key: cord-0786947-py36msib authors: M.Hussein, Ali; Taha, Zhala B.; Gailan Malek, Ahmed; Akram Rasul, Kamgar; Hazim Kasim, Dur; Jalal Ahmed, Reman; Badraden Mohamed, Usama title: D-Dimer and Serum ferritin as an Independent Risk Factor for Severity in COVID-19 Patients date: 2021-04-13 journal: Mater Today Proc DOI: 10.1016/j.matpr.2021.04.009 sha: 66d018b198f9ba8a8a36a5e38a450c93f52d64ce doc_id: 786947 cord_uid: py36msib Ferritin is an intracellular blood protein that contains iron, covid-19 diseases is an infectious disease caused by a virus called corona virus, the infected person mostly experiences mild to moderate respiratory illness ferritin level in blood mostly depend on severity of the covid-19 disease. Ferritin level could be used as an indicator for the covid-19 disease. Within 120 corona virus patients that used as individual in this study, the ferritin level in the blood were tested, also each of (D-Dimer, ESR, C.R protein) Depend on the results, the patients with over 60 years have a high ferritin level also the d-dimer were abnormal with 65% higher than normal range. The body contains iron in the form of ferritin, which is an intracellular protein composed of 24 subunits circling an iron core containing 4000 -4500 iron atoms [1] . Ferritin is an intracellular protein composed of 24 subunits surrounding an iron core containing 4000 -4500 iron atoms. Ferritin is a mediator for immune dysregulation, especially in hyper-ferritinemia, with direct immune suppressive and pro-inflammatory effects that cause cytokine storms [2] . The cytokine storm syndrome causes dangerous outcomes in covid-19 disease and the prevalence of the symptoms is depending on the cytokine cloud syndrome [3] . Ferritin levels in blood are common in stable individuals between the ages of 3 months and 16 years (20-200ng/mL) between the ages of 20 and 60 years (13-150ng/mL) and between the ages of 20 and 60 years (30-400ng/mL). Covid-19 disease is an infectious disease that has been declared a global public health emergency by the World Health Organization, with over 3.500.000 cases and 243.043 deaths reported globally almost since inception in Wuhan China. The bulk of covid-19 disease patients had asymptomatic or mild influenza-like illness [4] . Serum ferritin levels are closely linked to the incidence of covid-19 disease [5] . Treatment with iron chelators is one potential method for lowering serum ferritin levels in the body. Deferoxamine medication may also be used because it is a non-toxic iron chelator that has been approved by the FDA and has an effect on long-term iron chelation therapy [6] . Manipulation of serum ferritin levels may be used to reduce nutritional iron [7, 8] . Ferritin is identified as prognostic and predictive marker for liver injury [9] . The fight against covid-19 pandemic, attention to ferritin is increasing as risk factor for prognosis of covid-19 [10] . The ferritin is abnormal with the severity of covid-19 disease, but its value remains to be explored [11] , [12] . According to the diagnosis and the treatment of novel corona virus with these symptoms, Breath shortness, Oxygen saturation below than 93% and arterial partial pressure of oxygen. Liver injury patients could have elevated levels of aspartate aminotransferase, and alanine transaminase [13] . The samples for the ferritin blood test is a venipuncture samples. The date of beginning points of viral clearance is called admission date, and the date of ending point of viral clearance is called negative detection of covid-19 RNA [14] . Statistical programs used for analyzing the results with p<0.05, the following data were collected and arranged in different figures. Level of ferritin changed with the age of the patients, also (ESR, D-Dimer, Ferritin, C.R protein) showed different levels in comparison with the control group that was the normal range. In first group patients (20-40 years' male) the ferritin was 50% more than 400 which is the normal range. Patients of the second group (20-40 years' female) the ferritin was 15.38% more than 150 which is normal range. In third group (40-60 years' male) the ferritin was 80% more than 400 which is normal range. The fourth group (40-60 years' female) the ferritin was 80% more than 150 which is normal range. In fifth group (60-80 years' male) the ferritin was 100% more than 400 which is normal range. In the first test between (30-55 years' male & female) the ferritin was (575.815) more than 350 which is normal range. The second test between (30-55 years' male & female) the ESR was 35.5 over than 30 which is normal range. The third test between (30-55 years' male & female) the C.R Protein was 12 more than 10 which is normal range. The fourth test between (30-55 years' male & female) was 1.55 more than 0.5 which is normal range. the blood sample was drawn in 101 infected patients with Covid-19 disease, ferritin levels in the blood depend on the severity of the infection on the patient for study data of 101 patients that infected with covid-19 disease were analyzed the elevated range and normal range of ferritin in the patients labelled and matched. When compared to ferritin, which may serve as an easy-to-use predictor for covid-19 disorder, the model combination did not offer a positive prediction on infection incidence or liver damage [15] . Ferritin can serve as a marker for liver damage, serious illness, and course of treatment. Ferritin is an acute phase protein which can be discharged from destroyed hepatocytes [16] , [17] . Extra ferritinemia may be caused by impaired liver activity or a metabolic syndrome [18] . Covid-19 patients with abnormal ferritin levels has more risk of liver injury and severe illness, previous studies also found that liver injury is common in covid-19 patients [19] , [20] , [21] . Summary of these observations is indicative of the fact that early analysis of ferritin can efficiently have recognized liver damage, catastrophic disease, and prognosis of covid-19 patients. Patients with unusual ferritin level should be considered [22] . The Blood parameter shows that the ferritin level will increase in second week after affecting with Covid-19, also other parameters will be changed according to the normal range, such as D-Dimer, ESR, C.R protein. Depend on our case study, these levels will be change because they got Paracetamol vial 500ml daily twice in hospital that affect the liver function. 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