Evaluation of Correlation Between Severity and Laboratory Data for

COVID-19 Patients at Jakarta Private Hospital

Nona Ainah

, Diana Laila Ramatillah

and Michael

Faculty of Pharmacy, Universitas 17 Agustus 1945, Jakarta 14350, Indonesia

Clinical Pharmacy, Universiti Sains Malaysia, Malaysia

Keywords: Evaluation, Correlation, COVID-19, Severity, Laboratory Data.

Abstract: As of June 29, 2022, the COVID-19 outbreak has caused around 6 million confirmed cases, with the deaths

of around 156.000 patients in Indonesia. The purpose of this study was to clarify the correlation between

severity and laboratory data for COVID-19 patients at Jakarta Private Hospital. A retrospective cohort study

with convenience sampling was applied in this study. The study was conducted from March to June 2021.

There were 980 patients, but only 320 patients were eligible for inclutions criteria. The gender of the majority

of patients as the sample was male, 165 (52%) and 155 (48%) female patients. The results of this study showed

that almost all non-ICU patients had moderate severity, totaling 261 (91%). Meanwhile, patients admitted to

the ICU had a critical severity level of 32 (97%). In COVID-19 patients, severity correlated with ICU or non-

ICU (P-value <0.05). Laboratory data that show a correlation with the severity of COVID-19 infection are

leukocytes (P=0.001), platelets (P=0.006), urea (P=0.003), and creatinine (P=0.021). The conclusion in this

study shows that there is a significant correlation between laboratory data and the severity of COVID-19

patients (P-value <0.05).

1 INTRODUCTION

In December 2019, an outbreak of an unknown

pneumonia was reported. A virus called SARS-

CoV2, which is characterized as a highly contagious

and deadly disease, was discovered (Chen et al.,

2020). SARS-CoV-2 is a new type of coronavirus that

has never been identified in humans. At least two

types of coronavirus are known to cause illnesses that

can lead to severe symptoms, including Middle East

Respiratory Syndrome (MERS) and Severe Acute

Respiratory Syndrome (SARS) (Dirjen P2P

Kemenkes R1, 2020) (WHO, 2020).

The COVID-19 outbreak has caused around 6

million confirmed cases, with the deaths of around

156,000 patients in Indonesia as of June 29, 2022

(Worldometers, 2022). According to the Minister of

Health of the Republic of Indonesia, there are 4

categories of severity of COVID-19 patients: [1]

asymptomatic, [2] moderate symptoms (patients with

pneumonia symptoms and SpO2 93-95%), [3] severe

symptoms (patients with pneumonia and

SpO2<93%), and [4] critical illness (patients with

https://orcid.org/0000-0003-0207-0275

ARDS, sepsis, and septic shock) (Michael &

Ramatillah, 2022).

Some studies have shown that mild or

asymptomatic COVID-19 has low levels of SARS-

CoV, develops two specific antibodies, or cannot

detect them at all levels. However, severely ill patients

are at a higher level. This data raises questions with

the protective ability of antibodies and the

involvement of specific antibodies in the cause of

COVID-19 (a new coronavirus infection) (Goudouris,

2021).

The consequences of SARS-CoV-2 infection with

severe acute respiratory syndrome are very different,

and it is clear that the majority of young people

suffers from mild illness (Brodin, 2021). In patients

with severe illness, men are overestimated, probably

due to differences in evoked immune responses.

Comorbidities such as obesity, hypertension, chronic

obstructive pulmonary disease, and cardiovascular

disease are all associated with severe COVID-19

infections (Brodin, 2021). SARS-CoV-2 copies at

diagnosis were reported to be higher in patients with

severe COVID-19 than in patients with mild COVID-

Ainah, N., Ramatillah, D. and Michael, .

Evaluation of Correlation Between Severity and Laboratory Data for COVID-19 Patients at Jakarta Private Hospital.

DOI: 10.5220/0011978500003582

In Proceedings of the 3rd International Seminar and Call for Paper (ISCP) UTA â

Z45 Jakarta (ISCP UTA’45 Jakarta 2022), pages 193-196

ISBN: 978-989-758-654-5; ISSN: 2828-853X

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

193

19. Smoking is another risk factor. Cigarette smoke

induces the expression of angiotensin-converting

enzyme 2 (ACE2). This can allow SARS-CoV-2 to

invade cells and affect viral entry beyond adverse

effects on overall lung function (Brodin, 2021).

2 METHOD

This study used a retrospective cohort study with

convenience sampling conducted from March to June

2021 on COVID-19 patients treated at the Jakarta

Private Hospital.

2.1 Selection Criteria

2.1.1 Inclusion Criteria

▪ Patients are >18 years old;

▪ Patients who have complete medical records;

▪ COVID-19 positive patients with and without

comorbidities.

2.1.2 Exclusion Criteria

▪ Patients with advanced cancer;

▪ SLE sufferers;

▪ Pregnant women;

▪ HIV/AIDS sufferers.

2.2 Ethical Approval

The research received approval from the ethical

community by the Health Research Ethics Committee

at the University of 17 August 1945 Jakarta, based on

a certificate of ethical feasibility (Ethical Clearance).

2.3 Data Analysis

Before collecting data, the researcher first asked for

ethical approval. The process of data collection and

recording of medical record data for COVID-19

patients undergoing laboratory examinations. There

were 980 patients but only 320 patients met the

inclusion criteria. The gender of the majority of

patients in the sample were male 165 and 155 female

patients. Then the data was analyzed descriptively

with the Kruskal wallis method and Fisher's exact test

using SPSS version 25 software. In this study the

distribution was not normal or there was a significant

correlation indicated by P-value<0.05 (error rate of

5%).

