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. 2021 Oct 22;2021:1383830. doi: 10.1155/2021/1383830

A Biochemical Analysis of Patients with COVID-19 Infection

Adil R Sarhan 1,✉, Thaer A Hussein 1, Mohammed H Flaih 1, Khwam R Hussein 1
PMCID: PMC8542065  PMID: 34703628

Abstract

Several studies have demonstrated that age, comorbidities, and abnormalities in different clinical biomarkers can be important to understand disease severity. Although clinical features of COVID-19 have been widely described, the assessment of alterations of the most common biochemical markers that are reported in patients with COVID-19 still has not been well established. Here, we report clinical and blood biochemical indicators of 100 patients with COVID-19. Throat-swab upper respiratory samples were obtained from patients and real-time PCR was used to confirm SARS-CoV-2 infection. Gender, age, and clinical features such as diabetes mellitus, hypertension, and smoking habits were investigated. Biochemical parameters were categorized and analyzed according to these clinical characteristics. Triglycerides, GPT, and ALP are the biochemical markers that changed the most in the group of hypertension patients. Cholesterol and triglycerides were significantly different (P=0.01; P=0.04, respectively) between diabetic and nondiabetic patients with COVID-19. Potassium levels were significantly different (P=0.03) when comparing smokers with nonsmoker patients. Our results suggest several potential biochemical indexes that changed in patients with COVID-19 and whether certain comorbidity and clinical characteristics influence these markers.

1. Introduction

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by the recently discovered severe acute respiratory syndrome coronavirus 2, which is still spreading throughout the world. Most infected patients with COVID-19 will have mild to moderate respiratory illness that will be recovered without special medical care. However, elderly people and those with chronic medical conditions such as respiratory disease, heart disease, diabetes, and cancer are more likely to develop severe illnesses [1–3]. According to recent World Health Organization (WHO) figures, more than 110 million cases have been confirmed worldwide, with 2.44 million deaths as of February 16, 2021 [4].

Iraq has been greatly impacted by the ongoing outbreak of COVID-19. The first COVID-19 patient was reported in Iraq on 24 February 2020 [5]. Currently, as of February 16, 2021, over 650,000 diagnosed cases have been reported with more than 13,000 deaths [4]. Several biochemical tests are dramatically changed in patients with COVID-19. Early studies of COVID-19 showed substantial levels of alanine aminotransferase (ALT) in intensive care unit patients [6]. In addition, D-dimer, creatinine, blood urea, and neutrophil levels were also substantially increased in patients with severe symptoms, while lymphocyte counts were reduced [7]. D-dimer levels were also elevated in 70% of patients with severe symptoms and deceased cases [8].

Deng et al. found that, in certain patients, ALT and aspartate transaminase (AST) showed higher levels than the normal range with decreased total bilirubin levels. Creatinine and creatine phosphokinase were both increased in 13% of patients with COVID-19 [9] while Wu et al. observed a change in the percentages of liver function biomarkers (ALB, GGT, AST, ALT, TBIL, and ALP) [10].

This study aimed to demonstrate a systematic assessment for some of the biochemical laboratory tests in patients with COVID-19. All patients were admitted to the Al-Hussein Teaching Hospital, Thi-Qar Province, Iraq. Real-time PCR was used to confirm SARS-CoV-2 infection. Clinical characteristics and blood biochemical tests of COVID-19 patients were examined and recorded.

2. Materials and Methods

2.1. Data Collection

All patients were referred to Al-Hussein Teaching Hospital in Thi-Qar Province, Iraq, between November 2 and December 30, 2020, showing COVID-19 symptoms. Throat-swab upper respiratory specimens were obtained from 100 patients and real-time PCR (polymerase chain reaction) was used to confirm SARS-CoV-2 infection. Clinical characteristics and blood biochemical tests of COVID-19 patients were examined and recorded. Gender, age, and clinical characteristics such as diabetes mellitus, hypertension, and smoking have been investigated. Informed consent was obtained from patients. The study has been approved by the Institutional Review Board.

