Effects of comorbidities on COVID-19 biomarkers: a retrospective study

Authors

  • Pradnya M. Bagalkote Department of Home Science, Dharampeth M. P. Deo Memorial Science College, Nagpur, Maharashtra, India
  • Rekha S. Sharma UGC-Malviya Mission Teacher Training Centre, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur, Maharashtra, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20260008

Keywords:

COVID-19 biomarkers, D-dimer, Ferritin, C-reactive protein, Lactate dehydrogenase, Comorbidity

Abstract

Background: This retrospective investigation aimed to assess the effects of comorbidities on COVID-19 biomarkers at admission and during the post-discharge recovery period.

Methods: A total of 369 confirmed and hospitalized COVID-19 patients were included in this study. Biomarkers including D-dimer, ferritin, C-reactive protein (CRP), and lactate dehydrogenase (LDH) were recorded at three time points: hospital admission, 15 days post-discharge, and 30 days post-discharge. Data were retrieved from hospital records, and comorbidities were classified using the Charlson comorbidity index (CCI). Study design was retrospective cohort study

Results: About 44.87% of patients had diabetes as a pre-existing comorbidity, followed by hypertension (HTN) (27.07%) and cardiovascular disease (CVD) (25.78%). About 79.95% patients had diabetes mellitus (DM)+CVD+HTN.  The age (p=0.108) and gender (p=0.481) showed an insignificant association with the comorbidity of COVID-19 patients. The patients with diabetes as a comorbidity showed the highest levels of D-dimer, Ferritin and LDH, while patients with CVD showed the highest levels of CRP. The mean D dimer, ferritin and CRP levels at admission and after 15- and 30-days post-discharge did not differ significantly (p>0.05) with respect to comorbidities. However, the mean LDH differ significantly (p=0.00) for patients with diabetes and other comorbidities at admission and 15 days post-discharge.

Conclusions: The mean levels of COVID-19 biomarkers-D-dimer, ferritin, and CRP-measured at admission and at 15- and 30-days post-discharge showed no significant differences across comorbidity groups. In contrast, LDH levels at two time points differed significantly with respect to comorbidity. This significant variation in LDH suggests that it may serve as a useful indicator for assessing disease severity in patients with comorbid conditions.

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References

Singh MK, Mobeen A, Chandra A, Joshi S, Ramachandran S. A meta-analysis of comorbidities in COVID-19: Which diseases increase the susceptibility of SARS-CoV-2 infection? Comput Biol Med. 2021;130:104219. DOI: https://doi.org/10.1016/j.compbiomed.2021.104219

Chen N, Zhou M, Dong X, Jieming Q, Fengyun G, Yang H, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13. DOI: https://doi.org/10.1016/S0140-6736(20)30211-7

Guan WJ, Liang WH, Zhao Y, Heng-Rui L, Zi-Sheng C, Yi-Min L, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a-nationwide-analysis. Eur Respir J. 2020;55(5):2000547.

Yan H, Vijay A, Jiang F, Nanhong Z, Yaoren H, Honghua Y, et al. Serum glucose, lactate dehydrogenase and hypertension are mediators of the effect of body mass index on severity of COVID-19. Endocrinol Diabetes Metab. 2021;4(2):e00215. DOI: https://doi.org/10.1002/edm2.215

Dolan ME, Hill DP, Mukherjee G. Investigation of COVID-19 comorbidities reveals genes and pathways coincident with the SARS-CoV-2 viral disease. Preprint. bioRxiv. 2020;09.21.306720. DOI: https://doi.org/10.1101/2020.09.21.306720

Lau EH, Hsiung CA, Cowling BJ. A comparative epidemiologic analysis of SARS in Hong Kong, Beijing and Taiwan. BMC Infect Dis. 2010;10:50. DOI: https://doi.org/10.1186/1471-2334-10-50

Charlson ME, Pompei P, Ales KL. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373-83. DOI: https://doi.org/10.1016/0021-9681(87)90171-8

Abi-Ayad B, Mohammed B, Mohammed B, Souad G, Ikram M, Amel M, Rachid M, et al. The effect of inflammatory biomarkers on COVID-19 patients with diabetes and comorbidities. Roman J Diabetes Nutrit Metabolic Dis. 2024;31(3):337-46.

