COMPUTED TOMOGRAPHY-BASED ASSOCIATION OF HEMATOLOGICAL PARAMETERS AND SYSTEMIC INFLAMMATION MARKERS WITH COVID-19 SEVERITY IN HOSPITALIZED PATIENTS



Cite item

Full Text

Abstract

Laboratory data are important for confirming diagnosis, assessing COVID-19 progression, and determining treatment measures. The aim of this study was to evaluate the associations of hematological, coagulation parameters, and systemic inflammatory markers with COVID-19 severity according to computed tomography data in hospitalized patients. Materials and methods. Clinical blood test parameters were assessed in 356 patients with COVID-19. Results. Patients with severe vs. minimal and moderate lung tissue damage have a significant increase in the absolute leukocyte count, the relative and absolute number of neutrophils, and a decrease in the relative number of monocytes and lymphocytes. These differences are also observed in patients with moderate vs. minimal lung tissue damage, except for the absolute leukocyte count. However, the latter as well as the relative number of neutrophils and lymphocytes in patients with minimal and moderate lung tissue damage, along with the absolute number of neutrophils and the relative number of monocytes in all patients were within the reference range. In COVID-19 patients with severe lung tissue damage, markers of systemic inflammation (neutrophil-lymphocytic index, platelet-lymphocytic index, systemic inflammatory response index, systemic inflammation index and cumulative systemic inflammation index) were higher than in those with the minimum and average volume, and the monocyte-lymphocyte index is higher than in those with the average volume of lung tissue damage. At the same time, in patients with minimal lesion volume, neutrophil-lymphocyte index and systemic inflammation index were at lower level, than in case of average volume of lung tissue lesion. Conclusion. The study revealed an association between the relative count of neutrophils and lymphocytes, neutrophil-lymphocyte ratio, systemic inflammation index, and systemic inflammatory response index, aggregate systemic inflammation index and severe COVID-19 disease based on computed tomography data. These biomarkers provide valuable information about systemic inflammation and immune system activity and can be detected using standard blood tests.

About the authors

Marina Дьякова

St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg, Russian Federation

Email: marinadyakova@yandex.ru
ORCID iD: 0000-0002-7810-880X

Doctor of Biological Sciences, Senior Research of Microbiology, Biochemistry and Immunogenetics Research Laboratory 

Russian Federation, LigovskiyProspekt 2-4, St. Petersburg 191036, Russian Federation

Anna Valerievna Makarova

St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg, Russian Federation

Email: makarova_a09@mail.ru
ORCID iD: 0000-0003-2253-2289

Pediatrician

Russian Federation, LigovskiyProspekt 2-4, St. Petersburg 191036, Russian Federation

Olga Leonidovna Rubtsova

St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg, Russian Federation

Email: rub.olga@mail.ru

Physician of Clinical Diagnostics Laboratory, Head of Clinical Diagnostic Laboratory of St. Petersburg State Research Institute of Phthisiopulmonology of Ministry of Health of the Russian Federation

Russian Federation, LigovskiyProspekt 2-4, St. Petersburg 191036, Russian Federation

Dilyara Salievna Esmedlyaeva

St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg, Russian Federation

Email: diljara-e@yandex.ru
ORCID iD: 0000-0002-9841-0061

Candidate of Biological Sciences, Senior Research of Microbiology, Biochemistry and Immunogenetics Research Laboratory 

Russian Federation, Ligovskiy Prospekt 2-4, St. Petersburg 191036, Russian Federation

Petr Kazimirovich Yablonskiy

St. Petersburg Research Institute of Phthisiopulmonology, St. Petersburg, Russian Federation;
St. Petersburg University, St. Petersburg, Russian Federation

Author for correspondence.
Email: piotr_yablonskii@mail.ru
ORCID iD: 0000-0003-4385-9643

Doctor of Medical Science, Professor, Director of St. Petersburg State Research Institute of Phthisiopulmonology of Ministry of Health of the Russian Federation, Honored Doctor of Russia, Head of Hospital Surgery Department, Faculty of Medicine, St. Petersburg State University

Russian Federation, Ligovskiy Prospekt 2-4, St. Petersburg 191036, Russian Federation, 13B, Universitetskaya Emb., St. Petersburg, 199034, Russian Federation

