An overview of the diagnostic and prognostic values of biochemical markers in patients with COVID-19

Authors

DOI:

https://doi.org/10.15584/ejcem.2025.3.9

Keywords:

COVID-19 biomarkers, D-dimer, lactate dehydrogenase, liver enzymes

Abstract

Introduction and aim. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a global pandemic that disrupts both public health operations and financial structures throughout the world. This article aims to evaluate the relationship between the severity of coronavirus disease 2019 (COVID-19) and its alterations in specific biomarkers such as D-dimer and C-reactive protein (CRP) together with alanine transaminase (ALT), aspartate aminotransferase (AST) and lactate dehydrogenase (LDH).

Material and methods. Participants in this study were split into two groups consisting of 200 COVID-19 patients and 200 healthy controls ranging from 18 to 80 years old. Polymerase chain reaction and chest radiograph examinations were used to officially verify the participant’s diagnosis. This study used Mann-Whitney U tests combined with logistic regression and receiver operating characteristic (ROC) curves to identify and determine their value as diagnostic tools and prognostic indicators.

Results. D-dimer and CRP along with ALT, AST, and LDH demonstrated significant and elevated levels in COVID-19 infected participants when analyzed against control participants (p<0.0001). D-dimer emerged as a diagnostic biomarker according to ROC analysis with an AUC value of 0.96 and a p-value<0.001 which signified its quality for the evaluation of the severity of the disease. The additional biomarkers AST and LDH received AUC scores of 0.79 and 0.76, respectively,,with ALT reaching an AUC value of 0.74.

Conclusion. The combination of the biochemical markers D-dimer, AST, and LDH significantly improves risk assessment while enhancing predictions about disease outcomes. These biomarkers provide vital data for early disease detection in combination with disease progression through tracking patient outcomes and therapeutic planning assessments.

Downloads

Download data is not yet available.

References

Atzrodt CL, Maknojia I, McCarthy RDP, et al. A Guide to COVID-19: a global pandemic caused by the novel coronavirus SARS-CoV-2. The FEBS J. 2020;287(17):3633-3650. doi: 10.1111/febs.15375

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

Duffy MJ, Harbeck N, Nap M, et al. Clinical use of biomarkers in breast cancer: Updated guidelines from the European Group on Tumor Markers (EGTM). Eur J Cancer. 2017;75:284-298. doi: 10.1016/j.ejca.2017.01.017

Xiang J, Wen J, Yuan X, et al. Potential biochemical markers to identify severe cases among COVID-19 patients. MedR-xiv. 2020;2020:1-10. doi: 10.1101/2020.03.19.20034447

Ali ET, Sajid Jabbar A, Al Ali HS, Shaheen Hamadi S, Jabir MS, Albukhaty S. Extensive Study on Hematological, Immunological, Inflammatory Markers, and Biochemical Profile to Identify the Risk Factors in COVID-19 Patients. Li JD, ed. Int J Inflamm. 2022;2022:1-11. doi: 10.1155/2022/5735546

Alam MT, Mehdi A, Timsaal Y, et al. The clinical course, biochemical markers, and clinical outcomes of COVID-19 positive patients from the third wave in Pakistan: A retrospective cohort study. Ann Med Surg. 2022;77:1-8. doi: 10.1016/j.amsu.2022.103599

Ponti G, Maccaferri M, Ruini C, Tomasi A, Ozben T. Biomarkers associated with COVID-19 disease progression. Crit Rev Clin Lab Sci. 2020;57(6):389-399. doi: 10.1080/10408363.2020.1770685

Henry BM, De Oliveira MHS, Benoit S, et al. Hematologic, biochemical and immune biomarker abnormalities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a meta-analysis. Clin Chem Lab Med. 2020;58(7):1021-1028. doi: 10.1515/cclm-2020-0369.

Kermali M, Khalsa RK, Pillai K, Ismail Z, Harky A. The role of biomarkers in diagnosis of COVID-19-A systematic review. Life Sci. 2020;254:1-12. doi: 10.1016/j.lfs.2020.117788.

