Standard blood laboratory values as a clinical support tool to distinguish between SARS-CoV-2 positive and negative patients

  1. Rainer Thell
  2. Jascha Zimmermann
  3. Marton Szell
  4. Sabine Tomez
  5. Philip Eisenburger
  6. Moritz Haugk
  7. Anna Kreil
  8. Alexander Spiel
  9. Amelie Blaschke
  10. Anna Klicpera
  11. Oskar Janata
  12. Walter Krugluger
  13. Christian Sebesta
  14. Harald Herkner
  15. Brenda Laky

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Abstract

Standard blood laboratory parameters may have diagnostic potential, if polymerase-chain-reaction (PCR) tests are not available on time. We evaluated standard blood laboratory parameters of 655 COVID-19 patients suspected to be infected with SARS-CoV-2, who underwent PCR testing in one of five hospitals in Vienna, Austria. We compared laboratory parameters, clinical characteristics, and outcomes between positive and negative PCR-tested patients and evaluated the ability of those parameters to distinguish between groups. Of the 590 patients (20–100 years, 276 females and 314 males), 208 were PCR-positive. Positive compared to negative PCR-tested patients had significantly lower levels of leukocytes, neutrophils, basophils, eosinophils, lymphocytes, neutrophil-to-lymphocyte ratio, monocytes, and thrombocytes; while significantly higher levels were detected with erythrocytes, hemoglobin, hematocrit, C-reactive-protein, ferritin, activated-partial-thromboplastin-time, alanine-aminotransferase, aspartate-aminotransferase, lipase, creatine-kinase, and lactate-dehydrogenase. From all blood parameters, eosinophils, ferritin, leukocytes, and erythrocytes showed the highest ability to distinguish between COVID-19 positive and negative patients (area-under-curve, AUC: 72.3–79.4%). The AUC of our model was 0.915 (95% confidence intervals, 0.876–0.955). Leukopenia, eosinopenia, elevated erythrocytes, and hemoglobin were among the strongest markers regarding accuracy, sensitivity, specificity, positive and negative predictive value, positive and negative likelihood ratio, and post-test probabilities. Our findings suggest that especially leukopenia, eosinopenia, and elevated hemoglobin are helpful to distinguish between COVID-19 positive and negative tested patients.

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  1. Version published to 10.1038/s41598-021-88844-x
  2. ScreenIT

    SciScore for 10.1101/2020.10.23.20217844: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: The study protocol was approved both by the Ethics Commission of the City of Vienna (EK 20-122-VK) and the Ethics Commission of Sigmund Freud University Vienna (161/2020).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableData Collection: Data were collected from female and male adult patients with suspected COVID-19 who underwent reverse transcriptase PCR testing via a nasopharyngeal swab performed at one of the five hospitals (Klinik Donaustadt, Klinik Floridsdorf, Klinik Hietzing, Klinik Landstrasse, and Klinik Ottakring) between February 27, 2020 and April 27, 2020.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All data were analysed with SPSS software (IMP Statistics Version 25; SPSS Inc, Chicago, IL).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The following limitations of the study should be noted. The retrospective design with missing blood parameters and no validation cohort are amongst the major limiting factors and thus, our selected model may be over-fitted. Additionally, with the single time point evaluation, we were not able to retrieve information regarding progression of the disease. Furthermore, cytokines, especially interleukin-6, were not routinely measured, which may be better predictors, especially regarding the so-called, COVID-19 cytokine storm’, to elucidate COVID-19 positive from negative patients. Another fact to consider is the heterogeneity of underlying diseases, which may also contribute to variations in our findings. On the other hand, such a heterogeneity may reflect reality during a pandemic situation best. Eventually, all test quality crucially depends on the quality of the manual specimen acquisition.[19, 20] PCR results tend to be more positive in patients with an increased viral load and with a shorter duration of the disease.[21]

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.10.23.20217844v1 on medRxiv