References

  1. Коробова З.Р., Любимова Н.Е., Арсентьева Н.А., Жебелева М.С., Черных Е.И., Давлетшина В.В., Кащенко В.А., Тотолян А.A. Лабораторные показатели крови при COVID-19 и их взаимосвязь с геновариантом вируса // Инфекция и иммунитет. 2024. Т. 14, № 3. C. 429–436. Korobova Z.R., Liubimova N.E., Arsentieva N.A., Zhebeleva M.S., Chernykh E.I., Davletshina V.V., Kashchenko V.A., Totolian A.A. Laboratory blood markers in COVID-19 and their connection to viral variant. Russian Journal of Infection and Immunity, 2024, vol. 14, no. 3, pp. 429–436 [doi: 10.15789/2220-7619-LBM-16765]
  2. Титова О.Н., Волчков В.А., Кузубова Н.А., Козырев А.Г., Волчкова Е.В., Крошкина И.Ю. Клинико-лабораторные и лучевые параметры, ассоциируемые с различными исходами новой коронавирусной инфекции (COVID-19) тяжелого течения с пневмонией у пациентов, получавших тоцилизумаб // Медицинский Альянс. 2021. Т.9, №1. С. 35-42. Titova O., Volchkov V., Kuzubova N., Kozyrev A., Volchkova E., Kroshkina I. Clinical laboratory and radiation parameters associated with different outcomes of severe new coronavirus infection (COVID-19) with pneumonia in patients receiving tocilizumab. Medical Alliance, 2021, vol. 9, no. 1, pp. 34-42.] [doi: 10.36422/23076348-2021-9-1-35-42]
  3. Щербак С.Г., Камилова Т.А., Голота А.С., Шнейдер О.В., Вологжанин Д.А. Патогенез легочных осложнений COVID-19 // Медицинский Альянс. 2021. Т.9, №4. С.6-25. Shcherbak S., Kamilova T., Golota A., Schneider O., Vologzhanin D. Pathogenesis of pulmonary complications COVID-19. Medical Alliance, 2021, vol. 9, no. 4, pp. 6-25. [doi: 10.36422/23076348-2021-9-4-6-25]
  4. Adamescu A.-I., Tilişcan C., Stratan L.M., Mihai N., Ganea O.-A., Ciobanu S., Marinescu A.G., Aramă V., Aramă S..S. Decoding inflammation: the role of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in predicting critical outcomes in COVID-19 patients. Medicina, 2025, vol. 61, pp. 634. [doi: 10.3390/medicina61040634]
  5. Arini I.A., Masyeni S., Widhidewi N.W. Relationship between neutrophil-lymphocyte ratio and platelet-lymphocyte ratio with the severity of COVID-19. Narra J., 2024, vol. 4, no.1, pp. e262. [doi: 10.52225/narra.v4i1.262]
  6. Akhmaltdinova L., Mekhantseva I., Turgunova L., Kostinov M., Zhumadilova Z., Turmukhambetova A. As-sociation of soluble PD-L1 and NLR combination with 1-year mortality in patients with COVID-19. Int Immunopharmacol., 2024, vol. 129, pp.111600. [doi: 10.1016/j.intimp.2024.111600]
  7. Akkök B., Alkan Baylan F., Ateş S., Ceyhan F., Yalçınkaya K.T., Karaküçük S.N., Gişi G. The role of the systemic inflammatory index in determining the need for intensive care in COVID-19 pneumonia. Eurasian J Pulmonol., 2023, vol. 25, no. 3, pp. 183-90. [doi: 10.14744/ejp.2023.1207]
  8. Buonacera A., Stancanelli B., Colaci M., Malatino L. Neutrophil to lymphocyte ratio: an emerging marker of the relationships between the immune system and diseases. Int J Mol Sci., 2022, vol. 23, no.7, pp.3636.
  9. [doi: 10.3390/ijms23073636]
  10. Сhadaga K, Prabhu S, Bhat V, Sampathila N., Umakanth S., Chadaga R. Artificial intelligence for diagnosis of mild-moderate COVID-19 using haema-tological markers. Ann Med., 2023, vol. 55, no. 1, pp. 2233541. [doi: 10.1080/07853890.2023.2233541]
