Prognostic Indicators for Severity in COVID-19 Patients:a Meta-analysis

Abstract

Background The COVID-19 has become a global pandemic declared by the WHO, and the severity of which affects the prognosis of patients. Objective To explore the prognostic indicators for severity and their predictive values in COVID-19 patients, providing a reference for clinical prediction of patients'outcome and prognosis. Methods Eight databases (The Cochrane Library, Embase, PubMed, Web of Science, SinoMed, CNKI, Wanfang Data Knowledge Service Platform, VIP)were searched from inception to 2020-09-03 for randomized controlled trials(RCTs)about severe versus non-severe COVID-19 patients or deceased versus survived COVID-19 patients with prognostic indicators〔including procalcitonin (PCT), C-reactive protein (CRP), lymphocyte count (LYM), interleukin-6 (IL-6), D-dimer〕studied. The modified Jaded Scale was used to assess the methodological quality. Stata 12.0 was used for meta-analysis. Results Fifteen RCTs were included, involving 1 476 cases, all were assessed with high methodological quality(modified Jadad Scale score ranging from 4 to 5 points). Meta-analysis found that severe COVID-19 patients had higher mean values of PCT〔SMD=-2.28, 95%CI (-3.60, -0.98), P<0.001〕, CRP〔SMD=-2.23, 95%CI (-3.38, -1.07), P<0.001〕, IL-6〔SMD=-2.97, 95%CI (-4.94, -1.00), P<0.001〕, and D-dimer〔SMD=-1.22, 95%CI (-2.66, 0.21), P=0.008〕than non-severe COVID-19 patients. Severe COVID-19 patients had lower mean LYM〔SMD=1.41, 95%CI (0.34, 2.48), P<0.001〕. The deceased COVID-19 patients had higher mean values of PCT〔SMD=-4.11, 95%CI (-9.98, 1.76), P=0.007〕, CRP〔SMD=-2.73, 95%CI (-4.21, -1.25), P<0.001〕, IL-6〔SMD=-3.79, 95%CI (-4.90, -2.67), P<0.001〕, and D-dimer〔SMD=-0.68, 95%CI (-1.46, 0.09), P=0.009〕 than the survived.The deceased COVID-19 patients had lower mean LYM 〔SMD=2.08, 95%CI (0.93, 3.22), P<0.001〕. Conclusion Increased PCT, CRP, IL-6 and D-dimer and decreased LYM were found in severe or deceased COVID-19 patients, indicating that the former three may be positively correlated with severity, while the latter may be negatively correlated with severity. These five indicators may be used as prognostic indicators for severity, too high PCT, CRP, IL-6 and D-dimer, and too low LYM may suggest a poor prognosis. Copyright © 2021 by the Chinese General Practice.