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Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 5, 2021, Pages. 1023 - 1027 Received 15 April 2021; Accepted 05 May 2021.

Assessment of C-Reactive Protein and Lactate Dehydrogenase Levels in Patients Infected with COVID-19.

Safaa Abed Latef Al Meani 1 , Adnan Ali Hamad 2 , Ali Hazim Abdulkareem 1, Mohammed Mukhles Ahmed 1*, Reem Mahdi Salih3,

1Department of Biotechnology , College of Science , University of Anbar , Anbar , Iraq.

2 Iraqi Ministry of Education , Anbar Education Directorate , Anbar , Iraq.

2Department of Biology , College of Science , University of Anbar , Anbar , Iraq.

*Corresponding author. E mail: [email protected].

Abstract :

Corona virus is one of the serious dangerous viruses that infect the respiratory system, which pose a great threat in the Middle East, including Iraq, which lacks a significant decrease in health services as a result of the military operations and wars that have passed on this country. In view of the large increase in the rate of infections in Iraq, this study suggested an estimate C-reactive protien and LDH levels as primary parameters for early detection of Coronavirus. In this work , rate of infected males with COVID-19 is higher than females .All samples were identified by routine diagnosis method and molecular diagnosis using qPCR.

All study population (patients and control) were subjected to the evaluation of serum levels of CRP, and LDH. COVID‑ 19 patients showed a significant elevation in the levels of all parameters included in this study when compared with healthy controls. We also found that all of CRP, LDH are significantly associated with the severity of the COVID‑ 19 symptoms.

Key words : COVID-19 , LDH , C-ractive protien , Corona virus . Introduction :

Corona virus spreads rapidly to the rest of the world from its roots in Wuhan City, Hubei Province. Four corona viruses, namely HKU1, NL63, 229E and OC43, circulated in humans and usually caused mild respiratory disease. On December 2019, China reported the outbreak to the World Health Organization and closed the Huanan seafood market on January 1st[1].

Studies identified angiotensin receptor 2 (ACE2) as the receptor by which the virus reaches the respiratory mucosa figur1[2].

There is overwhelming evidence that elevated serum C-reactive protein (CRP), procalcitonin, D-Dimer,LDH, and hyperferritinemia are signs of hyper inflammation in critically ill patients. In addition, lymphopenia is closely linked to the severity of the disorder. The lymphocyte counts of patients who died from COVID19 are significantly lower than those of survivors. Other blood cells, such as neutrophils, eosinophils, platelets, and CD8+ cell counts, have been regarded as determinants in distinguishing mild from extreme COVID19, though their importance is still unknown[3]. According to figure 2 , there are many Theories on laboratory escape of existing COVID-19[4]. This research aimed to determine C- reactive protien and LDH in COVID-19 patients .

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Methods Study Design :

Figure 1 : Role of ACE2 in corona virus replication cycle .

Figure2 : Development of pandemic Corona virus

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Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 5, 2021, Pages. 1023 - 1027 Received 15 April 2021; Accepted 05 May 2021.

ages and sexes were included in this study as a control group. All of the patients and healthy persons were subjected to the estimation of serum D‑Dimer, lactate dehydrogenase (LDH), and CRP .

Samples collection :

Five ml of venous blood is collected from the study groups and healthy control. Blood samples was centrifuged to obtain serum which is used for the determination of serum concentration of LDH, and CRP.

Diagnosis of COVID-19 patients :

COVID-19 viruses was identified using qPCR and the antisera titer of IgG/IgM was estimated using Rapid test.

Determination of serum D‑ dimer and C‑ reactive protein :

Serum concentrations of LDH and CRP were evaluated using a specific automated protein analyzer (PA120) provided by (Shenzhen Genius Electronics Co., Ltd. China 2019). Serum samples for each of the patients and healthy persons were applied to the instrument then the concentrations of LDH and CRP are calculated automatically.

Statistics

The results of the current study are analyzed using (graph pad prism 8.0) to find the variation in the results of the study. Statistical significance was defined as a (P < 0.05). Statistical tests such as (paired t‑ test, percentage) were used for data analysis.

Results and discussion : Gender and infection :

In the current study, which is conducted in Anbar city, appeared that 57% of the COVID- 19infected women and 40% for men figure 3. Previous studied reported that male’s percentage of infection were higher than females and reached (56%) in Italy, (52%) in Germany, (53%) in France, (50%) in Spain, and (51%) in Canada[5]. Another study conducted by Safaa and his worker documented that the infected male with covid-19 was higher than females [6], [7].

Females and males have a variable response to viral infection such as SARS CoV, CoV, SARS CoV2, and other viruses. These differences lead to disease severity and incidence between both genders. Multiple factors lead to gender-specific disease outcomes following viral infections. Sex-specific steroids and X-linked gene activity, both modulating innate and adaptive immune response to virus infection, affect immune response[8]. In addition, the differences in the expression of angiotensin-converting enzyme (ACE) 2 receptor and cellular serine protease TMPRSS2, essential for binding and priming SARS CoV2, may play an important role. We also believe that increased stress and domestic work during the pandemic, especially in Iraq, may also affect women's immune system capabilities against COVID- 19[9].

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C-reactive protien and LDH:

According to table 1 , There is a strong significant increase in the levels of CRP, and LDH in COVID‑ 19 patients.

Table1 : The statistical relationship of CRP and LDH.

