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Article Type

Original Study

Abstract

Aim and objective Fever and lymphocyte count to start the interventions and not wait for the upregulation of IL-6 and down regulation of SpO2 levels amongst the patients. Background In SARS-CoV-2 host immune response play a critical role in disease pathogenesis. The coronavirus not only activates antiviral immune responses, but it can also cause uncontrolled inflammatory responses categorized by marked proinflammatory cytokine release in patients with severe COVID-19, leading to lymphopenia. In this present article we have studied the basic parameters of COVID-19 that includes fever and lymphocyte count and their deep association with markers of disease prognosis and cytokine storm such as IL-6, HRCT score and SpO2 levels. With this basic routine clinical and laboratory parameters we can consider recurrent/prolonged fever and low count of lymphocytes are the earliest biomarkers of the upcoming cytokine storm. Method We conducted a hospital-based case-control study of patients who visited to the tertiary healthcare centre in Amravati (Maharashtra), India with a positive SARS-CoV-2 polymerase chain reaction (PCR) assay, from August 01, 2020 to July 03, 2021. Upon hospital visit, all patients underwent a HRCT chest score, complete blood count (CBCs), renal and liver panel, IL-6. Patients with fever and other symptoms which were not responsive to the treatment were admitted to the hospital. Patients who tested positive and admitted to the hospital were not discharged until they had 2 negative RTPCR tests 24 hours apart. Patient details including demographics, history of comorbidities associated with every patient, the records of the vital signs, symptoms and all the reports of radiological and blood assays were obtained from computerized medical records of the hospital. Results We screened total 1324 patients admitted to Tertiary health care center Amravati (Maharashtra), India, from 01 August 2020 to 03 July 2021. From these study, total 156 patients are excluded because of the number of patients, i.e. 106/156 patients founded with no prolonged fever but having same common symptoms. And remaining 50 patients excluded because of they were found with no short duration of fever and asymptomatic. Data was collected from the remaining 1168 (88.21%) as a cohort control group. The cases with recurrent/prolonged fever and short duration had median age [52 (21-83) v/s 52 (17-92) p=0.42] it shows that age is not statistically significant. On the other hand, the cases with recurrent/prolonged fever were more likely to have hypoxia were SpO2 level [90 (50-98)] v/s in short duration of fever were observed.[95 (45-98) p=0.02] shows statistically associated. Similarly, the HRCT chest score in recurrent/prolonged fever were found to be around [8 (0-24)] v/s [6 (0-22) p=0.027] it represents the significant difference. Conclusion Fever and lymphocyte count and their deep association with markers of disease prognosis and cytokine storm such as IL-6, HRCT score and SpO2 level. With this basic routine clinical and labortory parameters we can consider recurrent/prolonged fever and low count of lymphocytes are the earliest biomarkers of the upcoming cytokine storm. Therefore, study recommends the use of fever and lymphocyte count to start the interventions and not wait for the upregulation of IL-6 and down regulation of SpO2 which occurs in late stage.

Keywords

Coronavirus disease 2019, high-resolution computed tomography, interleukin 6, lymphopenia, oxygen saturation

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