2.2. Sample Collection and Data Processing

Venous blood (4.5 mL) was obtained. Blood samples were dispensed into a gel tube. All tubes were allowed to stand for 30 minutes at room temperature, followed by centrifugation for 10 minutes at 3500 rpm to get the serum. Liver and kidney function tests including alanine transaminase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin, creatinine, and blood urea were measured. Uric acid, triglyceride, total cholesterol, high-density lipoprotein (HDL), calcium (Ca+2), sodium (Na+), potassium (K+), chloride (Cl−), magnesium (Mg+2), and phosphorus (P) were also measured using Gesan Chem-200 platform (Gesan Production SRL, Italy) according to the manufacturing protocols.

2.3. Statistical Analysis

Biochemical parameters were analyzed and categorized according to the following variables: (a) diabetes mellitus, (b) blood pressure, (c) smoking, and (d) gender. Biochemical tests were compared across patients grouped in these categories. Significance testing was performed in GraphPad Software using a t-test. A P value of <0.05 indicated statistical significance.

3. Results

A total of 100 COVID-19 patients were admitted to Al-Hussein Teaching Hospital in Thi-Qar Province, Iraq, from 2 November to 30 December 2020. Most cases (52%) were between the ages of 21 and 40 years, followed by those aged 41–60 years (29%). Approximately 54% of patients were female and 46% were male (Table 1). Most cases experienced influenza-like symptoms such as fever, cough, and mild myalgia during their time at the hospital. All patients were discharged following recovery of clinical symptoms. Diabetes mellitus, present in 23 out of 100 patients, was the most common comorbidity, followed by blood pressure, present in 14 patients. In addition, a summary of biochemical indexes outcomes among patients with COVID-19 is presented in Table 2.

Table 1.

Biochemical characteristics of patients with COVID-19 (N = 100).

