How to Cite:
Wajahat, M., Muhammad, J., Ali, S. S., Khan, N., Noureen, F., Khan, M. F., Khurshid, M., & Khan, A.
(2023). COVID-19 impact on hematological and biochemical parameters on outcomes of admitted
patients. International Journal of Health Sciences, 6(S7), 6864-6874.
https://doi.org/10.53730/ijhs.v6nS7.13916
COVID-19 impact on hematological and
biochemical parameters on outcomes of
admitted patients
Muhammad Wajahat
MPhil Scholar, Department of Microbiology, University of Haripur, Pakistan/
Laboratory Technologist, POF Hospital, Pakistan.
*Correspondence Author email: 397wajahat@gmail.com
Dr. Javed Muhammad
Assistant Professor, Department of Microbiology, University of Haripur, Pakistan.
Dr. Syed Sarwar Ali
Assistant Professor, Wah Medical College, POF Hospital, Pakistan.
Major Dr. Nabeela Khan
Assistant Professor, Wah Medical College, POF Hospital, Pakistan.
Dr. Fouzia Noureen
Assistant Professor, Wah Medical College, POF Hospital, Pakistan.
Muhammad Fawad Khan
Department of Biotechnology and Genetic engineering, Hazara University,
Mansehera, KP, Pakistan
Mehtab Khurshid
MPhil Scholar, Department of Microbiology, Abbottabad University of Science and
Technology, Pakistan.
Alam Khan
MPhil Scholar, Department of Microbiology, University of Haripur, Pakistan/
Laboratory Technologist, POF Hospital, Pakistan.
Abstract---COVID-19 an ongoing pandemic has high transmission
and mortality rate gets the attention of researchers to focus on the
disease. The burden of disease on the health care system focuses on
the COVID-19 impacts on the hematological and biochemical
parameters. This study aimed to focus on the laboratory indicators
that fluctuate in COVID-19. The single-center cross-sectional study in
the pathology department of POF hospital Wah Cantt from August
International Journal of Health Sciences ISSN 2550-6978 E-ISSN 2550-696X © 2023.
Manuscript submitted: 18 Oct 2022, Manuscript revised: 9 Nov 2022, Accepted for publication: 18 Dec 2022
6864
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2021 to December 2021. Three hundred positive COVID-19 patients
were included in the study. About 138 (46%) were males and 162
(54%) females and the mean age was 58 ± 15.06 (range 5 – 86). The
biochemical indicator raised in COVID-19 included CPK (191.25 ±
507.39), CRP (68.81 ± 70.95), LDH (429.48 ± 246.96), and ALT (46.50
± 43.23). In hematological parameters, only neutrophils elevated
(70.00 ± 13.52) lymphocytes decreased. Laboratory parameters
measured were similar values in recovered and death cases. The
findings suggest the raised level of CRP, LDH, CPK, ALT, ferritin, D-
Dimer, and neutrophils predict early diagnosis and prompt treatment.
Keywords---Hematological, Biochemical, COVID-19, Recovered,
Death, Outcomes, Pathology.
Introduction
WHO defined COVID-19 as an infection caused by SARS-CoV-2 and the patient
has a severe acute respiratory syndrome and presents on an epidemiological basis
of high-risk transmission and confirmed rRT-PCR. SARS-CoV-2 is a new strain of
the Coronoviridae family that is highly transmissible and infectious (Bogiel et al.,
2021). The high transmission rate and dynamic infectivity patterns make
coronavirus more pathogenic and mortal. On March 31, 2020, World Health
Organization announced the public health emergency action plan and takes
necessary measures to combat COVID-19. The positive cases may be
symptomatic, non-symptomatic, or severely ill (Rutledge et al., 2021).
COVID-19 affects the respiratory tract along with other organs including the
gastrointestinal system, liver, heart, etc. The hematological and biochemical
indices show the altered values in COVID-19 patients. These biomarkers were
helpful in a patient’s prognosis and in managing critical illness (Fong et al.,
2021).
These biomarker alterations indicate the coronavirus effect on the body. These
biomarkers show the pathological characteristics and prognosis and lead to
diagnosis if measured and manage with other co-morbidities (Siripanthong et al.,
2020).
