Official publication of Rawalpindi Medical University
Accuracy Of Serum Ferritin, C-Reactive Protein, Lactate Dehydrogenase And D. Dimers In Assessing Severity And Outcome Of COVID-19 Infection

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Covid-19 infection, inflammatory markers, area under curve, accuracy

How to Cite

Aziz-Un-Nisa, Muhammad D, Zaib S, Khan I, Zaib I, Saleem S. Accuracy Of Serum Ferritin, C-Reactive Protein, Lactate Dehydrogenase And D. Dimers In Assessing Severity And Outcome Of COVID-19 Infection . JRMC [Internet]. 2023 Sep. 26 [cited 2023 Dec. 6];27(3). Available from:




Covid-19 emerged as pandemic. In the beginning, due to the rapid spread of virus it was difficult to understand fully its pathogenesis but various inflammatory markers were found to be raised. Along with the detection of virus by polymerase reaction (PCR), studies of these markers not only help in diagnosis but also in assessing the prognosis of covid-19 infection.

Material and methods:

This cross sectional study was conducted in the Capital Hospital, CDA Islamabad from December to June 2022. After taking consent various inflammatory markers were recorded on a proforma. Patients were followed and outcome was also recorded. The data collected was analyzed by percentage/ frequency distribution. T-test was applied and p-values were calculated (significant p-value=<0.05).  Sensitivity, specificity, positive and negative predictive values, area under curve (AUC) and accuracy were calculated by using SPSS, version 23.


A total of 185 covid-19 PCR positive patients were included in the study. 112(60.5%) were men and 73 (39.5%) were women. 165(89.2%) patients were > 40 years of age. 117 (63.2%) patients had mild /moderate disease and 68(36.8%) had severe disease.  162 (87.5%) patients were discharged and 23 (23.4%) expired. AUC in relation to severity of disease was 0.603 for C- reactive protein (CRP), 0.543 for lactate dehydrogenase (LDH), 0.525 for D. dimers and 0.619 for ferritin. Accuracy in relation to disease severity was as following: CRP 57.4%, D. dimers 52.4 %, ferritin 57.9% and LDH 55.7%.  AUC in relation to outcome of covid-19 was 0.699 for CRP, 0.668 for LDH, 0.742 for D. dimers and 0.677 for ferritin. Accuracy of inflammatory markers in relation to outcome was as following: CRP 45.9%, D. dimers 61.2%, LDH 48.1% and ferritin 46.9%.


Serum ferritin showed the highest accuracy (57.9%) in assessing the covid-19 severity and D. dimer came up with highest accuracy (61.2%) in assessing disease outcome.


Bordi L, Nicastri E, Scorzolini L, Di Caro A, Capobianchi MR, Castilletti C, Lalle E; on behalf of INMI COVID-19 study group and Collaborating Centers2. Differential diagnosis of illness in patients under investigation for the novel coronavirus (SARS-CoV-2), Italy, February 2020. Euro Surveill. 2020 Feb;25(8):2000170. doi: 10.2807/1560-7917.

Shereen MA, Khan S, Kazmi A, Bashir N, Siddique R. COVID-19 infection: Origin, transmission, and characteristics of human coronaviruses. J Adv Res. 2020 Mar 16;24:91-98. doi: 10.1016/j.jare.2020.03.005.

England PH. SARS-CoV-2 variants of concern and variants under investigation in England. Technical briefing. 2021 Aug 6;23.

Aiyegbusi OL, Hughes SE, Turner G, Rivera SC, McMullan C, Chandan JS, Haroon S, Price G, Davies EH, Nirantharakumar K, Sapey E, Calvert MJ; TLC Study Group. Symptoms, complications and management of long COVID: a review. J R Soc Med. 2021 Sep;114(9):428-442. doi: 10.1177/01410768211032850.

Sheraton M, Deo N, Kashyap R, Surani S. A Review of Neurological Complications of COVID-19. Cureus. 2020 May 18;12(5):e8192. doi: 10.7759/cureus.8192.

Chavez S, Long B, Koyfman A, Liang SY. Coronavirus Disease (COVID-19): A primer for emergency physicians. Am J Emerg Med. 2021 Jun;44:220-229. doi: 10.1016/j.ajem.2020.03.036.

Sanyaolu A, Okorie C, Marinkovic A, Patidar R, Younis K, Desai P, Hosein Z, Padda I, Mangat J, Altaf M. Comorbidity and its Impact on Patients with COVID-19. SN Compr Clin Med. 2020;2(8):1069-1076. doi: 10.1007/s42399-020-00363-4.

Goudouris ES. Laboratory diagnosis of COVID-19. Jornal de pediatria. 2021 Feb 22;97:7-12.

Terpos E, Ntanasis-Stathopoulos I, Elalamy I, Kastritis E, Sergentanis TN, Politou M, Psaltopoulou T, Gerotziafas G, Dimopoulos MA. Hematological findings and complications of COVID-19. Am J Hematol. 2020 Jul;95(7):834-847. doi: 10.1002/ajh.25829.

Hu B, Huang S, Yin L. The cytokine storm and COVID‐19. Journal of medical virology. 2021 Jan;93(1):250-6.

Imran MM, Ahmad U, Usman U, Ali M, Shaukat A, Gul N. Neutrophil/lymphocyte ratio-A marker of COVID-19 pneumonia severity. Int J Clin Pract. 2021 Apr;75(4):e13698. doi: 10.1111/ijcp.13698.