  11. Chelariu A.-C., Coman A.E., Lionte C., Gorciac V., Sorodoc V., Haliga, R.E., Petris, O.R., Bologa C., Puha G., Stoica A., Constantin M., Sirbu O., Ceasovchih A., Sorodoc L. The Value of Early and Follow-Up Elevated Scores Based on Peripheral Complete Blood Cell Count for Predicting Adverse Outcomes in COVID-19 Patients. J. Pers. Med., 2022, vol. 12, pp. 2037. [doi: 10.3390/jpm12122037]
  12. Chen Y., Dong K., Fang C., Shi H., Luo W., Tang C.-E., Luo F. The predictive values of monocyte–lymphocyte ratio in postoperative acute kidney injury and prognosis of patients with Stanford type A aortic dissection. Front immunol., 2023, vol. 14, pp.1195421. [doi: 10.3389/fimmu.2023.1195421]
  13. Dziedzic E.A., Gasior J.S., Tuzimek A., Kochman W. Blood count-derived inflammatory markers and acute complications of ischemic heart disease in elderly women. J clin Med., 2023, vol. 12, no. 4, pp. 1369. [doi: 10.3390/jcm12041369]
  14. Dziedzic E. A., Gąsior J.S., Tuzimek A., Paleczny J., Junka A., Dąbrowski M., Jankowski P. Investigation of the associations of novel inflammatory biomarkers— systemic inflammatory index (SII) and systemic inflammatory Response index (SIRI)—with the severity of coronary artery disease and acute coronary syndrome occurrence. Int J Mol Sci., 2022, vol. 23, no.17, pp.9553. [doi: 10.3390/ijms23179553]
  15. Engelmann B., Massberg S. Thrombosis as an intravascular effector of innate immunity. Nat Rev Immunol., 2013, vol. 13, no.1, pp. 34-45. [doi: 10.1038/nri3345]
  16. Fan B.E., Chong V.C.L., Chan S.S.W., Lim G.H., Lim K.G.E., Tan G.B., Mucheli S.S., Kuperan P., Onget K.H. Hematologic parameters in patients with COVID-19 infection. Am J Hematol., 2020, vol. 95, no. 6, pp. 131–4. [doi: 10.1002/ajh.25774]
  17. Ghasemzadeh M., Ahmadi J., Hosseini E. Platelet-leukocyte crosstalk in COVID-19: How might the reciprocal links between thrombotic events and inflammatory state affect treatment strategies and disease prognosis? Thromb Res., 2022, vol. 213, pp. 179-194. [doi: 10.1016/j.thromres.2022.03.022]
  18. Gu S.X., Tyagi T., Jain K., Gu V.W., Lee S.H., Hwa J.M., Kwan J.M., Krause D.S., Lee A.I., Halene S., Martin K.A., Chun H.J., Hwa J. Thrombocytopathy and endotheliopathy: crucial contributors to COVID-19 thromboinflammation. Nat Rev Cardiol., 2020, vol. 18, no. 3, pp. 194–209. [doi: 10.1038/s41569-020-00469-1]
  19. Halmaciu I., Arbănași E.M., Kaller R., Mureșan A.V., Arbănași E.M., Bacalbasa N., Suciu B.A., Cojocaru I.I., Runcan A.I., Grosu F., Vunvulea V., Russu E. Chest CT severity score and systemic inflammatory biomarkers as pre¬dictors of the need for invasive mechanical ventilation and of COVID-19 patients’ mortality. Diagnostics, 2022, vol. 12, no. 9, pp. 2089. [doi: 10.3390/diagnostics12092089]
  20. He S., Blombäcka M., Wallenda H. COVID-19: Not a thrombotic disease but a thromboinflammatory disease. Upsala J. Medical Sciences, 2024, vol. 129, pp. e9863. [doi.org/10.48101/ujms.v129.9863]
  21. Huang I., Pranata R. Lymphopenia in severe coronavirus disease-2019 (COVID-19): systematic review and meta-analysis. J. Intensive. Care, 2020, vol. 8, pp. 36. [doi: 10.1186/s40560-020-00453-4]