3 RESULT AND DISCUSSION

3.1 Correlation Between Severity with

ICU / non-ICU of Covid-19 Patients

Almost all non-ICU patients had moderate severity,

with 261 (91%) patients. Meanwhile, patients

admitted to the ICU had a critical severity level of 32

(97%) patients. From table 1, it can be seen that there

is a correlation between severity and patients

admitted to ICU or non-ICU (p=0.001).

Based on research by Hockova et al. Up to a

quarter of hospitalized COVID-19 patients require

intensive care unit (ICU) treatment, revealing

epidemiological evidence that patients admitted to the

intensive care unit are susceptible to the following

illnesses: secondary pneumonia, heart injury, kidney

injury, and neurological disorders (Hocková et al.,

2021).

3.1 Correlation Between Severity with

Laboratory Data of COVID-19

Patients

In Table 2, it can be seen that most of the leukocytes

of COVID-19 patients had moderate severity in 262

(82%) patients. Leukocytes were found to be

correlated to patient severity (p=0.001). According to

the guidelines for interpreting clinical data in

Indonesia, the main functions of leukocytes are to

fight infection, protect the body by attracting foreign

organisms and produce or distribute antibodies.

Leukocytes have a normal value of 3200-

10,000/mm3 (Kemenkes RI, 2011).

Table 1: Correlation Between Severity and ICU/non-ICU.

Facto

Severit

Total Sig.

(P-Value)*

Mild

n (%)

Moderate

n (%)

Severe

n (%)

Critical Illness

n (%)

Non ICU 16 (5.5) 261 (91) 10 (3.48) 0 (0) 287 0.000

ICU 0 (0) 1 (3.0) 0 (0) 32 (97) 33

16 (5.0) 262 (81.9) 10 (3.1) 32 (10) 320

*Fisher`s Exact Test

ISCP UTA’45 Jakarta 2022 - International Seminar and Call for Paper Universitas 17 Agustus 1945 Jakarta

194

Table 2: Correlation Severity and Laboratory data.

Facto

Severit

Total Sig.

(P-Value)*

Mild

n (%)

Moderate

n (%)

Severe

n (%)

Critical illness

n (%)

ESR 16 (5) 262 (82) 10 (3) 32 (10) 320 0.870

Hb 16 (5) 262 (82) 10 (3) 32 (10) 320 0.952

RBC 16 (5) 262 (82) 10 (3) 32 (10) 320 0.601

WBC 16 (5) 262 (82) 10 (3) 32 (10) 320 0.001

Hematocrit 16 (5) 262 (82) 10 (3) 32 (10) 320 0.894

Platelets 16 (5) 261 (82) 10 (3) 32 (10) 319 0.006

MCV 16 (5) 262 (82) 10 (3) 32 (10) 320 0.782

MCH 16 (5) 262 (82) 10 (3) 32 (10) 320 0.914

MCHC 16 (5) 262 (82) 10 (3) 32 (10) 320 0.811

Kaliu

13 (4.4) 245 (82.4) 10 (3.4) 29 (9.8) 297 0.052

Natriu

13 (4.4) 245 (82.4) 10 (3.4) 29 (9.8) 297 0.212

Chloride 13 (4.4) 245 (82.4) 10 (3.4) 29 (9.8) 297 0.079

Urea 2 (2) 68 (75.8) 4 (4.4) 16 (17.8) 90 0.003

Creatinine 15 (5.4) 219 (81) 9 (3.3) 28 (10.3) 271 0.021

*Kruskal-Wallis Test

Platelets correlate with the severity of COVID-19

patiens (p=0.006) (table 2). According to the

guidelines for interpreting clinical data in Indonesia,

the normal value for platelets is 170-380. 103/mm3

(Kemenkes RI, 2011). Research by Dawood et al.,

2020, showed the occurrence of thrombocytosis in

6.26% of patients with a platelet count

>400,000/mm3 and thrombocytopenia in 5.36%

of patients with a platelet count <150,000/mm3 in

COVID-19 patients (Dawood et al., 2020).

Based on table 2, the highest creatinine in patients

with moderate severity was about 219 (80.8%), so

creatinine correlates with severity (p=0.021). Based

on the research of Cheng et al. (2020), 710 COVID-

19 patients were reported to have a prevalence of

15.5% increase in serum creatinine (Fadillah et al.,

2020)(Y. Cheng et al., 2020).

According to a study by Brian et al., creatinine

clearance values are determined by measuring the

concentration of endogenous creatinine (produced in

the body) in plasma and urine. The reference range

for men is generally in the range of 97-137 ml/min

and for women, 88-128 ml/min (Vesselaldo &

Ramatillah, 2022)(Nankivell, 2001). According to the

guidelines for interpretation of clinical data in

Indonesia, normal creatinine is 0.6-1.3 mg/dL

(Kemenkes RI, 2011).

Based on table 2, urea correlated with severity

(p=0.003). According to the guidelines for

interpreting clinical data in Indonesia, the normal

urea value in adult women is 6-21 mg/dL and adult

men, 8-24 mg/dL (Kemenkes RI, 2011). Blood urea

nitrogen (BUN) is the final nitrogen product of

protein metabolism and has been observed to be

associated with mortality from a variety of diseases

(Cheng et al., 2020). BUN is a surrogate marker that

predicts persistent organ failure after 48 hours of

hospitalization, in addition to its role in assessing

renal function (Cheng et al., 2020).

4 CONCLUSIONS

This study shows that there was a significant

correlation between laboratory data from leukocytes,

platelets, urea, and creatinine with the severity of

COVID-19 patients (P-value <0.05).

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