Adab P, Haroon S, O'Hara ME, Jordan RE. Comorbidities and COVID-19. BMJ. 2022;377:O1431. DOI: https://doi.org/10.1136/bmj.o1431

Sanyaolu A, Okorie C, Marinkovic A, Risha P, Kokab Y, Priyank D, et al. Comorbidity and Its Impact on Patients with COVID-19. SN Compr Clin Med. 2020;2(8):1069-76. DOI: https://doi.org/10.1007/s42399-020-00363-4

Argun Bariş S, Boyacı H, Akhan S, Mutlu B, Deniz M, Başyiğit İ, et al. Charlson Comorbidity Index in Predicting Poor Clinical Outcomes and Mortality in Patients with COVID19. Turk Thoracic J. 2022;23(2),145-53. DOI: https://doi.org/10.5152/TurkThoracJ.2022.21076

Guan WJ, Liang WH, Zhao Y, Heng-Rui L, Zi-Sheng C, Yi-Min L, et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a-nationwide-analysis. Eur Respir J. 2020;55(5):2000547. DOI: https://doi.org/10.1183/13993003.01227-2020

Grasselli G, Greco M, Zanella A, Giovanni A, Massimo A, Giacomo B, et al. Risk Factors Associated With Mortality Among Patients With COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern Med. 2020;180(10):1345-55. DOI: https://doi.org/10.1001/jamainternmed.2020.3539

Atkins JL, Masoli JAH, Delgado J, Luke CP, Chia-Ling K, George AK, et al. Preexisting Comorbidities Predicting COVID-19 and Mortality in the UK Biobank Community Cohort. J Gerontol A Biol Sci Med Sci. 2020;75(11):2224-30. DOI: https://doi.org/10.1093/gerona/glaa183

Reilev M, Kristensen KB, Pottegård A, Lars CL, Jesper H, Martin TE, et al. Characteristics and predictors of hospitalization and death in the first 11 122 cases with a positive RT-PCR test for SARS-CoV-2 in Denmark: a nationwide cohort. Int J Epidemiol. 2020;49(5):1468-81. DOI: https://doi.org/10.1093/ije/dyaa140

Richardson S, Hirsch JS, Narasimhan M, James MC, Thomas McG, Karina WD, et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020;323(20):2052-9. DOI: https://doi.org/10.1001/jama.2020.6775

Iaccarino G, Grassi G, Borghi C, Claudio F, Massimo S, Massimo V, et al. Age and Multimorbidity Predict Death Among COVID-19 Patients: Results of the SARS-RAS Study of the Italian Society of Hypertension. Hypertension. 2020;76(2):366-72. DOI: https://doi.org/10.1161/HYPERTENSIONAHA.120.15324

Poblador-Plou B, Carmona-Pírez J, Ioakeim-Skoufa I, Poncel-Falcó A, Bliek-Bueno K, Cano-Del Pozo M, et al. Baseline Chronic Comorbidity and Mortality in Laboratory-Confirmed COVID-19 Cases: Results from the PRECOVID Study in Spain. Int J Environ Res Public Health. 2020;17(14):5171. DOI: https://doi.org/10.3390/ijerph17145171

Tartof SY, Qian L, Hong V, Rong W, Ron FN, Heidi F, et al. Obesity and Mortality Among Patients Diagnosed With COVID-19: Results from an Integrated Health Care Organization. Ann Intern Med. 2020;173(10):773-81. DOI: https://doi.org/10.7326/M20-3742

Tuty Kuswardhani RA, Henrina J, Pranata R, Anthonius Lim M, Lawrensia S, Suastika K, et al. Charlson comorbidity index and a composite of poor outcomes in COVID-19 patients: A systematic review and meta-analysis. Diabetes Metab Syndr. 2020;14(6):2103-9. DOI: https://doi.org/10.1016/j.dsx.2020.10.022

Swain CK, Rout HS. Gender and age group-wise inequality in health burden and value of premature death from COVID-19 in India. Aging Health Res. 2023;3(3):100151. DOI: https://doi.org/10.1016/j.ahr.2023.100151

Gebhard C, Regitz-Zagrosek V, Neuhauser HK, Rosemary M, Sabra LK. Impact of sex and gender on COVID-19 outcomes in Europe. Biol Sex Differ. 2020;11(1):29. DOI: https://doi.org/10.1186/s13293-020-00304-9

Smith T. A supercomputer analyzed COVID-19-and an interesting new theory has emerged. 2020. Elemental. Available at: https://elemental.medium.com/a-supercomputer-analyzed-covid-19-and-an-interesting-new-theory-has-emerged-31cb8eba9d63. Accessed on 15 June 2025.