Patients having COVID-19 symptoms show a high concentration of inflammatory
markers like C-reactive protein, creatinine phosphate kinase, lactate
dehydrogenase and alanine aminotransferase showing an increase in value
(Rutledge et al., 2021). C-receptive protein, lactate dehydrogenase and
neutrophils were raised in critical patients, and lymphopenia than in negative
cases (Fan, 2020) (Fan et al., 2020). Another study on 145 patients, showed CRP
neutrophils and lymphocytes were significant indicators in critical patients
(Ahnach et al., 2020). Impact of COVID-19 observed the high values of
neutrophils, platelets, CRP and LDH (Javadi et al., 2022). Many studies have been
published on epidemiological, demographical, and clinical factors but the
laboratory parameters comparison between the recovery and death was limited.
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This study focused on the impact of COVID-19 on biochemical and hematological
indicators and compared them in recovered and death cases.
Material and methods
Ethical consideration
The study was approved by the University of Haripur ethical committee of. The
hospital management team has been informed of the research data collection.
Written or oral consent was not needed for the research design.
Study Design and Setting
The single-center hospital-based and clinical cross-sectional was conducted on
positive patients of COVID-19 who were presented to pathology laboratory POF
Hospital, Wah Cantt from august 2021 to December 2021. Patients were grouped
into two categories, recovered and dead. These groups were compared for different
pathological indicators that changed in COVID-19. SPSS evaluates the data by
using chi-square and t-test. The ethical committee of the University of Haripur
approved the study, KPK, Pakistan.
Data Collection
Patients confirmed by rRT-PCR for COVID-19 were selected. Demographic history
and clinical presentation are noted. All age groups and both genders will be
included. The COVID-19 positive patients were followed for the laboratory tests.
The blood samples were collected for the hematological and biochemical pathology
parameters to measure variation and case prognosis multiple parameters are
tested. Hematology parameters including hemoglobin, lymphocytes, neutrophil,
and platelets were measured on SYSMEX X1000. The biochemical tests include
Lactate dehydrogenase, C-reactive protein, Creatinine phosphate kinase, Alanine
aminotransferase, and D-Dimer were analyzed by COBAS C 311.
Statistical Analysis
The IBM SPSS Ver. 23 statistical package programs and Microsoft excel 2016 for
data analysis. Continuous variables mean, standard deviation and categorical
variables were measured as frequency and percentage. We determined the
comparison between multiple groups by using the chi-square and continuous
variable by independent t-test. The 95% CI having a two-tailed tests and p < 0.05
considered statistically significant.
Case Definitions
WHO defined a COVID-19 as an infection caused by SARS-CoV-2 and the patient
presented with the severe acute respiratory syndrome and present in an
epidemiological area of high-risk transmission and confirmed detected by the
nucleic acid amplification techniques. COVID-19 is a severe acute respiratory
syndrome caused by coronavirus. The mortality rate defined as the death of an
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admitted patient due to COVID-19. Recovery rate defined as the number of
patients discharged after being admitted to the hospital due to COVID-19 and
getting treated.
3. Results
In our study, three hundred patients were diagnosed with COVID-19 and
admitted to the hospital. The descriptive study presents among 300 patients, 138
(46%) were males and 162 (54%) females. Among them, 43 % (117) males and
56 % (153) females recovered. About thirty deaths were reported having 21 (70%)
in males and 9 (30%) in females during hospitalization. Demographic profile
shows in Figure 1.
60%
51%
50%
39%
COVID-19 Cases
40%
30%
20%
10% 7%
3%
0%
Male Female
Gender Outcomes
Recovered Cases Death Cases
Figure 1 Demographic Profile
The mean age was 58 years (range 4- 84 years) the positivity rate was high in
older patients. Males’ mean age was 58 ± 13.15 and females’ mean age was 58 ±
17.59 having a p-value of 0.00. The association between the age groups and
gender shows a p-value of 0.00. the mean age in the recovered group was 57 ±
16.03 and in the death, group was 60 ±12.12. Males had a higher mortality rate
21 (15%) than females (5.5%) and p > 0.002. the Table 1 shows Age correlation
with Outcomes in COVID-19 patients.
