Association of Laboratory Parameters with Clinical Outcomes of SARS-CoV-2 Patients

Abstract

Background: The COVID-19 pandemic has imposed a significant burden on healthcare systems, particularly in resource-limited settings. Laboratory biomarkers may help predict disease outcomes and guide clinical decisions. However, there is limited evidence from Nepal regarding the prognostic value of these markers among hospitalized COVID-19 patients.
Methods: A hospital-based observational study was conducted among 348 RT-PCR–confirmed COVID-19 patients admitted to the COVID ICUs and wards of a tertiary care hospital in Nepal between March 2022 and June 2023. Data on sociodemographic characteristics, haematological parameters, liver and inflammatory markers, urine microscopy, and SARS-CoV-2 molecular gene markers were collected prospectively. Clinical outcomes were categorized as survived or died. Descriptive statistics, chi-square tests, and binary logistic regression were used to analyse associations and identify predictors of mortality.
Results: Out of the total 348 patients included in the study, 71 patients (20.4%) died, while 277 patients (79.6%) survived. Among 348 patients, significant associations with mortality were observed for lymphopenia (p = .001), neutrophilia (p < .001), elevated ALT (p < .001), elevated AST (p = .001), and positive D-dimer (p < .001). High viral load (Ct value ?20) for E, N, and ORF1ab ab genes was also significantly associated with mortality in univariate analysis. Logistic regression identified D-dimer positivity (OR = 0.027, p = .001) and elevated ALT (OR = 0.356, p = .016) as independent predictors of mortality.
Conclusions: Laboratory parameters, especially lymphocyte count, D-dimer, and ALT levels, are valuable prognostic indicators of clinical outcomes in hospitalized COVID-19 patients. Integrating these markers into clinical assessment may enhance early risk stratification and resource allocation.
Keywords: Biomarkers; C-Reactive protein; COVID-19; critical care; d-dimer.