  22. Işler Y., Kaya H. Relationship of platelet counts, platelet volumes, and Curb-65 scores in the prognosis of COVID-19 patients. Am. J. Emerg. Med., 2022, vol. 51, pp. 257-261. [doi: 10.1016/j.ajem.2021.11.010]
  23. Kangro K., Wolberg A.S., Flick M.J. Fibrinogen, Fibrin, and Fibrin Degradation Products in COVID-19. Curr. Drug. Targets, 2022, vol. 23, no. 17, pp. 1593–1602. [doi: 10.2174/1389450123666220826162900]
  24. Koupenova M., Clancy L., Corkrey H.A., Freedman J.E. Circulating platelets as mediators of immunity, inflammation, and thrombosis. Circ Res., 2018, vol. 122, pp. 337–351. [doi: 10.1161/CIRCRESAHA.117.310795]
  25. Koupenova M., Corkrey H.A., Vitseva O., Manni G., Pang C.J., Clancy L., Yao C., Rade J., Levy D., Wang J.P., Finberg R.W., Kurt-Jones E.A., Freedman J.E. The role of platelets in mediating a response to human influenza infection. Nat. Commun., 2019, vol. 10, no. 1, pp. 1–18. [doi: 10.1038/s41467-019-09607-x]
  26. Kyala N.J., Mboya I., Shao E., Sakita F., Kilonzo K.G., Shirima L., Sadiq A., Mkwizu E., Chamba N., Marandu A., Muhali S., Raza F., Ndale E., Bayo D., Mujuni D., Lyamuya F. Neutrophil-to-lymphocyte ratio as a prognostic indicator in COVID-19: Evidence from a northern Tanzanian cohort. PLoS ONE, 2025, vol. 20, no. 1, pp. e0300231. [doi: 10.1371/journal.pone.0300231]
  27. Lin J., Yan H., Chen H., He C., Lin C., He H., Zhang S., Shi S., Lin K. COVID-19 and coagulation dysfunction in adults: A systematic review and meta-analysis. J Med Virol., 2021, vol.93, no.2, pp.934-944. [doi: 10.1002/jmv.26346]
  28. Luyendyk J.P., Schoenecker J.G., Flick M.J. The multifaceted role of fibrin¬ogen in tissue injury and inflammation. Blood, 2019, vol. 133, pp. 511–20. [doi: 10.1182/blood-2018-07-818211]
  29. McFadyen J.D., Hannah S., Karlheinz P. The emerging threat of (micro) thtombosis in COVID-19 and its therapeutic implications. Circulation Research., 2020, vol. 127, pp. 571–587. [doi: 10.1161/CIRCRESAHA.120.317447]
  30. N’dilimabaka N., Mounguegui D.M., Lekana-Douki S.E., Yattara M.K., Obame-Nkoghe J., Longo-Pendy N.M., Koumba I.P.K., Mve-Ella O.L.B., Moukouama S.K., Dzembo C.E., Bolo L.Y., Biyie-Bi-Ngoghe P., Mangouka G.L., Nzenze J.-R., Lekana-Douki J.-B. Biochemical and hematological factors associated with COVID-19 severity among Gabonese patients: A retrospective cohort study. Front. Cell. Infect. Microbiol., 2022, vol. 12, pp. 975712. [doi: 10.3389/fcimb.2022.975712]
  31. Pan K., Jin Y., Du W., Wang M., Zhang Y., Liu S., Zhang Y. Prognostic value of the neutrophil-to-lymphocyte ratio and C-reactive-protein-to-prealbumin ratio in hospitalized older patients with coronavirus disease 2019. Medicine (United States), 2024, vol. 103, pp. E37809. [doi: 10.1097/MD.0000000000037809]
  32. Sabbatinelli J., Matacchione G., Giuliani A., Ramini D., Rippo M.R., Procopio A.D., Bonafè M., Olivieri F. Circulating biomarkers of inflammaging as potential predictors of COVID-19 severe outcomes. Mech Ageing Dev., 2022, vol. 204, pp. 111667. [doi: 10.1016/j.mad.2022.111667]
  33. Samprathi M., Jayashree M. Biomarkers in COVID-19: An Up-To-Date Review. Front. Pediatr., 2021, vol. 8, pp. 607647 [doi: 10.3389/fped.2020.607647]