ID Ca Na K Cl Mg P Urea Crea. UA Chol. Tri HDL GOT GPT ALK TSB D BP S C G Age
1 1.97 139 4.1 99 1.9 3.2 29 0.7 4.8 178 134 32 26 32 178 0.3 No No No No F 35
2 2.16 141 4 100 1.9 2.5 28 0.6 5.2 160 125 36 45 43 206 0.4 No No No No F 19
3 2.42 138 3.9 99 1.8 2.6 30 0.8 4.4 210 166 31 34 26 167 0.3 No No No No M 45
4 2.46 144 3.9 102 2 2.7 29 0.7 4.2 156 156 43 32 31 156 0.2 Yes No No No F 29
5 2.33 137 4 101 1.8 2.8 33 0.8 4.9 188 145 45 23 32 166 0.2 No No No No F 33
6 2.4 138 3.8 99 2.1 3.3 32 0.8 3.9 149 234 32 19 23 145 0.3 No No No No F 20
7 2.25 140 4.1 98 2 2.6 41 1.3 5.6 154 198 45 40 46 345 0.7 No No No No M 41
8 2.3 143 4.4 99 1.2 3.3 37 1.2 5.1 177 198 47 33 29 189 0.6 No No No No F 38
9 2.43 141 4.1 99 1.9 3.5 27 0.6 3.8 182 167 51 24 27 156 0.3 No Yes No No M 19
10 2.5 144 4.2 98 1.9 3.2 38 1.4 4.6 163 156 46 28 37 176 0.4 Yes No No No F 44
11 2.35 145 4 100 1.8 2.9 36 1.2 4.8 148 167 39 19 26 145 0.3 No No No No M 39
12 2.39 143 4.3 99 2 4.2 29 0.7 3.8 198 233 37 21 31 148 0.2 No No No No F 19
13 2.42 144 3.9 98 2.1 3.6 29 0.7 3.7 202 256 35 34 41 198 0.5 No Yes No No F 18
14 2.37 148 4 101 1.9 3.2 28 0.6 4 139 167 47 45 54 356 0.8 No No No No F 23
15 2.32 141 3.8 102 2.1 2.5 27 0.6 3.8 168 198 48 44 54 398 0.8 No No No No M 27
16 2.2 142 4.1 99 1.9 2.6 30 0.8 4.1 190 216 36 38 35 189 0.7 Yes No No No F 22
17 2.2 139 4 98 1.8 2.7 30 0.9 4.5 175 198 51 37 35 169 0.4 No No No No F 30
18 2.19 137 3.9 99 2 2.8 35 1 5.5 167 189 44 25 27 144 0.3 No No No No M 52
19 2.31 139 3.9 100 2.2 3.3 29 0.6 3.7 185 215 33 27 37 154 0.4 No No No No F 42
20 2.5 141 4 101 2.1 2.6 29 0.8 4.2 172 189 46 29 40 189 0.7 No Yes Yes No M 34
21 2.1 138 3.8 102 1.9 3.3 35 1 5.4 167 177 47 39 43 188 0.5 No No No No F 62
22 2 144 4.1 103 1.9 3.5 44 1.3 5.7 144 155 51 47 54 349 0.8 No No No Yes M 23
23 2.29 137 4.4 102 1.8 3.2 29 0.8 4 136 145 40 78 86 412 0.9 No No Yes No M 36
24 2.52 138 4.1 101 2 2.9 28 0.6 3.6 184 199 50 45 54 377 1 Yes No No No F 51
25 2.37 140 4.2 99 1.8 4.2 30 0.8 4.2 156 178 47 37 38 190 0.6 No No No Yes F 28
26 1.97 143 4 99 2.1 3.6 45 1.6 5.6 165 197 44 45 44 336 0.9 No Yes No No M 74
27 2.16 141 4.3 100 2 3.2 49 1.7 5.9 176 195 51 67 81 367 1.1 Yes No No No F 63
28 2.42 144 3.9 99 1.2 2.5 30 0.8 4.4 157 176 45 24 26 144 0.3 No No Yes No M 22
29 2.46 145 4 102 1.9 2.6 40 1.3 6 134 154 42 26 31 145 0.3 Yes No No No F 54
30 2.33 143 3.8 101 1.9 2.7 44 1.4 5.7 155 188 39 17 23 136 0.2 No No No No M 37
31 2.4 144 4.1 99 1.8 2.8 30 0.8 4.3 146 165 36 19 22 127 0.2 No Yes No No F 25
32 2.25 148 4 98 2 3.3 31 0.9 4.4 181 241 40 34 28 134 0.3 No No No No F 17
33 2.3 141 3.9 99 2.1 2.6 28 0.7 3.8 155 186 45 22 19 122 0.3 No No No Yes F 20
34 2.43 142 3.9 99 1.9 3.3 29 0.8 4.6 184 216 54 37 35 149 0.4 No No No No M 55
35 2.5 139 4 98 2.1 3.5 32 0.9 5 194 216 34 35 38 178 0.5 Yes No No No M 46
