Complete Blood Count Profile and Association with Disease Severity among Hospitalized COVID-19 Adult Patients at Two COVID-19 Treatment Centers, Addis Ababa, Ethiopia
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Date
2025
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Addis Ababa University
Abstract
Background: The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes the disease COVID-19, has rapidly spread worldwide, present significant public health challenges. In low-resource settings, there is a critical need for straightforward, accessible, and cost-effective laboratory tests that can effectively indicate the severity and prognosis of COVID-19 patients. Among various diagnostic tools, the Complete Blood Count (CBC) offers a practical approach for evaluating the hematological alterations associated with COVID-19. Understanding the CBC profile's relationship with disease severity in hospitalized patients can be invaluable for clinicians, as it may guide treatment decisions and improve patient outcomes in environments where advanced diagnostic facilities are limited. This study aims to investigate the association between CBC parameters and the severity of COVID-19 illness in hospitalized patients, thereby enhancing our ability to monitor and manage this global health crisis.
Methods: This prospective study evaluated hematological findings in 384 adult COVID-19 patients admitted to Millennium COVID-19 Care Center and Eka Kotebe General Hospital from May 25 to September 21, 2021. The Complete Blood Count (CBC) profiles were assessed at three time points: upon admission, on day 7, and on day 21, distinguishing between non-severe and severe cases based on clinical criteria. Key hematological parameters, including white bloodcell count, neutrophil count, Eosinophil count, lymphocyte count, NLR and platelet count, were analyzed to identify association with disease severity. Statistical analyses were conducted to examine these relationships and changes in hematological profiles over time. The findings aim to demonstrate the potential of CBC parameters as indicators of prognosis and to support clinical decision-making in resource-limited environments.
Results: Patients with severe COVID-19 demonstrated significantly elevated mean white blood cell (WBC) counts upon admission (9.9x10³ vs. 8.4x10³ cells/mm³) and by day seven (9.97x10³ vs. 8.5x10³ cells/mm³; p=0.001). The mean absolute neutrophil count was also significantly higher in severe cases compared to non-severe cases at both admission (8.7 vs. 7.1) and day seven (8.9 vs. 7.1; p<0.0001). The neutrophil-to-lymphocyte ratio was notably higher in severe cases from admission to day 21 (18.9 vs. 11.8, 15.5 vs. 9.7, and 14.0 vs. 8.8; p<0.0001), while lymphocyte counts were significantly lower in severe cases throughout this period (p<0.05). Additionally, severe patients had a reduced average percentage of eosinophils (0.31 vs. 0.54;p<0.0001) and lower platelet counts (251 vs. 275.8; p<0.05) compared to non-severe cases at admission.
Conclusions: This study highlights significant hematological differences between severe and non-severe COVID-19 patients. Severe cases exhibited higher mean WBC and absolute neutrophil counts, a higher neutrophil-to-lymphocyte ratio, and lower mean absolute lymphocyte and percentage eosinophil counts compared to non-severe cases during their hospital stay.
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Keywords
COVID-19, Disease Severity, Complete Blood Count.