Table 1 Age correlation with Outcomes
Clinical Outcome 95 % CI
characteristics
Recovered Death P-Value Lower Upper
(n = 270) (n = 30)
Age 57 ± 16.03 60 ±12.12 0.039 -8.14 3.74
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Creatinine phosphate kinase enzyme, an inflammatory indicator raised in COVID-
19 infection raised to 191 u/L, C-Reactive protein raised to 68 u/L which is
among the indicators. Lactate dehydrogenase, a muscle protein shows an
increase in value with a mean of 429 u/L in infected patients. Alanine transferase
shows a slight increase in changes.
The hematological parameters show the hemoglobin is in the normal range of
12.29 g/dL. neutrophil raised in COVID-19 and shows the mean of 70 % in
positive patients. Lymphocytes in the below normal range show non-significance.
Platelets remain in the normal range for COVID-19. Table 2 shows the statistical
means of the laboratory indicators.
Table 2 Mean Statistics of Laboratory Parameters
Parameters Normal Range Mean ± S. D
CPK 46-171 u/L 191.25 ± 507.39
CRP <5 u/L 68.81 ± 70.95
LDH 125-220 u/L 429.48 ± 246.96
ALT <40 u/L 46.50 ± 43.23
HB 13-17 g/dL 12.29 ± 2.11
Neutrophil 40-75 % 70.00 ± 13.52
Lymphocytes 20-45% 20.60 ± 13.00
Platelets 150-400 225.29 ± 103.96
D-Dimer <200
The hematological profile of COVID-19 patients shows the lymphocytic count was
decreased and neutrophils were raised. Platelets and hemoglobin levels were in
the normal range. There is no significant difference in hemoglobin, neutrophils
and lymphocytes count between the recovered and dead groups and p values were
0.764, 0.332 and 0.113 respectively. Only the p-value of platelets is 0.001,
showing a significant difference. Table 3 shows the impact of hematological
parameters.
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Table 3 Comparison of Hematological Parameters among patients with
COVID-19
Hematological Outcome
indicators P-Value 95% CI
Recovered Death Lower upper
(n = 270) (n = 30)
Hemoglobin 12.32 ± 2.11 12.06 .764 -5.4 1.0
± 2.14
Neutrophils 69.66 ± 13.72 73.03 .332 -8.4 1.7
±
11.28
Lymphocytes 20.48 ± 11.56 21.73 .113 -6.1 2.6
±
22.35
Platelets 220.26 ± 270.2 ± .001* -88.97 -10.89
94.75 160.3
The biochemical indicators were compared between the two groups of recovered
and death. The biochemical parameters CPK, CRP, LDH and ALT were showing p
values of 0.928, 0.063, 0.193 and 0.071 respectively between death and recovered
cases. Table 4 shows the impact of biochemical parameter.
Table 4 Comparison of Biochemical Parameters among patients with COVID-
19
Biochemical Outcome 95% CI
Indicators P-Value
Recovered Death Lower Upper
(n = 270) (n = 30)
CPK 188.8 ± 525.06 212 ± 0.928 -23.71 97.87
314.8
6
CRP 63.92 ± 69.69 112 ± 0.063 -48.2- 13.79
68.41
LDH 414.62 ± 561 ± 0.193 147.0 46.85
244.64 231.10 7
ALT 46.69 ± 44.80 0.071 1.88 8.33
44.75 ±
26.34
Discussion
The COVID-19 pandemic caused the world to open versatile fields and
advancements in techniques to the world. The immediate spread of COVID-19
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and its impact on human cells are still unknown to date. There were much more
gaps and flaws in the COVID-19 in prediction and clinical correlation. The hidden
information and lack of communication between different fields is a major
drawback to exploring SARS-CoV-2. The enormous workload and tremendous
efforts from the health staff managed the COVID-19 pandemic under control. The
strategies developed to control the transmission, innovations in detecting SARS-
CoV-2 and treatment procedures (Gennaro and Health, 2020).
The diagnostic technique for COVID-19 through the molecular technique for
accurate and reliable results. The isolation of SARS-CoV-2 and its tracking for the
epidemiological basis to break the chain of infections become enhanced and
effective due to rapid detection methods (Carter LJ, 2020, May).
In the early phase of COVID-19 in Pakistan, most cases fell in young and adults
group ranging age from 20 to 40 years, and very few cases in old, aged patients.
About 71 % were males and 28 % were females at the start of the COVID-19
pandemic (Abid et al., 2020). Pakistan’s population has an average age of about
22 years only and has only 4% of individuals above 65 years and an expected life
of 67 years. These demographics show a low mortality rate and low CFR in
COVID-19 (Waris et al., 2021). In my study males were 46% affected and females
were 54%. Another study reported a high number of males affected than females
due to social and cultural factors (Noreen et al., 2020).
