Early changes in laboratory parameters are predictors of mortality and ICU admission in patients with COVID-19: a systematic review and meta-analysis

Szabolcs Kiss,Noémi Zádori,Klementina Ocskay,Mária Földi,Péter Jenő Hegyi,Fanni Dembrovszky,Noémi Gede,Dávid Németh,Hussain Alizadeh,Zsolt Szakács,Zsolt Molnár,Bettina Nagy,Péter Hegyi,Andrea Párniczky,Gabriella Pár,Márk Félix Juhász,Bálint Erőss

doi:10.1007/s00430-020-00696-w

Abstract

Despite the growing knowledge of the clinicopathological features of COVID-19, the correlation between early changes in the laboratory parameters and the clinical outcomes of patients is not entirely understood. In this study, we aimed to assess the prognostic value of early laboratory parameters in COVID-19. We conducted a systematic review and meta-analysis based on the available literature in five databases. The last search was on July 26, 2020, with key terms related to COVID-19. Eligible studies contained original data of at least ten infected patients and reported on baseline laboratory parameters of patients. We calculated weighted mean differences (WMDs) for continuous outcomes and odds ratios (ORs) with 95% confidence intervals. 93 and 78 studies were included in quantitative and qualitative syntheses, respectively. Higher baseline total white blood cell count (WBC), C-reactive protein (CRP), lactate-dehydrogenase (LDH), creatine kinase (CK), D-dimer and lower absolute lymphocyte count (ALC) (WMDALC = − 0.35 × 109/L [CI − 0.43, − 0.27], p < 0.001, I2 = 94.2%; < 0.8 × 109/L, ORALC = 3.74 [CI 1.77, 7.92], p = 0.001, I2 = 65.5%) were all associated with higher mortality rate. On admission WBC, ALC, D-dimer, CRP, LDH, and CK changes could serve as alarming prognostic factors. The correct interpretation of laboratory abnormalities can guide therapeutic decisions, especially in early identification of potentially critical cases. This meta-analysis should help to allocate resources and save lives by enabling timely intervention.

Highlights

Coronavirus disease-19 (COVID-19) is a novel coronavirus infection caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which was first detected in Wuhan, China, in December 2019 after a series of pneumonia cases of unknown aetiology had emerged [1]
A better understanding of early prognostic clinical laboratory parameters could save many lives by enabling timely intervention and better resource allocation since intensive care unit (ICU) capacity is limited in most countries. In this meta-analysis, we aimed to explore the significance of changes in the laboratory parameters and assessed the correlation between clinical laboratory data and the clinical outcomes of patients with COVID-19
Results of risk of bias assessments and evaluation of smallstudy effect are summarized in Supplementary Figures and among limitations of this study. In this meta-analysis, we have assessed the correlations between changes in laboratory parameters and the outcomes of patients with COVID-19

Summary

Introduction

Coronavirus disease-19 (COVID-19) is a novel coronavirus infection caused by the novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which was first detected in Wuhan, China, in December 2019 after a series of pneumonia cases of unknown aetiology had emerged [1]. On 11 March 2020, WHO declared the rapid spread of this. Extended author information available on the last page of the article virus a pandemic [2]. Since the initial detection of the virus, more than 25,000,000 cases of COVID-19 have been confirmed worldwide with over 850,000 fatal cases [3]

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