Relation of chest HRCT scan findings with hematological, biochemical, and immunological parameters of hospitalized Covid-19 patients in a tertiary hospital in Chattogram city

Abstract

The chest HRCT scan can be used as a diagnostic tool for COVID-19 disease in cases of clinical suspicion, false-negative RT-PCR, or unavailability of the test. The study aimed to investigate the relation of HRCT findings (1) Normal, (2) Ground Glass Opacity (GGO), and (3) GGO plus Consolidation (GGO+Co) with hematological, biochemical, immunological parameters, and clinical manifestations of COVID-19 patients. As such, oone hundred and thirty-five COVID-19 RT-PCR-confirmed patients were enrolled in this study from a dedicated COVID-19 ward in a tertiary care hospitals in Chattogram city. Chest HRCT scans were analyzed for all enrolled patients. D-dimer, CRP, procalcitonin, IL-6, and total count/TC, differential count/DC, and Platelet count were analyzed by automated biochemistry and hematology analyzer. Among the participants, 62.7% were male and 37.3% female with age for both genders were 49 years. Based on HRCT density, normal, GGO, and GGO+Co cases were identified in 36%, 21%, and 43% of the patients, respectively. Lung infections were not detected in the normal group but were present in the GGO and GGO+Co groups. Mild (75.86%), moderate (13.79%), and severe (10.34%) cases were found in the GGO,group, and they were 24.13%, 50%, and 24.13% respectively in GGO+Co groups. Critical cases (1.72%) were found only in the GGO+Co group. Clinical manifestations were recorded in three groups of COVID-19 patients where the fever was the most predominant symptom in the Normal (91.67%), GGO (92.85%), and GGO+Co (96.55%) groups, followed by cough in Normal (68.08%), GGO (71.42%), and GGO+Co (72.41%). In the Normal patients group, Mild, Moderate, and severe oxygen saturation (SpO2) levels in N=47(97.92%, N=1(2.08%), and N=0 (0%) respectively. SpO2 levels, Mild 93.10% (N=27), Moderate 6.89 %( N=2), and Severe 0 %(N=0) had detected in GGO patients groups. On the other hand, SpO2 level N=39/67.24% (Mild), N=1/1.72 %( Moderate), and only N=18/31.03 %( Severe) cases were found in GGO+Co patients groups. GGO+Co group had higher levels of CRP (82.37 mg/L), D-dimer (0.97 μg/ml), and PCT (0.68 ng/mL) compared to normal cases with CRP (13.22 mg/L), D-dimer(0.44 μg/ml), and PCT (0.14 ng/mL), and GGO cases had levels of CRP (25.88 mg/L), D-dimer (0.55 μg/ml), and PCT (0.22 ng/mL). Significant p-values (GGO+Co vs normal) were found for CRP (p=0.000000077*) and PCT (p=0.000000077*). Differences in hematological features were also observed, with higher counts neutrophils (72.45%), and platelets (231.92 x 10^9/L) in the GGO+Co group compared to the normal and GGO cases. Il-6 mean levels were 52.34pg/ML, 80.6 pg/ML, and 105.78 pg/ML for normal, GGO, and GGO+Co groups, respectively. In suspected COVID-19 RT-PCR false negative cases, chest HRCT can be used as an alternative test, and its laboratory findings (CRP, PCT, D-dimer, Total & differential Count of WBC, Platelet) can be taken as prognostic markers for the treatment of COVID-19 to reduce the mortality rate.