Inflammatory and hematologic markers as predictors of severe outcomes in COVID-19 infection: A systematic review and meta-analysis

• Published in: The American journal of emergency medicine Vol. 41; pp. 110 - 119
• Main Authors: Hariyanto, Timotius Ivan, Japar, Karunia Valeriani, Kwenandar, Felix, Damay, Vika, Siregar, Jeremia Immanuel, Lugito, Nata Pratama Hardjo, Tjiang, Margaret Merlyn, Kurniawan, Andree
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2021; Elsevier Limited
• Subjects: Albumin; Biomarker; Biomarkers; Biomarkers - blood; C-reactive protein; C-Reactive Protein - metabolism; Coronavirus; Coronaviruses; COVID-19; COVID-19 - blood; COVID-19 - complications; COVID-19 - diagnosis; COVID-19 Serological Testing; Disease transmission; Emergency medical care; Fibrin Fibrinogen Degradation Products - metabolism; Humans; Infections; Inflammation; L-Lactate dehydrogenase; L-Lactate Dehydrogenase - blood; Laboratories; Laboratory; Laboratory tests; Lactic acid; Meta-analysis; Pneumonia; Procalcitonin; Procalcitonin - blood; Prognosis; Proteins; Risk Assessment; SARS-CoV-2; Serum Albumin - metabolism; Severe acute respiratory syndrome coronavirus 2; Severity of Illness Index; Systematic review; COVID-19; SARS-CoV-2; Biomarker; Coronavirus; Laboratory
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2020.12.076

Laboratory testing is commonly performed in patients with COVID-19. Each of the laboratory parameters has potential value for risk stratification and prediction of COVID-19 outcomes. This systematic review and meta-analysis aimed to evaluate the difference between these parameters in severe and nonsevere disease and to provide the optimal cutoff value for predicting severe disease. We performed a systematic literature search through electronic databases. The variables of interest were serum procalcitonin, albumin, C-reactive protein (CRP), D-dimer, and lactate dehydrogenase (LDH) levels in each group of severity outcomes from COVID-19. There were a total of 4848 patients from 23 studies. Our meta-analysis suggest that patients with severe COVID-19 infections have higher procalcitonin, (mean difference 0.07; 95% CI 0.05–0.10; p < 0.00001), CRP (mean difference 36.88; 95% CI 29.10–44.65; p < 0.00001), D-Dimer (mean difference 0.43; 95% CI 0.31–0.56; p < 0.00001), and LDH (mean difference 102.79; 95% CI 79.10–126.49; p < 0.00001) but lower levels of albumin (mean difference −4.58; 95% CI −5.76 to −3.39; p < 0.00001) than those with nonsevere COVID-19 infections. The cutoff values for the parameters were 0.065 ng/mL for procalcitonin, 38.85 g/L for albumin, 33.55 mg/L for CRP, 0.635 μ/L for D-dimer, and 263.5 U/L for LDH, each with high sensitivity and specificity. This meta-analysis suggests elevated procalcitonin, CRP, D-dimer, and LDH and decreased albumin can be used for predicting severe outcomes in COVID-19. •Currently, the cut-off value for laboratory markers to differentiate severity of COVID-19 is still unclear.•Our study suggest serum procalcitonin, albumin, CRP, D-dimer, and LDH can assist in differentiating the severity of COVID-19.•Physicians should check these laboratory parameters in COVID-19 patients for predicting the outcome of the disease.