36 2.35 137 3.8 100 1.9 3.2 27 0.6 3.5 176 187 44 27 29 138 0.3 No No No No F 36
37 2.39 139 4.1 99 1.8 2.9 33 0.9 4.8 155 167 38 44 49 352 0.7 No No No No M 34
38 2.42 141 4.4 98 2 4.2 34 0.9 5.2 172 190 60 28 27 134 0.4 Yes No No No F 18
39 2.37 138 4.1 101 2.2 3.6 41 1.2 5.9 146 176 41 19 28 113 0.3 No No No No F 43
40 2.32 144 4.2 102 2.1 3.2 35 1 6.1 186 209 38 36 39 177 0.5 No No No No M 55
41 2.2 137 4 99 1.9 2.5 29 0.7 3.7 167 178 51 41 44 190 0.9 Yes No No No M 26
42 2.2 138 4.3 98 1.9 2.6 38 1.4 5.9 154 189 44 23 21 123 0.3 No No Yes No M 65
43 2.19 140 3.9 99 1.8 2.7 28 0.6 3.5 187 216 43 24 23 127 0.3 Yes No No No F 26
44 2.31 143 4 100 2 2.8 36 1.1 4.7 213 256 34 16 27 161 0.3 No No Yes No F 44
45 2.5 141 3.8 101 1.8 3.3 29 0.7 4.4 167 178 53 25 34 166 0.4 No No No No F 34
46 2.1 144 4.1 102 2.1 2.6 28 0.7 3.7 223 267 43 56 68 423 0.8 No No Yes No M 22
47 2 145 4 103 2 3.3 44 1.5 6.2 234 255 41 36 43 412 0.9 Yes No Yes No M 31
48 2.29 143 3.9 102 1.2 3.5 30 0.8 4.9 145 198 42 31 28 185 0.4 No No No No F 33
49 2.52 144 3.9 101 1.9 3.2 51 1.8 6.6 166 189 34 25 31 136 0.5 No Yes Yes No M 48
50 2.37 148 4 99 1.9 2.9 29 0.7 4 199 231 43 22 26 124 0.4 No No No No F 29
51 1.97 141 3.8 99 1.8 4.2 34 0.9 4.3 211 223 32 16 19 123 0.3 Yes No Yes No M 46
52 2.16 142 4.1 100 2 3.6 39 1.5 5.8 225 245 37 43 55 369 0.8 No No No No F 70
53 2.42 139 4.4 99 2.1 3.2 37 1.3 5.4 157 156 34 26 28 116 0.4 No No No Yes M 24
54 2.46 137 4.1 102 1.9 2.5 29 0.8 4.6 145 175 38 53 68 390 0.7 No No Yes No M 38
55 2.33 139 4.2 101 2.1 2.6 27 0.6 3.9 187 190 42 23 19 128 0.3 Yes No No No F 52
56 2.4 141 4 99 1.9 2.7 26 0.6 3.7 162 134 32 21 21 118 0.3 No No No No F 36
57 2.25 138 4.3 98 1.8 2.8 33 1 5.1 161 145 36 16 25 143 0.4 No No Yes No M 66
58 2.3 144 3.9 99 2 3.3 52 1.7 6.4 209 246 35 18 26 136 0.3 Yes No No No F 64
59 2.43 137 4 99 2.2 2.6 36 0.9 4.8 172 147 44 15 21 128 0.3 No No Yes No M 17
60 2.5 138 3.8 98 2.1 3.3 26 0.7 4 191 210 36 34 38 168 0.6 No No No No F 23
61 2.35 140 4.1 100 1.9 3.5 29 0.8 4.7 226 233 29 26 33 156 0.5 No No Yes No M 45
62 2.39 143 4 99 1.9 3.2 30 0.7 4.1 179 189 34 56 71 355 0.8 Yes No No No F 30
63 2.42 141 3.9 98 1.8 2.9 33 0.9 5.2 156 167 45 67 76 423 0.9 No No No No F 27
64 2.37 144 3.9 101 2 4.2 32 0.8 4.8 188 198 38 30 33 187 0.7 No No Yes No M 28
65 2.32 145 4 102 1.8 3.6 31 0.9 5.7 159 145 50 33 36 197 0.5 No No No Yes M 37
66 2.2 143 3.8 99 2.1 3.2 35 1.2 6.6 190 189 46 24 28 127 0.4 Yes No No No F 49
67 2.2 144 4.1 98 2 2.5 29 0.7 4.9 209 215 33 26 32 123 0.3 No No Yes No M 26
68 2.19 148 4.4 99 1.2 2.6 29 0.7 4.3 188 190 43 35 34 154 0.5 No No No No F 24
69 2.31 141 4.1 100 1.9 2.7 28 0.6 3.8 167 165 42 37 40 198 0.8 Yes No Yes No M 56
70 2.5 142 4.2 101 1.9 2.8 27 0.6 3.6 156 124 38 21 23 121 0.3 No No Yes No M 45