Males were 223 (56.2%), and 174 (43.8%) were females and more deaths were
reported in males (Sobhani et al., 2021).
The first death by COVID-19 in Pakistan was reported on 18th March 2020 and
the ratio began to rise to 1.67% for 100 deaths (Chughtai and Malik, 2020).
Patients under 20 years of age were safe from the pandemic and adults from 20
years to 50 years of age were highly exposed by at minor risk with mild effects
but the old age group shows a high-risk danger from COVID-19 and a high
mortality rate (Chaudhry A et al., 2020).
The COVID-19 cause low deaths in young adults less than 40 years but more
death in aged patients above 40 years (Wu and McGoogan, 2020). Researchers
grouped the patients having confirmed COVID-19 cases. About 75% of cases were
above 50 years of age (Saddique et al., 2021). Our study aligned with the previous
reports and about 73.4 % of patients were older than 50 years of age. Age is
considered a significant indicator of COVID-19 outcomes. As in my study mean
age in recovered and dead patients were similar i.e., 57 ± 16.03 and 60 ±12.12
having a p-value of 0.039. In a study by Pakistani researchers on 317 patients,
about 198 (62.5%) were males and 111 (35.0%) were females. The mortality rate
was 15.8% among admitted patients (Khalid et al., 2021).
Xavier and his fellows also enlighten the biochemical parameter to focus on
prognoses like raised CRP, LDH, and ALT in patients. Hemoglobin shows a decline
in value by about 40-50% (Xavier et al., 2020).
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Our study shows a minor increase in levels of ALT levels up to 46.50 ± 43.23.
Zhang shares his findings of COVID-19 patients having liver dysfunction showing
raised ALT levels in 14 to 53% of cases during the infection period (Zhang et al.,
2020). Similar findings were reported in MERS-CoV having raised liver enzymes
including LDH, ALT and AST. They also share that the recovery rate was
enhanced if treated with special attention in mild COVID-19 cases (Zhang et al.,
2020).
In our study, CRP raised to a mean of 68.81 ± 70.95 (<5 u/L). The CRP raised to
63.92 ± 69.69 in deceased patients and 112 ± 68.41 in recovered patients. Our
study also reports the increase in CRP, a strong biomarker and indicator in death
and recovered patients. The level of C-reactive protein elevates up to 49.73 ±
53.59 and a p-value less than 0.001, a highly an important indicator of COVID-19
(Khalid et al., 2021).
Our study also reported elevated levels of biochemical bioindicators. In the study
by Chan and his fellow summarizing the elevated levels of CPK, CRP, LDH, and D-
Dimer in COVID-19 patients. The study by Chen on 99 confirmed positive
patients admitted to the hospital have raised LDH levels and a study by Huang in
2020 reported the significant levels of serum ferritin , C-reactive protein, and D-
Dimer in COVID-19 prognosis (Najim, 2020). Our study conducted on 300
patients showed the level of LDH was extremely high 429.48 ± 246.96 u/L. LDH
increase in COVID-19 and have a significant p-value of less than 0.001 between
the critical and deceased group (Khalid et al., 2021).
CBC test was performed immediately and reported with distinguished factors
giving more in-depth knowledge as a strong biomarker. These biomarkers include
neutrophils, lymphocytes, platelets, and white blood cells. In our study
hemoglobin remains in the normal range of 12.29 ± 2.11 g/dL with a standard
deviation of ± 2.11. The study revealed that admitted patients have normal
hemoglobin levels and show no variations (Lei et al., 2020). Hemoglobin level
shows no significant correlation (p-value = 0.77). between critical and non-critical
patients (Waris et al., 2021).
WBC differential count represents the neutrophil raised to 70 %, CRP 16.16
mg/L, and D-dimer 580 ng/mL in an admitted 33-year-old lady (Lei et al., 2020).
Another study conducted on 32 confirmed patients, reported a decrease in
lymphocytes and raised neutrophils. They were significant indicators in severe
and critical patients (Katipoğlu et al., 2020). Our study supports the previous
research and confirms that neutrophilia along with lymphocytopenia were an
indicator of COVID-19. Neutrophilia was reported by Singapore on 148 admitted
patients having critical illnesses. Gong et al. and Qin et al. and Li et al. also
reported similar findings of neutrophilia in admitted patients (Khalid et al., 2021).
