Association of Clinical Markers with Inflammation and Efficacy of Vaccination in Patients with COVID-19 Infection


  • Jabar Mohammed Amin Muhidin Department of Laboratory, Ministry of Health, Sulaimania, Iraq


COVID-19, Vaccination, Biological markers, Troponin-I, D-Dimer


Background:  Coronavirus disease 2019 (COVID-19) is a widespread illness caused by the coronavirus 2 that causes severe acute respiratory syndrome (SARS-CoV-2). We intend to investigate the clinical characteristics and symptom status of SARS-CoV-2 patients. Method: We collected clinical data of 381 patients infected with SARS-CoV- 2 from early-June to mid-August 2020. Biological markers analyzed in this study include: PCRct value, CR-Protein, D-Dimer, LDL, and Troponin-I regarding the signs and symptoms for all patients enrolled in this study. Results:  Among 381 confirmed COVID-19 patients (166 males, 160 females), that divided into two groups; 213 who received vaccination (single dose or booster mRNA vaccination), and 139 patients who did not receive vaccination. The significant differences were reported in the first week and second week of infection for both vaccinated and unvaccinated patients that reported for both cases (pv<.0001). Importantly, there were a significant differences reported in the symptoms for both group in the first and second weeks of infection that were (pv=.0001). The study reported that the D-Dimer was significantly elevated in both groups of the study, which were (pv=<0.0001) for both group. While, there is no significant differences between the two group that reported in the first and second week of infection with (pv=0.9974). Significantly, CR-Protein in vaccinated COVID-19 cases was (pv=0.0001) similar to that of un-vaccinated COVID-19 patients. Hence, the symptoms, Troponin, D-dimer, CRP level were higher in COVID-19 patients in the second week during laboratory analysis including hospitalized patients. Significantly, high LDL level in the second week and especially in female were considerably reported in this study. Conclusion:  Clinical markers have a crucial role in determining the prognosis for SARS-CoV-2 patients, and vaccination effectiveness helped to reduce the severity of the virus's signs and symptoms.


W. Guan et al., “Clinical Characteristics of Coronavirus Disease 2019 in China,” N. Engl. J. Med., vol. 382, no. 18, pp. 1708–1720, 2020, doi: 10.1056/nejmoa2002032.

G. Quaglio et al., “Public Health Action,” vol. 12, no. 1, pp. 34–39, 2022.

J. Chadha, L. Khullar, and N. Mittal, “Facing the wrath of enigmatic mutations: a review on the emergence of severe acute respiratory syndrome coronavirus 2 variants amid coronavirus disease-19 pandemic,” Environ. Microbiol., vol. 24, no. 6, pp. 2615–2629, 2022, doi: 10.1111/1462-2920.15687.

W. H. Organization, “Manajemen klinis infeksi saluran pernapasan akut parah yang diduga penyakit coronavirus 2019,” Geneva World Heal. Organ., pp. 1–22, 2020.

C. Guideline, “Diagnosis and treatment protocol for novel coronavirus pneumonia (Trial version 7),” Chin. Med. J. (Engl)., vol. 133, no. 9, pp. 1087–1095, 2020, doi: 10.1097/CM9.0000000000000819.

M. S. Dhar et al., “Genomic characterization and epidemiology of an emerging SARS-CoV-2 variant in Delhi, India,” Science (80-. )., vol. 374, no. 6570, pp. 995–999, 2021, doi: 10.1126/science.abj9932.

O. Stirrup et al., “SARS-CoV-2 lineage B.1.1.7 is associated with greater disease severity among hospitalised women but not men: Multicentre cohort study,” BMJ Open Respir. Res., vol. 8, no. 1, pp. 1–10, 2021, doi: 10.1136/bmjresp-2021-001029.

T. H. Ali AM, Tofiq AM, Rostam HM, Ali KM, “Reply to Letter to the Editor on disease severity and efficacy of homologous vaccination among patients infected with SARS-CoV-2 Delta or Omicron VOCs, compared to unvaccinated using main biomarkers,” J. Med. Virol., 2022, doi:

D. T. Halperin et al., “Revisiting COVID-19 policies : 10 evidence- based recommendations for where to go from here,” pp. 1–12, 2021.

H. Noori et al., “Clinical laboratory parameters and comorbidities associated with severity of coronavirus disease 2019 ( COVID-19 ) in Kurdistan Region of Iraq,” Pract. Lab. Med., vol. 31, p. e00294, 2022, doi: 10.1016/j.plabm.2022.e00294.

R. J. Harris, J. A. Hall, A. Zaidi, N. J. Andrews, J. K. Dunbar, and G. Dabrera, “Effect of Vaccination on Household Transmission of SARS-CoV-2 in England,” N. Engl. J. Med., vol. 385, no. 8, pp. 759–760, 2021, doi: 10.1056/nejmc2107717.

J. Shastri et al., “Severe SARS-CoV-2 Breakthrough Reinfection With Delta Variant After Recovery From Breakthrough Infection by Alpha Variant in a Fully Vaccinated Health Worker,” Front. Med., vol. 8, no. August, pp. 1–13, 2021, doi: 10.3389/fmed.2021.737007.

