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Demographics, Laboratory Parameters and Outcomes of 1061 Patients with COVID-19: a Report from Tehran, Iran

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Journal Pre-proof Demographics, laboratory parameters and outcomes of 1061 patients with COVID-19: A report from Tehran, Iran Mihan Pourabdollah Toutkaboni, Elham Askari, Nastaran Khalili, Payam Tabarsi, Hamidreza Jamaati, Ali Akbar Velayati, Atosa Dorudinia, Mitrasadat Rezaei, Seyed Alireza Nadji, Abdolreza Mohamadnia, Neda Khalili PII: S2052-2975(20)30129-3 DOI: https://doi.org/10.1016/j.nmni.2020.100777 Reference: NMNI 100777 To appear in: New Microbes and New Infections Received Date: 17 June 2020 Revised Date: 27 September 2020 Accepted Date: 29 September 2020 Please cite this article as: Toutkaboni MP, Askari E, Khalili N, Tabarsi P, Jamaati H, Velayati AA, Dorudinia A, Rezaei M, Nadji SA, Mohamadnia A, Khalili N, Demographics, laboratory parameters and outcomes of 1061 patients with COVID-19: A report from Tehran, Iran, New Microbes and New Infections, https://doi.org/10.1016/j.nmni.2020.100777. This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. © 2020 Published by Elsevier Ltd. Demographics, laboratory parameters and outcomes of 1061 patients with COVID-19: A report from Tehran, Iran Running Title: Characteristics of COVID-19 in Iran Mihan Pourabdollah Toutkaboni 1, Elham Askari 1*, Nastaran Khalili 2,3 , Payam Tabarsi 4, Hamidreza Jamaati 1, Ali Akbar Velayati 5, Atosa Dorudinia 1, Mitrasadat Rezaei 6, Seyed Alireza Nadji 6, Abdolreza Mohamadnia 1, Neda Khalili 2,3 * 1 Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 2 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran 3 Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran 4 Clinical TB and epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 5 Mycobacteriology Research Center (MRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 6 Virology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid BeheshtiJournal University of Medical Pre-proof Sciences, Tehran, Iran *Corresponding authors: Elham Askari, MD Assistant Professor of Pathology, Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Email: [email protected]; Tel: +98 2127123000; Fax: +98 2126109680 Neda Khalili, MD, MPH School of Medicine, Tehran University of Medical Sciences, Tehran, Iran Email: [email protected]; Tel: +98 2166405357; Fax: +98 2188953003 Journal Pre-proof 1 Demographics, laboratory parameters and outcomes of 1061 patients with 2 COVID-19: A report from Tehran, Iran 3 Abstract 4 We aimed to determine the characteristics of coronavirus disease-2019 among the Iranian 5 population. In this study, we collected and analyzed the demographics, laboratory findings and 6 outcomes of patients with COVID-19 who were admitted to Masih Daneshvari Hospital in 7 Tehran, Iran between February 20, 2020 and April 2, 2020. Of 1061 patients, the median age was 8 55 years (interquartile range [IQR], 44-66 years) and 692 (65.2%) were male. Among these, 129 9 (12.2%) patients died at some point during hospitalization in the ward or intensive care unit 10 (ICU). From the remaining 932 survivors, 46 (5.0%) patients were admitted to the ICU and 886 11 (95.0%) patients were hospitalized in the ward. Patients who died were significantly older than 12 those hospitalized in the ward (p<0.001). The median absolute number of lymphocytes was 1.2 × 13 10 3 per microliter (IQR, 0.9-1.6 × 10 3 per microliter) and 708 (66.7%) patients had lymphopenia 14 (absolute lymphocyte count <1500 per microliter). Among the laboratory tests, D-dimer, serum 15 ferritin and albumin hadJournal the strongest correlation Pre-proof with mortality (r = 0.455, r = 0.412, r = -0.406, 16 respectively; p-values <0.001). Conclusively, laboratory findings could provide useful 17 information in regard to the management of patients with COVID-19. 18 19 Keywords: COVID-19; coronavirus disease 2019; laboratory; lymphocyte; Iran 20 21 1 22 Introduction 23 In December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 24 identified in Wuhan City, Hubei province, China (1). The disease caused by this highly 25 contagious viral pathogen, which was later named as the novel coronavirus disease 2019 26 (COVID-19) by the World Health Organization (WHO), spread rapidly to other countries, 27 including Iran, South Korea, and Italy. As of May 13, 2020, 188 countries have reported 28 confirmed cases of COVID-19 with more than 293,241 deaths having occurred worldwide (2). 