In another study, there was a significant correlation between critically ill and mild
group patients having a p-value of 0.28 (Waris et al., 2021). In the present study,
lymphocytes also show a minor decline, measured at 20.60 ± 13.00% (20.60 ±
13.00). Lymphocytopenia has been observed in the studies of Khalid, Atiqa, et al.,
CDC, and Huang et al in China among COVID-19 patients (Khalid et al., 2021).
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Thrombocytopenia was observed in the COVID-19 patients and predicted the
severity and prognosis. Our study showed the platelets counts were below in
range (225.29 ± 103.96) and have a p-value of 0.001 between recovered and death
groups. The mean platelets count decreased in critical patients to 165.0 × 109/L
(Waris et al., 2021). Thrombocytopenia in ventilated patients had a p-value of
0.049, indicating platelets were a major biomarker in COVID-19 (Khalid et al.,
2021). Therefore, thrombocytopenia is a major biomarker for identifying
coagulopathy.
Conclusion:
Elevated levels of LDH, CRP, CPK and ALT along with neutrophilia and
lymphocytopenia help in predicting the COVID-19 without being evaluated for RT-
PCR. The early detection helps in the productive prognosis of COVID-19
minimizes the patients’ complications and reduces the risk of transmission. The
monitoring and identifying of the hematological and biochemical parameters
assist clinicians in prognosis and treatment. The raised values of inflammatory
indicators help the careful monitoring of these parameters.
Limitations
These biomarkers and clinical investigations need further studies and should be
used for risk stratification in patients with COVID-19. This study gives new
knowledge into the significant job of other clinical attributes in patients with
COVID-19. This will additionally assist with figuring out how to control and
relieve the pandemic in general. Researchers need multiple center studies among
COVID-19 patients on large scale to reach a single destination.
Declaration of competing interest
The authors have no conflicts of interest relevant to this article.
Acknowledgments
The authors thank all their colleagues who co-operated in this investigation.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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Refrences
Abid, K., Bari, Y. A., Younas, M., Tahir Javaid, S. and Imran, A. J. A. P. J. o. P. H.
(2020) 'Progress of COVID-19 Epidemic in Pakistan', 32(4), pp. 154-156.
Ahnach, M., Zbiri, S., Nejjari, S., Ousti, F. and Elkettani, C. J. J. o. m. b. (2020)
'C-reactive protein as an early predictor of COVID-19 severity', 39(4), pp. 500.
Bogiel, T., Rzepka, M. and Depka, D. J. D. (2021) 'Reliable Diagnostics of SARS-
CoV-2 Infections Using One-and Two-Gene Molecular Tests for a Viral RNA
Detection—Results Questioning Previous Observations', 11(10), pp. 1839.
Carter LJ, G. L., Smoot JW, Li Y, Zhou Q, Saveson CJ, Sasso JM, Gregg AC,
Soares DJ, Beskid TR, Jervey SR, Liu C. (2020, May) 'Assay Techniques and
Test Development for COVID-19 Diagnosis. ', ACS Cent Sci. Epub, 27;6(5)(
PMID: 32382657; ), pp. 591-605. DOI: doi: 10.1021/acscentsci.0c00501.
Chughtai, A. and Malik, A. J. G. B. (2020) 'Is Coronavirus disease (COVID-19)
case fatality ratio underestimated?', 2(1).
Fan, B. E. J. A. j. o. h. (2020) 'Hematologic parameters in patients with COVID-19
infection: a reply', 95(8), pp. E215-E215.
Fong, S. J., Dey, N. and Chaki, J. (2021) Artificial intelligence for coronavirus
outbreak. Springer.
Gennaro, F. D. J. I. J. o. E. R. and Health, P. (2020) 'Damiano Pizzol at all. 2020.
Coronavirus Diseases (Covid 19) Current Status and Future Perspectivees: A
Narative Review', 2690.
Javadi, A., Dabiri, S., Meymandi, M. S., Bahremani, M. H., Soleimantabar, H.,
Dabiri, B., Vosough, H., Sharan, M. G. and Sedaghati, F. J. I. J. o. P. (2022)
'Changes of Routine Hematological Parameters in COVID-19 Patients:
Correlation with Imaging Findings, RT-PCR and Outcome', 17(1), pp. 37.