Stasi C, Fallani S, Voller F, Silvestri C. Treatment for COVID-19: An overview. Eur J Pharmacol. 2020 Dec 15;889:173644. doi: 10.1016/j.ejphar.2020.173644.

Bradbury CA, McQuilten Z. Anticoagulation in COVID-19. Lancet. 2022 Jan 1;399(10319):5-7. doi: 10.1016/S0140-6736(21)02503-4.

Abbas, S., Hayat, A., Majeed, N., Jaffar, S., Asghar, J., & Ali, S. (2020). COMPARISON OF INFLAMMATORY MARKERS WITH DIFFERENT LEVELS OF SEVERITY OF COVID-19 DISEASE. Pakistan Armed Forces Medical Journal, 70(2), S455-58.

Ali N. Elevated level of C‐reactive protein may be an early marker to predict risk for severity of COVID‐19. Journal of medical virology. 2020 Nov;92(11):2409. doi: 10.1002/jmv.26097

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX; China Medical Treatment Expert Group for Covid-19. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020 Apr 30;382(18):1708-1720. doi: 10.1056/NEJMoa2002032.

Young B, Gleeson M, Cripps AW. C-reactive protein: a critical review. Pathology. 1991 Apr;23(2):118-24. doi: 10.3109/00313029109060809.

Henry BM, Aggarwal G, Wong J, Benoit S, Vikse J, Plebani M, Lippi G. Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis. Am J Emerg Med. 2020 Sep;38(9):1722-1726. doi: 10.1016/j.ajem.2020.05.073.

Zhou Y, Ding N, Yang G, Peng W, Tang F, Guo C, Chai X. Serum lactate dehydrogenase level may predict acute respiratory distress syndrome of patients with fever infected by SARS-CoV-2. Ann Transl Med. 2020 Sep;8(17):1118. doi: 10.21037/atm-20-2411.

Umair, M., Kim, D. & Choi, M. Impact of climate, rising atmospheric carbon dioxide, and other environmental factors on water-use efficiency at multiple land cover types. Sci Rep 10, 11644 (2020).

M Hussein A, Taha ZB, Gailan Malek A, Akram Rasul K, Hazim Kasim D, Jalal Ahmed R, Badraden Mohamed U. D-Dimer and Serum ferritin as an Independent Risk Factor for Severity in COVID-19 Patients. Mater Today Proc. 2021 Apr 13. doi: 10.1016/j.matpr.2021.04.009.

Zhou M, Zhang X, Qu J. Coronavirus disease 2019 (COVID-19): a clinical update. Front Med. 2020 Apr;14(2):126-135. doi: 10.1007/s11684-020-0767-8.

Prasetya IB, Cucunawangsih, Lorens JO, Sungono V, El-Khobar KE, Wijaya RS. Prognostic value of inflammatory markers in patients with COVID-19 in Indonesia. Clin Epidemiol Glob Health. 2021 Jul-Sep;11:100803. doi: 10.1016/j.cegh.2021.100803.

Asghar MS, Khan NA, Haider Kazmi SJ, Ahmed A, Hassan M, Jawed R, Akram M, Rasheed U, Memon GM, Ahmed MU, Tahniyat U, Tirmizi SB. Hematological parameters predicting severity and mortality in COVID-19 patients of Pakistan: a retrospective comparative analysis. J Community Hosp Intern Med Perspect. 2020 Oct 29;10(6):514-520. doi: 10.1080/20009666.2020.1816276.

Parimoo A, Biswas A, Baitha U, Gupta G, Pandey S, Ranjan P, Gupta V, Barman Roy D, Prakash B, Wig N. Dynamics of Inflammatory Markers in Predicting Mortality in COVID-19. Cureus. 2021 Oct 27;13(10):e19080. doi: 10.7759/cureus.19080

Şan İ, Gemcioğlu E, Davutoğlu M, Çatalbaş R, Karabuğa B, Kaptan E, Erden A, Küçükşahin O, Ateş İ, Karaahmetoğlu S, Hasanoğlu İ, İnan O, Ünal BN, Erdemir E, Kahraman FA, Güner R. Which hematological markers have predictive value as early indicators of severe COVID-19 cases in the emergency department? Turk J Med Sci. 2021 Dec 13;51(6):2810-2821. doi: 10.3906/sag-2008-6.

Barrett B, Pamphile S, Yang F, Naeem F, Kim J, Annam J, Borczuk R, Yellin S, Bass C, Fowler S, Mosheyev M, Mayer YJ, Friedman BW. Inflammatory markers are poorly predictive of clinical outcomes among hospitalized patients with COVID-19. Am J Emerg Med. 2021 Aug;46:595-598. doi: 10.1016/j.ajem.2020.11.038.

Luo X, Zhou W, Yan X, Guo T, Wang B, Xia H, Ye L, Xiong J, Jiang Z, Liu Y, Zhang B, Yang W. Prognostic Value of C-Reactive Protein in Patients With Coronavirus 2019. Clin Infect Dis. 2020 Nov 19;71(16):2174-2179. doi: 10.1093/cid/ciaa641

Li Y, Hu Y, Yu J, Ma T. Retrospective analysis of laboratory testing in 54 patients with severe- or critical-type 2019 novel coronavirus pneumonia. Lab Invest. 2020 Jun;100(6):794-800. doi: 10.1038/s41374-020-0431-6

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Copyright (c) 2023 Aziz-Un-Nisa, Dur Muhammad, Sultan Zaib, Ibrahim Khan, Imran Zaib, Shehrish Saleem