Parameters Patients Control P-value

Mean ± Standard deviation

C-reactive protein 133.2±79.1 4.52±1.87 0.01

LDH 533±93 132±57 0.01

LDH is a cytoplasmic glycolytic enzyme used in almost all tissues. Its elevation, in general, indicates tissue damage. Increased LDH was a common finding in MERSCoV infected patients [10]. For patients with severe acute respiratory syndrome, separate mortality factors have been reported [11] and H1N1 infection[12] . Previous studied reported that increasing LDH in severe COVID‐ 19 cases suggested possible subclinical tissue injury. Since the virus binds to the human ACE2 receptor in the lungs, which explains why the lungs are the first affected organs, various cytokine defects and multiple organ dysfunction can be found in severe patients as the disease progresses [13] , [3] [14].

CRP levels were elevated in COVID19 patients, and it was discovered that survivors had a median CRP of approximately 40 mg/L, whereas non survivors had a median CRP of (125 mg/L), implying a strong connection between disease severity and prognosis[10] , [15] , [16]

.

Figure 3 : Distribution of corona virus according to gender

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Annals of R.S.C.B., ISSN:1583-6258, Vol. 25, Issue 5, 2021, Pages. 1023 - 1027 Received 15 April 2021; Accepted 05 May 2021.

Conclusion :

In contrast to previous research, this current study discovered that females could have a low risk of contracting COVID-19. Infection with COVID19 results in a substantial increase in CRP and LDH levels. These distinctions were found to be significantly correlated with disease severity and progression, implying the utility of certain clinical markers in identifying serious illnesses. Both C-Reactive Protein and Lactate Dehydrogenase are biomarkers for detecting Coronavirus.

References :

[1] D. Kumar, R. Malviya, and P. K. Sharma, “Corona virus: a review of COVID-19,” EJMO, vol. 4, no.

1, pp. 8–25, 2020.

[2] R. M. Touyz, H. Li, and C. Delles, “ACE2 the Janus-faced protein–from cardiovascular protection to severe acute respiratory syndrome-coronavirus and COVID-19,” Clin. Sci., vol. 134, no. 7, pp. 747–

750, 2020.

[3] A. S. Kadhim and Y. J. Abdullah, “Serum levels of interleukin-6, ferritin, C-reactive protein, lactate dehydrogenase, D-dimer, and count of lymphocytes and neutrophils in COVID-19 patients: Its correlation to the disease severity,” Biomed. Biotechnol. Res. J., vol. 5, no. 1, p. 69, 2021.

[4] A. Banerjee, A. C. Doxey, K. Mossman, and A. T. Irving, “Unravelling the zoonotic origin and transmission of SARS-CoV-2,” Trends Ecol. Evol., 2020.

[5] C. Gebhard, V. Regitz-Zagrosek, H. K. Neuhauser, R. Morgan, and S. L. Klein, “Impact of sex and gender on COVID-19 outcomes in Europe,” Biol. Sex Differ., vol. 11, pp. 1–13, 2020.

[6] S. A. L. Al Meani, M. M. Ahmed, A. H. Abdulkareem, N. M. Hamid, and M. O. Ibrahim, “Effect of COVID-19 Virus on Biomass Index of Infected Patients,” Syst. Rev. Pharm., vol. 11, no. 9, pp. 1134–

1136, 2020.

[7] S. A. L. Al Meani, A. H. Abdulkareem, M. O. Ibrahim, M. M. Ahmed, and M. Y. Mukhlif,

“Assessment the Correlation of D-dimer and Ferritin Level in Patients Infected with Covid-19 in Anbar Governorate of Iraq,” Syst. Rev. Pharm., vol. 11, no. 9, pp. 1130–1133, 2020.

[8] J. Yang et al., “Prevalence of comorbidities in the novel Wuhan coronavirus (COVID-19) infection: a systematic review and meta-analysis,” Int J Infect Dis, vol. 10, 2020.

[9] L. Pala and F. Conforti, “Sex-based dimorphism in the SARS-CoV2 virulence,” J. Intern. Med., vol.

288, no. 4, pp. 477–478, 2020.

[10] T. P. Velavan and C. G. Meyer, “Mild versus severe COVID-19: laboratory markers,” Int. J. Infect.

Dis., vol. 95, pp. 304–307, 2020.

[11] K. W. Choi et al., “Outcomes and prognostic factors in 267 patients with severe acute respiratory syndrome in Hong Kong,” Ann. Intern. Med., vol. 139, no. 9, pp. 715–723, 2003.

[12] X. Xi, Y. Xu, L. Jiang, A. Li, J. Duan, and B. Du, “Hospitalized adult patients with 2009 influenza A (H1N1) in Beijing, China: risk factors for hospital mortality,” BMC Infect. Dis., vol. 10, no. 1, pp. 1–

8, 2010.

[13] J. Sun et al., “Prolonged persistence of SARS-CoV-2 RNA in body fluids,” Emerg. Infect. Dis., vol.

26, no. 8, p. 1834, 2020.

[14] S. A. L. Al Maeni, M. M. Ahmed, A. D. Abed, R. H. Abbas, S. A. A. Jassim, and A. M. Mohamad,

“Extraction and Purification of Staphylolysin Enzyme from Local Isolate of Pseudomonas Aeruginosa,” Ann. Rom. Soc. Cell Biol., pp. 1201–1208, 2021.

[15] M. M. Ahmed and S. L. Al Meani, “Occurrence of Klebsiella pneumoniae carbapenemase KPC gene in Klebsiella pneumoniaeisolated from patients in Anbar city of Iraq.,” Ann. Trop. Med. Heal., vol.

22, pp. 108–116, 2019.

[16] S. A. L. Al Meani, M. M. Ahmed, and A. H. Abdulkareem, “Synergistic Effect between Zingiber Officinale Volatile Oil and Meropenem against Acinetobacter Baumannii Producing-Carbapenemase Isolated from Neurosurgery in Iraq,” Syst. Rev. Pharm., vol. 11, no. 9, pp. 920–925, 2020.

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