A. M. Ali, H. M. Rostam, and M. H. Fatah, “Serum troponin , D ‐ dimer , and CRP level in severe coronavirus ( COVID ‐ 19 ) patients,” no. September 2021, pp. 1–10, 2022, doi: 10.1002/iid3.582.

I. R. Mendiola-Pastrana, E. López-Ortiz, J. G. Río de la Loza-Zamora, J. González, A. Gómez-García, and G. López-Ortiz, “SARS-CoV-2 Variants and Clinical Outcomes: A Systematic Review,” Life, vol. 12, no. 2, 2022, doi: 10.3390/life12020170.

M. Eaaswarkhanth, A. Al Madhoun, and F. Al-Mulla, “Could the D614G substitution in the SARS-CoV-2 spike (S) protein be associated with higher COVID-19 mortality?,” Int. J. Infect. Dis., vol. 96, pp. 459–460, 2020, doi: 10.1016/j.ijid.2020.05.071.

X. Pang et al., “Emerging Severe Acute Respiratory Syndrome Coronavirus 2 Mutation Hotspots Associated With Clinical Outcomes and Transmission,” Front. Microbiol., vol. 12, no. October, pp. 1–12, 2021, doi: 10.3389/fmicb.2021.753823.

A. M. Ali, K. M. Ali, M. H. Fatah, H. M. Tawfeeq, and H. M. Rostam, “SARS-CoV-2 reinfection in patients negative for immunoglobulin G following recovery from COVID-19,” New Microbes New Infect., vol. 43, p. 100926, 2021, doi: 10.1016/j.nmni.2021.100926.

A. M. Ali, A. M. Tofiq, H. M. Rostam, and K. M. Ali, “Disease Severity and Efficacy of Homologous Vaccination Among Patients Infected with SARS-CoV-2 Delta or Omicron VOCs, Compared to Unvaccinated using Main Biomarkers,” doi: 10.1002/jmv.28098.

K. M. Ali, A. M. Ali, H. M. Tawfeeq, G. Figueredo, and H. M. Rostam, “Hypoalbuminemia in Patients Following Their Recovery from Severe Coronavirus Disease 2019.,” J. Med. Virol., pp. 0–2, 2021, doi: 10.1002/jmv.27002.

A. Daverey and K. Dutta, “Journal of Environmental Chemical Engineering COVID-19 : Eco-friendly hand hygiene for human and environmental safety,” J. Environ. Chem. Eng., vol. 9, no. 2, p. 104754, 2021, doi: 10.1016/j.jece.2020.104754.

H. L. Fateh and A. M. Ali, “Association between diet quality and BMI with side e ff ects of P fi zer-BioNTech COVID-19 vaccine and SARS-CoV-2 immunoglobulin G titers,” 2022, doi: 10.1108/NFS-09-2022-0338.

H. Han et al., “Prominent changes in blood coagulation of patients with SARS-CoV-2 infection,” Clin. Chem. Lab. Med., vol. 58, no. 7, pp. 1116–1120, 2020, doi: 10.1515/cclm-2020-0188.

H. Debi, Z. T. Itu, M. T. Amin, F. Hussain, and M. S. Hossain, “Association of serum C-reactive protein (CRP) and D-dimer concentration on the severity of COVID-19 cases with or without diabetes: a systematic review and meta-analysis,” Expert Rev. Endocrinol. Metab., vol. 17, no. 1, pp. 83–93, 2022, doi: 10.1080/17446651.2022.2002146.

A. Salari et al., “An investigation of risk factors of in-hospital death due to COVID-19: a case-control study in Rasht, Iran,” Ir. J. Med. Sci., vol. 190, no. 4, pp. 1321–1333, 2021, doi: 10.1007/s11845-020-02455-5.

Y. Li et al., “Changes in lipid metabolism in patients with severe COVID-19,” Clin. Chim. Acta, pp. 1–25, 2021, [Online]. Available:

G. Wang et al., “Low high-density lipoprotein level is correlated with the severity of COVID-19 patients: An observational study,” Lipids Health Dis., vol. 19, no. 1, pp. 1–7, 2020, doi: 10.1186/s12944-020-01382-9.

M. Outcomes, “Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19),” vol. 2019, no. 7, pp. 811–818, 2020, doi: 10.1001/jamacardio.2020.1017.

W. T. Harvey et al., “Omicron variant of SARS-CoV-2 harbors a unique insertion mutation of putative viral or human genomic origin,” J. Virus Erad., vol. 12, no. 1, pp. 517–522, 2021, [Online]. Available:

T. P. Peacock et al., “The altered entry pathway and antigenic distance of the SARS-CoV-2 Omicron variant map to separate domains of spike protein,” bioRxiv, p. 2021.12.31.474653, 2022, [Online]. Available:

P. Shinu and R. Bareja, “Omicron ; past , current and future perspectives,” vol. 8, no. 1, pp. 1–2, 2022, doi: 10.1002/jmv.27588.Foxnews.