  34. Sarkar S., Kannan S., Khanna P., Sing A.K. Role of platelet-to-lymphocyte count ratio (PLR), as a prognostic indicator in COVID-19: a systematic review and meta-analysis. J. Med. Virol., 2022, vol.94, pp. 211-221. [doi: 10.1002/jmv.27297]
  35. Sejópoles M.D., Souza-Silva J.P., Silva-Santos C., Paula-Duarte M.M., Fontes C.J.F., Gomes L.T. Prognostic value of neutrophil and lymphocyte counts and neutrophil/lymphocyte ratio for predicting death in patients hospitalized for COVID-19. Heliyon, 2023, vol.9, no.6, pp.16964. [doi: 10.1016/j.heliyon.2023.e16964]
  36. Skevaki C., Fragkou P.C., Cheng C., Xie M., Renz H. Laboratory characteristics of patients infected with the novel SARS-CoV-2 virus. J Infect., 2020, vol. 81, no.2, pp. 205-212. [doi: 10.1016/j.jinf.2020.06.039]
  37. Snopkowska Lesniak S.W., Maschio D., Henriquez-Camacho C., Moreno Cuerda V. Biomarkers for SARS-CoV-2 infection. A narrative review. Front. Med., 2025, vol. 12, pp. 1563998 [doi: 10.3389/fmed.2025.1563998]
  38. Stark K., Massberg S. Interplay between inflammation and thrombosis in cardiovascular pathology. Nat Rev Cardiol., 2021, vol.18, no.9, pp. 666-682. [doi: 10.1038/s41569-021-00552-1]
  39. Teimury A., Khameneh M.T., Khaledi E.M. Major Coagulation disorders and parameters in COVID‑19 patients. European Journal of Medical Research, 2022, vol. 27, no.1, pp. 25. [doi: 10.1186/s40001-022-00655-6]
  40. Undurraga E. A., Chowell G., Mizumoto K. COVID-19 case fatality risk by age and gender in a high testing setting in Latin America: Chile, march–august 2020. Infect. Dis. Poverty, 2021, vol. 10, no. 1, pp. 1–11. [doi: 10.1186/s40249-020-00785-1]
  41. Wu Z., Cao Y., Liu Z., Geng N., Pan W., Zhu Y., Shi H., Song Q., Liu B., Ma Y. Study on the predictive value of laboratory inflammatory markers and blood count-derived inflammatory markers for disease severity and Zprognosis in COVID-19 patients: a study conducted at a university affiliated infectious disease hospital. Annals of Medicine, 2024, vol. 56, no. 1, pp.2415401. [doi: 10.1080/07853890.2024.2415401]
  42. Yang X., Yang Q., Wang Y., Wu Y., Xu J., Yu Y., Shang Y. Thrombocytopenia and its association with mortality in patients with COVID-19. J. Thromb. Haemost., 2020, vol. 18, no. 6, pp. 1469-1472. [doi: 10.1111/jth.14848]
  43. Zein A.F.M.Z., Sulistiyana C.S., Raffaelo W.M., Pranata R. The association between mean platelet volume and poor outcome in patients with COVID-19: Systematic review, meta-analysis, and meta-regression. J. Intensive Care Society, 2023, vol. 24, no. 3, pp. 299–308. [doi: 10.1177/17511437221121234]
  44. Zhao Q., Meng M., Kumar R., Wu Y., Huang J., Deng Y., Weng Z., Yang L. Lymphopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A systemic review and meta-analysis. Int. J Infect. Dis., 2020, vol. 96, pp.131-135.
  45. [doi: 10.1016/j.ijid.2020.04.086]
  46. Zhu L. and Yao Y. Prediction of the risk of mortality in older patients with coronavirus disease 2019 using blood markers and machine learning. Front. Immunol., 2024, vol. 15, pp. 1445618.
  47. [doi: 10.3389/fimmu.2024.1445618]

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) Дьякова a M., Makarova a A.V., Rubtsova a O.L., Esmedlyaeva a D.S., Yablonskiy a,b P.K.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 64788 от 02.02.2016.