71 2.1 139 4 102 1.8 3.3 31 0.9 5.3 211 212 48 22 26 122 0.3 No No No No M 36
72 2 137 4.3 103 2 2.6 30 0.8 4.7 241 312 51 39 36 178 0.4 Yes No No No F 21
73 2.29 139 3.9 102 2.1 3.3 29 0.7 4.4 154 133 34 34 31 151 0.3 No No No No F 28
74 2.52 141 4 101 1.9 3.5 40 1.4 6.1 176 127 36 33 30 154 0.3 No No Yes No M 52
75 2.37 138 3.8 99 2.1 3.2 47 1.6 6.4 133 123 36 36 32 145 0.5 No No No No F 46
76 1.97 144 4.1 99 1.9 2.9 28 0.8 4.4 184 199 44 28 35 147 0.4 No Yes Yes No M 37
77 2.16 137 4 100 1.8 4.2 39 1.3 5.4 178 188 46 19 21 114 0.2 No No No No F 57
78 2.42 138 3.9 99 2 3.6 38 1.4 5.8 167 156 52 28 33 123 0.3 No No Yes No M 60
79 2.46 140 3.9 102 2.2 3.2 27 0.6 3.5 198 200 54 37 42 165 0.4 Yes No No Yes M 21
80 2.33 143 4 101 2.1 2.5 43 1.5 6.2 195 198 39 44 48 214 0.7 No Yes Yes No M 48
81 2.4 141 3.8 99 1.9 2.6 36 1 6 155 112 40 35 36 177 0.6 No No No No F 40
82 2.25 144 4.1 98 1.9 2.7 29 0.7 4.8 210 243 38 27 23 121 0.3 No No Yes No M 26
83 2.3 145 4.4 99 1.8 2.8 31 0.8 4.4 145 145 34 24 19 126 0.3 No No Yes No M 41
84 2.43 143 4.1 99 2 3.3 32 0.9 4.9 178 167 41 23 15 144 0.4 No No No No F 67
85 2.5 144 4.2 98 1.8 2.6 29 0.7 5.1 155 122 35 17 18 155 0.5 No No No No F 38
86 2.35 148 4 100 2.1 3.3 43 1.5 6.3 182 190 44 37 38 156 0.5 No Yes No No F 23
87 2.39 141 4.3 99 2 3.5 33 0.9 5.5 196 197 45 41 47 213 0.7 No No Yes No M 25
88 2.42 142 3.9 98 1.2 3.2 29 0.8 5.8 228 265 35 40 45 245 0.9 Yes Yes No No F 32
89 2.37 139 4 101 1.9 2.9 29 0.7 4.9 128 133 36 69 82 434 1.1 No No No No F 29
90 2.32 137 3.8 102 1.9 4.2 31 0.9 5.9 168 178 38 71 93 390 1.2 No No No No F 19
91 2.2 139 4.1 99 1.8 3.6 30 0.8 4.5 190 176 48 23 25 134 0.3 No No Yes No F 25
92 2.2 141 4 98 2 3.2 26 0.6 4.1 205 234 53 27 31 143 0.4 No Yes No No F 22
93 2.19 138 3.9 99 2.1 2.5 30 0.8 5.2 213 213 29 28 24 134 0.2 Yes Yes No No M 16
94 2.31 144 3.9 100 1.9 2.6 36 1.2 5.9 189 199 35 16 17 114 0.3 No No No No F 31
95 2.5 137 4 101 2.1 2.7 29 0.7 3.8 179 189 34 15 21 115 0.3 No No Yes No M 40
96 2.1 138 3.8 102 1.9 2.8 28 0.6 3.9 135 134 36 24 26 134 0.5 Yes No No No F 41
97 2 140 4.1 103 1.8 3.3 38 0.8 4.7 150 156 32 33 34 157 0.4 No Yes No No M 24
98 2.29 143 4.4 102 2 2.6 40 1.3 6.1 182 187 48 22 28 156 0.6 No No Yes No M 55
99 2.52 141 4.1 101 2.2 3.3 55 1.7 6.5 173 156 45 31 34 176 0.6 No No No No F 59
100 2.37 144 4.2 99 2.1 3.5 37 1.3 5.8 197 145 38 37 39 186 0.5 Yes Yes No No M 41
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Ca: calcium; Na: sodium; K: potassium; Cl: chloride; Mg: magnesium; P: phosphorus; Crea.: creatinine; Chol.: cholesterol; Trig: triglyceride; HDL: high-density lipoprotein; GOT: aspartate aminotransferase; GPT: alanine aminotransferase; ALK: alkaline phosphatase; TSB; total bilirubin; D: diabetic; B: blood pressure; S: smoking; C: cancer; G: gender.