Ullah W, Thalambedu N, Haq S, et al. Predictability of CRP and D-Dimer levels for in-hospital outcomes and mortality of COVID-19. J Community Hosp Intern Med Perspect. 2020;10(5):402-408. doi: 10.1080/20009666.2020.1798141

Lv Y, Zhao X, Wang Y, et al. Abnormal liver function tests were associated with adverse clinical outcomes: an observational cohort study of 2,912 patients with covid-19. Front Med. 2021;8:1-22. doi: 10.3389/fmed.2021.639855.

Poggiali E, Zaino D, Immovilli P, et al. Lactate dehydrogenase and C-reactive protein as predictors of respiratory failure in CoVID-19 patients. Clin Chim Acta. 2020;509:135-138. doi: 10.1016/j.cca.2020.06.012

Kadhim AS, Abdullah YJ. Serum levels of interleukin-6, ferritin, C-reactive protein, lactate dehydrogenase, D-dimer, and count of lymphocytes and neutrophils in CO-VID-19 patients: Its correlation to the disease severity. Biomed Biotechnol Res J. 2021;5(1):69-73. doi 10.4103/bbrj.bbrj_188_20

Ye L, Chen B, Wang Y, et al. Prognostic value of liver biochemical parameters for COVID-19 mortality. Ann Hepat. 2021;21:1-14. doi: 10.1016/j.aohep.2020.10.007

Cohen J. Statistical power analysis. Curr Dir Psychol Sci. 1992;1(3):98-101. doi: 10.1111/1467-8721.ep10768783

Kang H. Sample Size Determination and Power Analysis Using the G*Power Software. J Educ Eval Health Prof. 2021;18(17):17-29. doi: 10.3352/jeehp.2021.18.17

Erben Y, Franco-Mesa C, Gloviczki P, et al. Deep vein thrombosis and pulmonary embolism among hospitalized coronavirus disease 2019-positive patients predicted for higher mortality and prolonged intensive care unit and hospital stays in a multisite healthcare system. J Vasc Surg Venous Lymphat Disord. 2021;9(6):1361-1370. doi: 10.1016/j.jvsv.2021.03.009

Magaña M, Bercovitch R, Fedullo P. Diagnostic Approach to Deep Venous Thrombosis and Pulmonary Embolism in the Critical Care Setting. Crit Care Clin. 2011;27(4):841-867. doi: 10.1016/j.ccc.2011.08.003

Bloom PP, Meyerowitz EA, Reinus Z, et al. Liver Bioche-mistries in Hospitalized Patients With COVID‐19. Hepatol. 2020;73(3):890-900. doi: 10.1002/hep.31326

Pourfathi M, Kadlecek SJ, Chatterjee S, Rizi RR. Metabolic Imaging and Biological Assessment: Platforms to Evaluate Acute Lung Injury and Inflammation. Front Physiol. 2020;11:937-951. doi: 10.3389/fphys.2020.00937

Gemmati D, Bramanti B, Serino ML, Secchiero P, Zauli G, Tisato V. COVID-19 and Individual Genetic Susceptibility/Receptivity: Role of ACE1/ACE2 Genes, Immunity, Inflammation and Coagulation. Might the Double X-Chromosome in Females Be Protective against SARS-CoV-2 Compared to the Single X-Chromosome in Males?. Int J Mol Sci. 2020;21(10):3474-3497. doi: 10.3390/ijms21103474

Hu W, Wang X, Yang R. Evaluation of D-dimer and lactate dehydrogenase plasma levels in patients with relapsed acute leukemia. Oncol Lett. 2016;12(1):591-596. doi: 10.3892/ol.2016.4657

Downloads

Published

2025-09-30

How to Cite

Almnaseer, Z. A., Mohammed, A. N., Al-Badran, I. M., Jaddoa, H., & Hussein, W. N. (2025). An overview of the diagnostic and prognostic values of biochemical markers in patients with COVID-19. European Journal of Clinical and Experimental Medicine, 23(3), 589–595. https://doi.org/10.15584/ejcem.2025.3.9

Issue

Section

ORIGINAL PAPERS