Initial TLC, NLR, LDH, CRP, D-Dimer, and Procalcitonin in Intubated vs Non Intubated COVID-19 Patients

Ridha Surya Nugraha, Indriasari Indriasari, Ricky Aditya


COVID-19 is an acute respiratory disease caused by the SARS-CoV-2 virus that has caused a pandemic with symptoms of upper respiratory infection, respiratory failure, and even mortality.  Several asymptomatic patients, with no  shortness of breath, were found to experience impaired oxygenation in examination for objective data (happy hypoxia). Thus, objective data are needed, including data on inflammatory parameters (TLC, NLR, LDH, CRP, D-dimer and PCT) to monitor the severity and prognosis of COVID-19 patients. This study aimed to evaluate the inflammatory parameters in the initial days of treatment for COVID-19 patients between intubated and non-intubated patients during hospitalization. The study was conducted in the COVID isolation ward of Dr. Hasan Sadikin General Hospital Bandung, Indonesia, from July 2020 to July 2021. This was a retrospective cross-sectional comparative analytical observational study that involved patients’ first laboratory examination results. The statistical analysis was performed using Mann Whitney test for numerical data and Chi Square test for categorical data. There were significant differences in inflammatory parameters values in both groups (p<0.01). The TLC values of intubated patients were lower than those of non-intubated patients, while the NLR, LDH, CRP, D-dimer and PCT values of intubated COVID-19 patients were higher than those of non-intubated patients.


COVID-19; Inflammatory; Intubation; Respiratory Failure

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  1. Burhan E, Dwi Susanto A, Nasution SA, Ginanjar E, Wicaksono Pitoyo C, Susilo A, et al. Pedoman tatalaksana COVID-19 [Internet]. 2nd ed. 2020. p. 1–112. Available from: Tatalaksana COVID-19 edisi 2.pdf
  2. Amanda DA. Rasio neutrofil-limfosit pada covid-19; sebuah tinjauan literatur. Wellness Heal Mag. 2020;2(2):219–23.
  3. Akhlaghi H, Vogrin S, Parnis S, O’Reilly G, Esmaeilian Z, Golshani K. Clinical decision tools to predict orotracheal intubation and in-hospital mortality among covid-19 patients: a retrospective multi-centre study. SSRN Electron J. 2020;1(1):1–47.
  4. WHO. Tatalaksana klinis infeksi saluran pernapasan akut berat (SARI) suspek penyakit COVID-19. World Heal Organ. 2020;4(1):1–25.
  5. Suliman LA, Abdelgawad TT, Farrag NS, Abdelwahab HW. Validity of ROX index in prediction of risk of intubation in patients with COVID-19 pneumonia. Adv Respir Med. 2021;89(1):1–7.
  6. Azwar MK, Setiati S, Rizka A, Fitriana I, Saldi SRF, Safitri ED. Clinical profile of elderly patients with COVID-19 hospitalised in Indonesia’s National General Hospital. Acta Med Indones. 2020;52(3):199–205.
  7. Mahayasa DPS, Putri AK. Maskulinitas dan Pandemi COVID-19: Studi Kasus Pakistan. J Hub Int. 2020;13(2):163–84.
  8. Keski H. Hematological and inflammatory parameters to predict the prognosis in COVID-19. Indian J Hematol Blood Transfus. 2021;37(4):534–42.
  9. Fan BE, Chong VCL, Chan SSW, Lim GH, Lim KGE, Tan GB, dkk. Hematologic parameters in patients with COVID-19 infection. Am J Hematol. 2020;95(6):131–4.
  10. Tjendra Y, Al Mana AF, Espejo AP, Akgun Y, Millan NC, Gomez-Fernandez C, et al. Predicting disease severity and outcome in COVID-19 patients: A review of multiple biomarkers. Arch Pathol Lab Med. 2020;144(12):1465–74.
  11. Muharramah DH, Prihartono N. Obesity and severity COVID-19 : literature review study. J Epidemiol Kesehat Komunitas. 2021;6(2):323–32.
  12. Guan W, Liang W, Zhao Y, Liang H, Chen Z, Li Y, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J. 2020;55(5):640.
  13. Tonglolangi OS, Pratiningrum M, Yadi Y. Hubungan nilai CT pada pemeriksaan real-time PCR SARS-CoV-2 dengan gejala klinis. J Kedokt Mulawarman. 2021;8(3):89–99.
  14. Huang I, Pranata R. Lymphopenia in severe coronavirus disease-2019 (COVID-19): Systematic review and meta-analysis. J Intensive Care. 2020;8(1):1–10.
  15. Wang X, Li X, Shang Y, Wang J, Zhang X, Su D, et al. Ratios of neutrophil-to-lymphocyte and platelet-to-lymphocyte predict all-cause mortality in inpatients with coronavirus disease 2019 (COVID-19): a retrospective cohort study in a single medical center. Epidemiol Infect. 2020;148(211):1–8.
  16. Selanno Y, Widaningsih Y, Esa T, Arif M. Analysis of neutrophil lymphocyte ratio and absolute lymphocyte count as predictors of severity of COVID-19 patients. Indones J Clin Pathol Med Lab. 2021;27(2):184–9.
  17. Poggiali E, Zaino D, Immovilli P, Rovero L, Losi G, Dacrema A, et al. Lactate dehydrogenase and C-reactive protein as predictors of respiratory failure in COVID-19 patients. Clin Chim Acta. 2020;509(1):135–8.
  18. Asghar MS, Haider Kazmi SJ, Ahmed Khan N, Akram M, Hassan M, Rasheed U, et al. Poor prognostic biochemical markers predicting fatalities caused by COVID-19: a retrospective observational study from a developing country. Cureus. 2020;12(8):1–17.
  19. Lv XT, Zhu YP, Cheng AG, Jin YX, Ding HB, Wang CY, et al. High serum lactate dehydrogenase and dyspnea: positive predictors of adverse outcome in critical COVID-19 patients in Yichang. World J Clin Cases. 2020;8(22):5535–46.
  20. Alzoughool F, Alanagreh L, Abumweis S, Atoum M. Cerebrovascular comorbidity, high blood levels of C-reactive protein and D-dimer are associated with disease outcomes in COVID-19 patients. Clin Hemorheol Microcirc. 2021;77(3):311–22.
  21. Ali N. Elevated level of C-reactive protein may be an early marker to predict risk for severity of COVID-19. J Med Virol. 2020;92(11):2409–11.
  22. Yu HH, Qin C, Chen M, Wang W, Tian DS. D-dimer level is associated with the severity of COVID-19. Thromb Res. 2020;195(1):219–25.
  23. Mueller AA, Tamura T, Crowley CP, DeGrado JR, Haider H, Jezmir JL, et al. Inflammatory biomarker trends predict respiratory decline in COVID-19 patients. Cell Reports Med. 2020;1(8):1–11.
  24. Dolci A, Robbiano C, Aloisio E, Chibireva M, Serafini L, Falvella FS, et al. Searching for a role of procalcitonin determination in COVID-19: a study on a selected cohort of hospitalized patients. Clin Chem Lab Med. 2021;59(2):433–40.


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