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Introduction: The Coronavirus Disease 2019 (COVID-19) infection has experienced three peaks in India, with possibilities of reinfections and future peaks. A comprehensive understanding of the disease, particularly in terms of inflammatory markers, is crucial. Neutrophil-to-Lymphocyte Ratio (NLR) and C-Reactive Protein (CRP) have been established as markers of disease severity in COVID-19 during the first wave, but limited data exists regarding these markers in the second and third waves. Aim: This study aims to investigate the association between baseline levels of CRP and NLR with disease severity and mortality among COVID-19 patients in three waves. Materials and Methods: A cross-sectional study was conducted at a tertiary care hospital in Bangalore from March 2020 to March 2022. The study included clinical data from 1485 patients with COVID-19. CRP and NLR levels were measured on the day of hospital visit, and their association with severity and mortality was assessed. Continuous variables were compared using independent t-test, one-way analysis of variance (ANOVA), or Kruskal-Wallis test as appropriate. Categorical variables were compared using the Chi-square test. Results: Wave 1 demonstrated a significant increase in CRP and NLR values among patients with critical illness (mean±SD: 11.96±11.9, 12.41±13.7) compared to other categories. The values of these two parameters in other categories of wave 1 were as follows: asymptomatic (2.28±6.0, 3.17±2.0), mild (1.67±3.4, 2.41±2.7), moderate (1.07±1.7, 3.71±2.4), and severe (6.47±7.2, 4.39±4.3). In wave 2, critical illness (10.52±8.9 and 10.73±7.8) showed elevated values compared to other categories (0.957±1.1, 2.61±1.7), (4.90±5.9, 4.27±4.1), (4.84±4.8, 4.03±2.4), (7.35±6.7, 7.10±6.7). In wave 3, the two parameters in critical cases (15.0±17.3 and 16.47±7.6) were elevated compared to other categories (3.67±2.9, 16.44±10.3), (3.3 and 13.9), (3.7±5.9, 19.10±1.6). Conclusion: CRP and NLR were found to be useful early markers for assessing disease severity and mortality in COVID19 patients across all three waves.

Introduction: Coronavirus disease 2019 (COVID-19) was was a global pandemic outbreak that emerged in three waves of varying severity. The inflammatory markers can be used to identify the transition of severity of the disease from a mild to severe or critical illness and also to predict the mortality. To improve clinical outcomes, continuous monitoring of these biomarkers in hospitalised patients is essential. Aim: To compare the serum C-Reactive Protein (CRP), Lactate Dehydrogenase (LDH), serum ferritin and D-Dimer as a predictor of severity and mortality in hospitalised patients in different clinical categories during three waves of COVID-19 . Materials and Methods: This retrospective study was conducted at Vydehi Institute of Medical Sciences and Research Centre, Karnataka. A total of 6189 patient’s data were retrieved from medical record section with confirmed cases of COVID-19 admitted during the three waves of COVID-19. The results of four inflammatory marker on the day of admission were analysed in mild, moderate, severe and critically ill patients and compared with disease severity, survival and death and also assessed the difference between first, second, and third wave of COVID-19 for sensitivity and specificity. Data was analysed by Chi-square test, Mann Whitney U test, ANOVA (Analysis of Variance), and Kruskal Wallis test and Receiver Operating Curve (ROC). Results: The median age of patients in the mild category was found to be younger in all three waves compared to those in the severe and critically ill categories. In terms of gender distribution, males were more prevalent than females. Inflammatory markers were significantly increased in all three waves in the severe and critically ill categories. The median CRP (mg/dL) values were significantly increased in the critically ill in wave three compared to waves one and two. The median values of LDH IU/L significantly increased in critically ill patients in the second wave. The median values of ferritin increased significantly in wave one. The D-dimer values significantly increased in the critically ill category in wave three. Conclusion: Before proceeding on to a specific diagnosis by RT-PCR, a combination of standard laboratory markers (CRP, LDH, and Ferritin D-Dimer) could accurately and reliably predict the diagnosis of COVID-19 with established sensitivity and specificity.