29 Patients infected with this novel betacoronavirus mostly manifest with fever, cough, dyspnea, 30 headache and fatigue (3, 4). In a minority of patients, SARS-CoV-2-associated pneumonia can 31 lead to severe complications such as, acute respiratory distress syndrome, multiple organ failure 32 and even death (3-6). 33 According to literature, patients with COVID-19 are prone to developing lymphopenia, increased 34 neutrophil count and thrombocytopenia (4, 7, 8). More recently, neutrophil-to-lymphocyte ratio 35 (NLR) and platelet-to-lymphocyte ratio (PLR) were proposed as potential predictors of mortality 36 in confirmed cases of COVID-19 (9-11). Higher levels of infection-related markers, including C- 37 reactive protein (CRP),Journal erythrocyte sedimentation Pre-proof rate (ESR), D-dimer, serum ferritin, and 38 proinflammatory cytokines (IL-6, IL1B, IFNγ, TNF α) have also been suggested as markers of 39 disease progression in several studies (12-14). 40 The vast majority of studies describing the demographics and clinical characteristics, as well as 41 the laboratory findings of patients with COVID-19 are from Mainland China (3-6). Although 42 Iran is one of the countries greatly affected by this novel coronavirus, to date information on the 43 laboratory findings of COVID-19 infection among Iranian patients is scarce. Herein, we report 2 44 the demographic and laboratory data of 1061 patients who were admitted to a specifically 45 designated hospital for COVID-19 in Tehran, Iran. 46 Materials and Methods 47 Study design and participants 48 This retrospective study was conducted on 1061 patients with suspected COVID-19 who were 49 admitted to Masih Daneshvari Hospital, Tehran, Iran between February 20, 2020 and April 2, 50 2020. This hospital was the first and largest hospital that was specifically designated for the 51 hospitalization of patients with suspected COVID-19 in Tehran. All cases who tested positive for 52 SARS-CoV-2 by real-time reverse transcriptase polymerase chain reaction (RT-PCR) or those 53 suspected with COVID-19 infection based on characteristic clinical symptoms and chest 54 computed tomography (CT) findings, were included in this study. Demographic data including 55 age, sex, date of admission, and laboratory findings were collected from patients’ electronic 56 medical records. One researcher reviewed the data collection forms for quality control. No age 57 limitation was considered in our study; however, approximately all included patients were adults. 58 Final follow-up date wasJournal May 1, 2020. Patients Pre-proofwere divided into three main groups: patients 59 who were admitted to the ward, patients who were admitted to the intensive care unit (ICU) and 60 those who died until follow-up. It should be noted that patients who had died by the end of final 61 follow-up but had also received care in the ICU/ward during hospitalization were included in the 62 ‘expired’ group, and all the patients in the ‘ward’ and ‘ICU’ groups had survived until final 63 follow-up date. This study was approved by the ethics committee of Shahid Beheshti University 64 of Medical Sciences and written informed consent was obtained from all patients prior to 65 enrollment in the study. 3 66 Laboratory tests 67 Laboratory tests were taken based on the hospital protocol for COVID-19 management. These 68 assessments included complete blood count (CBC), coagulation tests [prothrombin time (PT), 69 international normalized ratio (INR), partial thromboplastin time (PTT)], serum total protein, 70 serum albumin, lactate dehydrogenase (LDH), C-reactive protein (CRP), serum ferritin 71 (measured by ELISA), cardiac troponin I, erythrocyte sedimentation rate (ESR), D-dimer, 25- 72 OH-VitD3, interleukin-6 (IL-6), blood urea, creatinine, aspartate aminotransferase (AST), and 73 alanine aminotransferase (ALT). In addition, RT-PCR assay was performed on nasopharyngeal 74 specimens for SARS-CoV-2 detection in all patients with Taqman® Premix TAKARA (TaKaRa, 75 Dalian, China) considering the protocols provided by the manufacturer. In patients with 76 laboratory examinations
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