Table 2.

Comparison summary of biochemical parameters among patients with COVID-19 (N = 100).

Parameters Mean ± SD
Ca, mmol/L 2.31 ± 0.15
Na, mmol/L 141.25 ± 2.94
K, mmol/L 4.04 ± 0.17
Cl, mmol/L 99.92 ± 1.47
Mg, mg/dL 1.92 ± 0.2
P, mg/dL 3.09 ± 0.47
Urea, mg/dL 33.27 ± 6.3
Creatinine, mg/dL 0.94 ± 0.32
Uric acid, mg/dL 4.86 ± 0.87
Cholesterol, mg/dL 176.18 ± 24.68
Triglyceride, mg/dL 186.56 ± 37.67
HDL, mg/dL 41.26 ± 6.62
GOT, U/L 32.28 ± 12.86
GPT, U/L 36 ± 15.59
ALK, U/L 192.72 ± 90.59
TSB, mg/dL 0.49 ± 0.24
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In the blood pressure group, triglycerides, alanine aminotransferase (GPT), and alkaline phosphatase (ALP) were the most common biochemical laboratory abnormalities identified (Figure 1). However, no significant association was found between elevated blood pressure and normal blood pressure in all biochemical laboratory parameters as shown in Figure 1. We then analyzed the correlation between the biochemical characteristics and diabetes mellitus in patients with COVID-19. Among the biochemical parameters, cholesterol and triglycerides had a significant difference (t = 2.572, P=0.01; t = 1.992, P=0.04, respectively) between the diabetic and nondiabetic COVID-19-infected patients (Figure 2). Furthermore, in a few patients, creatinine, alanine aminotransferase (GPT), alkaline phosphatase (ALP), and aspartate aminotransferase (GOT) levels were shown to be higher than the normal range. However, when comparing them according to diabetic and nondiabetic classification, none of these variations were statistically significant (Figure 2).

Figure 1.

Figure 1

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Scatter plots showing all the laboratory biochemical tests analyzed according to COVID-19 patients with normal blood pressure versus elevated blood pressure. The highlighted area indicates the normal range of each test.

Figure 2.

Figure 2

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Scatter plots showing all the laboratory biochemical tests analyzed according to COVID-19 patients with diabetic versus nondiabetic. The highlighted area indicates the normal range of each test. Statistical significance was calculated by t-test (∗P < 0.05).

Figure 3 indicates the gender-based breakdown of biochemical indexes. Out of 100 patients, 54% of the patients were female and 46% were male. Some biochemical measures such as creatinine, triglycerides, alkaline phosphatase and GOT, were found to have increased levels (Figure 3). However, when comparing these biomarkers between males and females, no evidence of significant differences was found.

Figure 3.

Figure 3

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Scatter plots showing all the laboratory biochemical tests analyzed according to gender. The highlighted area indicates the normal range of each test.

Smoking has been shown to increase serum lipid profiles including triglycerides [11, 12]. We, therefore, analyze whether smoking habits may influence the balance of serum biochemistry in patients with COVID-19. Low serum concentrations of magnesium, phosphorus, and calcium, have been seen in certain patients (Figure 4). Further analysis revealed high serum levels of creatinine, GPT, ALP, GOT, and urea in just a few other patients (Figure 4) whereas only potassium concentrations were significantly different (t = 2.140, P=0.03) when comparing smokers with nonsmoker patients.