Peckham H, de Gruijter NM, Raine C, Anna R, Coziana C, Lucy RW, et al. Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission. Nat Commu. 2020;11(1):6317. DOI: https://doi.org/10.1038/s41467-020-19741-6

Traish AM, Morgentaler A. What’s testosterone got to do with it? A critical assessment of the contribution of testosterone to gender disparities in COVID-19 infections and deaths. Androgens Clin Res Therapeut. 2021;2(1):1810. DOI: https://doi.org/10.1089/andro.2020.0012

Abid A, Umar A, Qamar S. Disease Outcomes of COVID-19 in Diabetic and Hypertensive Patients During the Hospital Stay. Cureus 2023;15(10):e46943. DOI: https://doi.org/10.7759/cureus.46943

Assiri RA, Bepari A, Patel W, Syed AH, Shaik KN, Asma Al, et al. Exploration of Sex and Age-Based Associations in Clinical Characteristics, Predictors of Severity, and Duration of Stay among COVID-19 Patients at the University Hospital of Saudi Arabia. Healthcare (Basel). 2023;11(5):751. DOI: https://doi.org/10.3390/healthcare11050751

Endeshaw Y, Campbell K. Advanced age, comorbidity and the risk of mortality in COVID-19 infection. Natl Med Assoc. 2022;114(5):512-7. DOI: https://doi.org/10.1016/j.jnma.2022.06.005

Huang S, Wang J, Liu F, Liu J, Cao G, Yang C, et al. COVID-19 patients with hypertension have more severe disease: a multicenter retrospective observational study. Hypertension Res. 2020;43(8):824-31. DOI: https://doi.org/10.1038/s41440-020-0485-2

Elemam NM, Hannawi H, Salmi IA, Naeem KB, Alokaily F, Hannawi S, et al. Diabetes mellitus as a comorbidity in COVID-19 infection in the United Arab Emirates. Saudi Med J. 2021;42(2):170-80. DOI: https://doi.org/10.15537/smj.2021.2.25700

Wang X, Tang N, Li D, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020;18(4):844-7. DOI: https://doi.org/10.1111/jth.14768

Hashim IEI, Kamal AMH, Adam EME, Seri I. Comparison between D-dimer levels in diabetic and non-diabetic positive COVID-19 adult patients: A hospital-based study. Endocrinol Diabetes-Meta. 2022;5(4):e349. DOI: https://doi.org/10.1002/edm2.349

Simes J, Robledo KP, White HD, David E, Ralph AS, David RS, et al. D-Dimer Predicts Long-Term Cause-Specific Mortality, Cardiovascular Events, and Cancer in Patients with Stable Coronary Heart Disease: LIPID Study. Circulation. 2018;138(7):712-23. DOI: https://doi.org/10.1161/CIRCULATIONAHA.117.029901

Cheng L, Li H, Li L, Liu C, Yan S, Chen H, et al. Ferritin in the coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. J Clin Lab Anal. 2020;34(10):e23618. DOI: https://doi.org/10.1002/jcla.23618

Yang F, Shi S, Zhu J, Shi J, Dai K, Chen X, et al. Clinical characteristics and outcomes of cancer patients with COVID-19. J Med Virol. 2020;92(10):2067-73. DOI: https://doi.org/10.1002/jmv.25972

Sheu WH, Chen YT, Lee WJ, Chen-Wen W, Lih-Yuan L. A relationship between serum ferritin and the insulin resistance syndrome is present in non-diabetic women but not in non-diabetic men. Clin Endocrinol (Oxf). 2003;58(3):380-5. DOI: https://doi.org/10.1046/j.1365-2265.2003.01729.x

Rajpathak SN, Wylie-Rosett J, Gunter MJ, Negassa A, Kabat GC, Rohan TE, et al. Biomarkers of body iron stores and risk of developing type 2 diabetes. Diabetes Obes Metab. 2009;11(5):472-9. DOI: https://doi.org/10.1111/j.1463-1326.2008.00985.x

Marnell L, Mold C, Du Clos TW. C-reactive protein: ligands, receptors and role in inflammation. Clin Immunol. 2005;117(2):104-11. DOI: https://doi.org/10.1016/j.clim.2005.08.004

Fachri M, Hatta M, Widowati E, Risky A, Ressy D, Ahmad S, et al. Correlations between comorbidities, chest X-ray findings, and C-Reactive protein level in patients with COVID-19. Ann Med Surg. 2022;77:103553. DOI: https://doi.org/10.1016/j.amsu.2022.103553

Iskandar A, Mayashinta DK, Robert R, Samsu N, Endharti AT, Widjajanto E, et al. Correlation Between IL-8, C-Reactive Proteins (CRP) and Neutrophil to Lymphocyte Ratio (NLR) as Predictor of Mortality in COVID-19 Patients with Diabetes Mellitus Comorbidity. Int-J-Gen-Med. 2023;16:2349-54. DOI: https://doi.org/10.2147/IJGM.S412070

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Published

2026-01-09

How to Cite

Bagalkote, P. M., & Sharma, R. S. (2026). Effects of comorbidities on COVID-19 biomarkers: a retrospective study. International Journal of Advances in Medicine. https://doi.org/10.18203/2349-3933.ijam20260008

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Original Research Articles