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COVID-19 has been shown to present with varied clinical course, necessitating a need for more specific diagnostic tools that could identify severe cases and predict outcomes during COVID-19 infection. Recent evidence has shown an expanded potential role for calprotectin, both as a diagnostic tool and also as a tool in stratifying COVID-19 patients in terms of severity. Therefore, this systematic review and meta-analysis aims to evaluate the levels of calprotectin in severe and non-severe COVID-19 and also identify the implication of raised calprotectin levels. MEDLINE, EMBASE, The Cochrane Library, Web of science and MedRxiv were searched. Meta-analysis was done to compare the serum/fecal levels of calprotectin between severe and non-severe COVID-19 infections. A total of ten studies included in the review (eight had quantitative data while two were qualitative). A pooled analysis of the eight studies from 613 patients who were RT-PCR positive for COVID-19 (average age = 55 years; 52% males) showed an overall estimate as 1.34 (95%CI: 0.77, 1.91). In conclusion, calprotectin levels have been demonstrated to be significantly elevated in COVID-19 patients who develop the severe form of the disease, and it also has prognostic importance.

Pregnancy is associated with an increased risk of venous thromboembolism (VTE). D-dimer is a biomarker used as an exclusion criterion of VTE disease, but its usefulness during pregnancy shows limitations because D-dimer levels physiologically increase through pregnancy. The aim of our study was to follow the changes of D-dimer levels and to establish trimester-specific reference intervals during normal pregnancy. This is a longitudinal prospective study in which the reference population finally included 102 healthy pregnant women. Plasma D-dimer levels were measured during the three trimesters of pregnancy, using a latex-based immunoturbidimetric assay. Reference intervals were calculated according to the Clinical and Laboratory Standards Institute recommendations. D-dimer levels increased progressively and significantly through pregnancy and peaked in the third trimester, in which D-dimer levels were above the conventional cut-off point (500 µg/L) in 99% of pregnant women. The following reference intervals were defined: first trimester: 169-1202 µg/L, second trimester: 393-3258 µg/L and third trimester: 551-3333 µg/L. The study provides reference intervals of D-dimer during the pregnancy using latex-based immunoturbidimetry on the ACL 300 TOP automated coagulation analyser. Further prospective studies of pregnant women with clinical suspicion of VTE are needed to validate these results.

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