NL Journal of Medical and Pharmaceutical Sciences

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The Use of Lymphocyte Count and CT Chest Imaging for Assessment of COVID-19 Severity in Sudan: A single Center Cross-Sectional Study

Author(s) : Mohamed M. Mustafa, Eyhab El-Obeid, Eltayeb A. Elamin, Ahmed Elmogtaba S. E. Abd Alhaleem, Musaab Karrar H. E. Ali, Marwa Abdalla, Samah Ahmed, Tasnim A. Nour ElHadi, Smitha Bhaumik, Emilie J. Calvello Hynes.

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Abstract

Introduction: The COVID-19 (Coronavirus Disease 2019) global pandemic has strained health systems worldwide, including in Sudan, where there have been over 37,138 cases with an estimated case fatality rate of 7.5% as of August 2021. Emergency department physicians in Sudan play an important role in the triage, diagnosis and resuscitation of patients with COVID-19. Available laboratory and imaging investigations, namely complete blood counts and computed tomography (CT) scans, are being used to help characterize disease severity and anticipated clinical course. This study is conducted to evaluate the predictive value of lymphocyte counts and CT in characterizing disease severity among Sudanese patients with COVID-19 who present for emergency care. Methods: This was a retrospective review of patients diagnosed with COVID-19 at a single academic center in Sudan. A questionnaire was used to gather de-identified data on patient demographics, co-morbidities, vitals, symptoms, laboratory and imaging findings. Patient disease severity was stratified based on respiratory distress defined by respiratory rate, oxygen saturations and PaO2:FiO2 ratio. Results: Among 110 included patients, shortness of breath was the dominant symptom (68.8 %), and hypertension was the dominant comorbidity (49.1%). The mean lymphocyte count was in the lymphopenic range (mean: 1320/µL, reference: 2500 – 10000/µL). The correlation between lymphocyte count and severe clinical presentation was statistically significant (p= 0.01). Ground glass opacities were seen in the majority of CTs (93.6%). Computed Tomography Severity Score (CTSS) had a statistically significant correlation with clinical severity (mean=18.18, range=16 - 25, p=0.01). Lymphocyte count did not correlate with CTSS (p= 0.21). Conclusion: Lymphocyte count and CTSS both correlate with COVID-19 severity in Sudan. The lymphocyte count may be used in hospitals with limited PCR or CT availability to assist with prognostication. Keywords: COVID-19 clinical severity, emergency care, Sudan, lymphopenia, computed tomography

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