• Milena Tocut, Yousef Abuleil, Mona Boaz, Amos Gilad, and Gisele Zandman-Goddard.
• Department of Medicine C, Wolfson Medical Center, Holon, Israel, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
• Isr Med Assoc J. 2025 Jan 1; 27 (1): 283328-33.

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic showed the need to evaluate disease severity promptly at the time of hospital admission.ObjectivesTo establish an admission protocol, which included clinical and laboratory findings.MethodsWe conducted a retrospective study at Wolfson Medical Center, Israel, for a period of 19 months (2020-2021). We established a protocol for patients who were admitted with COVID-19 infection. The protocol parameters included demographic data, co-morbidities, immune status, oxygen level at room air on admission, oxygen demand, lymphopenia, C-reactive protein (CRP) level, lactate dehydrogenase, D-DIMER, creatinine, aspartate transferase, alanine aminotransferase, and ferritin. Based on this protocol, we defined the severity of COVID-19 at the beginning of hospitalization and started treatment without delay. This protocol included ferritin levels as a guide to severity and outcome of patients. A database was established for all the parameters of the patients included in the study.ResultsThe study included 407 patients; 207 males (50.9%), 200 females (49.1%). The age range was 18-101 years. Hyperferritinemia (> 1000 ng/dl) was one of the strongest and most significant predictors for severe disease in these patients (P < 0.001). Lymphopenia, high levels of CRP, alanine aminotransferase, aspartate transferase, lactate dehydrogenase, and creatinine also correlated with severe disease, complications, and death.ConclusionsAbnormal ferritin levels were a very significant and clear indicator of the development of severe COVID-19. The addition of ferritin levels to our protocol aided in finding which patients were at increased risk for morbidity and mortality.

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