Figure 4.

Figure 4

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Scatter plots showing all the laboratory biochemical tests analyzed according to smoking habits. The highlighted area indicates the normal range of each test. Statistical significance was calculated by t-test (∗P < 0.05).

4. Discussion

COVID-19 is an ongoing pandemic and the virus is still spreading worldwide. As stated by World Health Organization (WHO) reports, more than 110 million cases have been confirmed globally and 2.44 million deaths through February 16, 2021 [4]. On 24 February 2020, the first COVID-19 patient was confirmed in Iraq [5]. Recently, as of February 16, 2021, over 650,000 diagnosed cases have been reported with over 13,000 deaths [4]. Several studies have shown that age, comorbidities, and abnormalities of various clinical biomarkers can be essential to understand disease severity [13–16]. Even though clinical features of COVID-19 have been widely described, the overview of changes in the most common biochemical parameters that are observed in patients with COVID-19 infection is still unclear. Therefore, this report aims to study the changes in certain biochemical markers encountered in patients with COVID-19. In addition, clinical characteristics and comorbidity in 100 patients with COVID-19 have also been studied.

A strong relationship between lipid profiles and hypertension has been reported in [17–20]. Higher triglycerides values were found in patients with elevated blood pressure which are consistent with these reports. We found that triglycerides, GPT, and GOT were elevated although there was no significant difference between COVID-19 patients with elevated and normal blood pressure suggesting that COVID-19 infection may alter these biochemical laboratory markers regardless of hypertension. Furthermore, the higher triglyceride levels in certain patients might be due to body fat and distribution, a condition not investigated in this study. These findings seem to be consistent with other studies which found that high levels of triglyceride were more positively correlated with body fat than with changes in blood pressure [21, 22].

We discovered a marked increase in levels of cholesterol and triglycerides in diabetic and nondiabetic COVID-19-infected patients. Creatinine, GPT, ALP, and GOT values were shown to be higher than the normal range in some COVID-19-infected patients. The most notable comorbidities with COVID-19 in our study were diabetes (23%) and hypertension (14%). Coronaviruses bind to their target cells via angiotensin-converting enzyme 2 (ACE2), which is widely expressed in the kidney, intestine, and epithelial cells of the lung [23]. It has also been demonstrated that the expression of ACE2 is markedly upregulated in patients with diabetes which would promote the infection with COVID-19 [24, 25].

Several epidemiological data have shown no substantial correlation between smoking and disease severity in patients with COVID-19 [26–28]. In contrast, Leung et al. reported that smokers showed an upregulation of ACE2 gene expression than nonsmokers which facilitated COVID-19 infection [29]. When we analyzed the data according to smoking habits, elevated serum levels of triglyceride, creatinine, GPT, ALP, GOT, and urea were shown in few patients. Besides that, the concentrations of magnesium, phosphorus, and calcium were decreased in other patients. Interestingly, potassium levels showed significant differences when comparing smokers with nonsmoker patients. It has been shown that smoking habits might have induced alterations in potassium levels [30, 31]. However, the link between smoking and potassium levels has not been well studied. In conclusion, our results suggest several potential biochemical indexes change in patients with COVID-19 and that certain patient and clinical characteristics may influence these indexes.

Acknowledgments

The authors would like to acknowledge the cooperation and help they have received from Al-Hussein Teaching Hospital in Thi-Qar Province, Iraq.

Data Availability

All data are included in the supplementary materials.

Disclosure

The manuscript has been deposited as a preprint in Heliyon [32].

Conflicts of Interest

The authors declare no conflicts of interest.

Supplementary Materials

Supplementary Materials

Overview of the clinical information, age, gender, and biochemical parameters for the 100 participants in the study.

Click here for additional data file. (8.6KB, txt)

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplementary Materials

Overview of the clinical information, age, gender, and biochemical parameters for the 100 participants in the study.

Click here for additional data file. (8.6KB, txt)

Data Availability Statement

All data are included in the supplementary materials.

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