 on blood glucose: A systematic review and meta-analysis. Front Endocrinol. 2020;11:574541. https://doi.org/10.3389/fendo.... PMid:33123093 PMCid:PMC7570435.
Apicella M, Campopiano MC, Mantuano M, Mazoni L, Coppelli A, Del Prato S. COVID-19 in people with diabetes: Understanding the reasons for worse outcomes. Lancet Diabetes Endocrinol. 2020;8(9):782-92. https://doi.org/10.1016/S2213-... PMid:32687793.
Cheng Y, Luo R, Wang K, et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int. 2020;97(5):829-38. https://doi.org/10.1016/j.kint... PMid:32247631 PMCid:PMC7110296.
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. https://doi.org/10.1016/S0140-... PMid:31986264.
Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. Lancet. 2020;395(10223):507-13. https://doi.org/10.1016/S0140-... PMid:32007143.
Meduri GU, Headley S, Kohler G, et al. Persistent elevation of inflammatory cytokines predicts a poor outcome in ARDS: Plasma IL-1β and IL-6 levels are consistent and efficient predictors of outcome over time. Chest. 1995; 107(4):1062-73. https://doi.org/10.1378/chest.... PMid:7705118.
Lv Y, Zhao X, Wang Y, et al. Abnormal liver function tests were associated with adverse clinical outcomes: An observational cohort study of 2,912 patients with COVID-19. Front Med. 2021;8:639855. https://doi.org/10.3389/fmed.2... PMid:34179034 PMCid:PMC8219933.
Kulkarni AV, Kumar P, Tevethia HV, et al. Systematic review with meta‐analysis: Liver manifestations and outcomes in COVID‐19. Aliment Pharmacol Ther. 2020;52(4):584-99. https://doi.org/10.1111/apt.15... PMid:32638436 PMCid:PMC7361465.
Mao R, Qiu Y, He J-S, et al. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: A systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020;5(7):667-78. https://doi.org/10.1016/S2468-... PMid:32405603.
Hanif W, Ali O, Shahzad H, Younas M, Iqbal H, Afzal K. Biochemical markers in COVID-19 in Multan. J Coll Physicians Surg Pak. 2020;30(10):1026-9. https://doi.org/10.29271/jcpsp... PMid:33143821.
Deng P, Ke Z, Ying B, Qiao B, Yuan L. The diagnostic and prognostic role of myocardial injury biomarkers in hospitalized patients with COVID-19. Clin Chim Acta. 2020;510:186-90. https://doi.org/10.1016/j.cca.... PMid:32681933 PMCid:PMC7363604.
Lartey AH, Li X, Li Z, Zhang Q, Wang J. Age- and sex-specific profiles of temporal fasting plasma glucose variability in a population undergoing routine health screening. BMC Public Health. 2021;21(1):320. https://doi.org/10.1186/s12889... PMid:33563261 PMCid:PMC7871645.
Rajagopal G, Suresh V, Sachan A. High-density lipoprotein cholesterol: How high. Indian J Endocrinol Metab. 2012;16(Suppl 2):S236-8.
LaRosa JC. At what levels of total low-or high-density lipoprotein cholesterol should diet/drug therapy be initiated? United States guidelines. Am J Cardiol. 1990;65(12):7-10. https://doi.org/10.1016/0002-9... PMid:2180270.
Miller M, Stone NJ, Ballantyne C, et al. Triglycerides and cardiovascular disease: A scientific statement from the American Heart Association. Circulation. 2011;123(20): 2292-333. https://doi.org/10.1161/CIR.0b... PMid:21502576.
Bastug A, Bodur H, Erdogan S, et al. Clinical and laboratory features of COVID-19: Predictors of severe prognosis. Inter Immunopharmacol. 2020;88:106950. https://doi.org/10.1016/j.inti... PMid:32919217 PMCid:PMC7480980.
Ye B, Deng H, Zhao H, Liang J, Ke L, Li W. Association between an increase in blood urea nitrogen at 24 h and worse outcomes in COVID-19 pneumonia. Ren Fail. 2021; 43(1):347-50. https://doi.org/10.21203/rs.3.....
Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol. 2014;170(3):G1-47. https://doi.org/10.1530/EJE-13... PMid:24569125.
Jung WJ, Lee HJ, Park S, et al. Severity of community acquired hypernatremia is an independent predictor of mortality. Intern Emerg Med. 2017;12:935-40. https://doi.org/10.1007/s11739... PMid:28474207.
Hadi JM, Hassan SM, Saeed MM, et al. Estimation of serum calcium on the severity and mortality in COVID-19 infections in Sulaymaniyah City, Kurdistan Region of Iraq: A cross-sectional study. Clin Pract. 2022;12(6):1001-8. https://doi.org/10.3390/clinpr... PMid:36547111 PMCid:PMC9777466.
Sharma R, Heidari A, Johnson RH, Advani S, Petersen G. Serum magnesium levels in hospitalized patients with SARS-CoV-2. J Investig Med. 2022;70(2):409-14. https://doi.org/10.1136/jim-20... PMid:34580159 PMCid:PMC8478578.
de la Rica R, Borges M, Aranda M, et al. Low albumin levels are associated with poorer outcomes in a case series of COVID-19 patients in Spain: A retrospective cohort study. Microorganisms. 2020;8(8):1106. https://doi.org/10.3390/microo... PMid:32722020 PMCid:PMC7463882.
Khan AQ, Butt I, Ali S, Sohail S, Qamar MK, Tahir F. Association of serum albumin and total protein levels with lymphopenia in COVID-19 infection at a tertiary care hospital in Pakistan. Pak J Pathol. 2022;33(2):65-8. https://doi.org/10.55629/pakjp....
Pitamberwale A, Mahmood T, Ansari AK, et al. Biochemical parameters as prognostic markers in severely Ill COVID-19 patients. Cureus. 2022;14(8):e28594. https://doi.org/10.7759/cureus... PMid:36185918 PMCid:PMC9521622.
Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020;8(4):420-2. https://doi.org/10.1016/s2213-... PMid:32085846.
Suriawinata E, Mehta KJ. Iron and iron-related proteins in COVID-19. Clin Exper Med. 2022. https://doi.org/10.1007/s10238... PMid:35849261 PMCid:PMC9289930.