Katipoğlu, B., Sönmez, L. Ö., Vatansev, H., Yüce, N., Sabak, M., Szarpak, L.,
Evrin, T. J. D. and Journal, E. M. (2020) 'Can hematological and biochemical
parameters fasten the diagnosis of COVID-19 in emergency departments?',
5(4), pp. 175-181.
Khalid, A., Ali Jaffar, M., Khan, T., Abbas Lail, R., Ali, S., Aktas, G., Waris, A.,
Javaid, A., Ijaz, N. and Muhammad, N. J. H. (2021) 'Hematological and
biochemical parameters as diagnostic and prognostic markers in SARS-COV-
2 infected patients of Pakistan: a retrospective comparative analysis', 26(1),
pp. 529-542.
Lei, J., Li, J., Li, X. and Qi, X. J. R. (2020) 'CT imaging of the 2019 novel
coronavirus (2019-nCoV) pneumonia', 295(1), pp. 18-18.
Najim, R. H. J. S. R. i. P. (2020) 'Biochemical and hematological parameters as a
predictor for COVID-19 infection in 65 patients diagnosed by real time? PCR
in Kirkuk city', 11(5), pp. 797-799.
Noreen, N., Naveed, I., Dil, S., Niazi, S., Saleem, S., Mohiuddin, N., Khan, N.,
Noor, B., Khan, M. and Khan, F. J. G. B. (2020) 'Trend Analysis of
exponential increase of Covid-19 cases in Pakistan: An interpretation', 2(1).
Rutledge, A. C., Choi, Y.-H., Karp, I., Bhayana, V. and Stevic, I. J. C. b. (2021)
'Biochemistry tests in hospitalized COVID-19 patients: Experience from a
Canadian tertiary care centre', 95, pp. 41-48.
Saddique, A., Adnan, S., Bokhari, H., Azam, A., Rana, M. S., Khan, M. M., Hanif,
M., Sharif, S. J. E. S. and Environment (2021) 'Prevalence and associated
risk factor of COVID-19 and impacts of meteorological and social variables on
its propagation in Punjab, Pakistan', 5(3), pp. 785-798.
6874
Siripanthong, B., Nazarian, S., Muser, D., Deo, R., Santangeli, P., Khanji, M. Y.,
Cooper Jr, L. T. and Chahal, C. A. A. J. H. r. (2020) 'Recognizing COVID-19–
related myocarditis: The possible pathophysiology and proposed guideline for
diagnosis and management', 17(9), pp. 1463-1471.
Sobhani, S., Aryan, R., Kalantari, E., Soltani, S., Malek, N., Pirzadeh, P.,
Yarahmadi, A. and Aghaee, A. J. I. p. o. i. d. (2021) 'Association between
clinical characteristics and laboratory findings with outcome of hospitalized
COVID-19 patients: a report from Northeast Iran', 2021.
Waris, A., Din, M., Khalid, A., Abbas Lail, R., Shaheen, A., Khan, N., Nawaz, M.,
Baset, A., Ahmad, I. and Ali, M. J. J. o. C. L. A. (2021) 'Evaluation of
hematological parameters as an indicator of disease severity in Covid‐19
patients: Pakistan's experience', 35(6), pp. e23809.
Wu, Z. and McGoogan, J. M. J. j. (2020) 'Characteristics of and important lessons
from the coronavirus disease 2019 (COVID-19) outbreak in China: summary
of a report of 72 314 cases from the Chinese Center for Disease Control and
Prevention', 323(13), pp. 1239-1242.
Xavier, A. R., Silva, J. S., Almeida, J. P. C., Conceição, J. F. F., Lacerda, G. S. and
Kanaan, S. J. J. B. d. P. e. M. L. (2020) 'COVID-19: clinical and laboratory
manifestations in novel coronavirus infection', 56.
Zhang, D., Zhou, X., Yan, S., Tian, R., Su, L., Ding, X., Xiao, M., Chen, Y., Zhao,
H. and Chen, H. J. C. C. A. (2020) 'Correlation between cytokines and
coagulation-related parameters in patients with coronavirus disease 2019
admitted to ICU', 510, pp. 47-53.
