Platelet-to-lymphocyte ratio (PLR), a novel inflammatory marker, has been suggested to predict the severity of COVID-19 patients. This systematic review aims to evaluate the association between PLR levels on admission and the severity of COVID-19 patients. A systematic literature search was done on 23 July 2020 to identify peer-reviewed studies, preprints, and grey literatures. Research articles comparing the PLR value on admission in adult patients with COVID-19 with varying degrees of severity were included in the analysis. The following keywords were used for the search: “COVID-19”, “PLR”, “severity”, and “mortality”. A total of seven studies were included in the meta-analysis, six of which were conducted in China. From a total of 998 participants included, 316 (31.7%) had severe diseases; and those in the severe group were generally older and had underlying diseases compared to the non-severe group. In comparison to non-severe patients, the meta-analysis showed that severe COVID-19 patients had higher PLR levels on admission (SMD 0.68; 95%CI 0.43-0.93; I2 =58%). High PLR levels on admission were associated with severe COVID-19 cases. Therefore, the on-admission PLR level is a novel, cost-effective, and readily available biomarker with a promising prognostic role for determining the severity of COVID-19 patients.
Background
Platelet-to-lymphocyte ratio (PLR), a novel inflammatory marker, has been suggested to be able to predict the severity of COVID-19 patients. This systematic review aims to evaluate the association between PLR levels on admission and the severity of COVID-19 patients.
Methods
A systematic literature search was done on 23 July 2020 to identify peer-reviewed studies across four different databases (Ovid MEDLINE, EMBASE, SCOPUS, and the Cochrane Library), preprints from two databases (MedRxiv and SSRN), and grey literature from two databases (WHO COVID-19 Global Research Database and Center for Disease Control and Prevention COVID-19 Research Article). Research articles comparing the PLR value on admission in adult patients with COVID-19 with varying degrees of severity were included in the analysis. The following keywords were used for the search: 'COVID-19', 'PLR', 'severity', and 'mortality'. The inverse variance method was used to calculate the pooled effect standardized mean difference (SMD) along with its 95% confidence interval (CI).
Results
A total of seven studies were included in the meta-analysis, six of which were conducted in China. From a total of 998 participants included, 316 (31.7%) had severe diseases; and those in the severe group were generally older and had underlying diseases compared to the non-severe group. In comparison to non-severe patients, the meta-analysis showed that severe COVID-19 patients had higher PLR levels on admission (SMD 0.68; 95%CI 0.43-0.93; I2 =58%).
Conclusion
High PLR levels on admission were associated with severe COVID-19 cases. Therefore, on-admission PLR level is a novel, cost-effective, and readily available biomarker with a promising prognostic role for determining the severity of COVID-19 patients.
<p align="justify"><strong><em>Introduksi:</em></strong><em> Coronavirus Disease 2019 (COVID-19) merupakan penyakit infeksius yang masih menjadi permasalahan serius di dunia. Meskipun presentasi klinis utama COVID-19 adalah gejala respirasi, manifestasi gastrointestinal seperti nyeri perut dan diare dapat ditemukan sebagai satu-satunya presentasi dari penyakit ini. Swab anal dapat dilakukan untuk penegakkan diagnosis COVID-19 dengan presentasi gastrointestinal. Namun perananya dalam diagnosis COVID-19 masih belum diketahui secara pasti.</em></p><p align="justify"><strong><em>Laporan kasus:</em></strong><em> Laporan kasus ini membahas seorang pasien dewasa yang datang dengan keluhan gastrointestinal tanpa adanya gejala respirasi. Pasien ini kemudian terkonfirmasi COVID-19 melalui pemeriksaan polymerase chain reaction (PCR) pada sampel swab nasofaring dan swab anal.</em></p><p align="justify"><strong><em>Diskusi: </em></strong><em>COVID-19 dapat ditandai dengan berbagai gejala dari organ tubuh manapun, salah satunya adalah gejala gastrointestinal. Swab anal menjadi sampel yang cukup representatif dalam membantu penegakkan diagnosis COVID-19 dengan gejala gastrointestinal. </em></p><div><p align="justify"><strong><em>Kesimpulan</em></strong><em>: Di tengah pandemi ini, presentasi gastrointestinal tanpa gejala respirasi perlu dipertimbangkan sebagai presentasi klinis atipikal dari COVID-19. Hal ini menuntut kehati-hatian tenaga kesehatan untuk menghindari misdiagnosis COVID-19 dengan menggunakan pengambilan sampel dari organ lain seperti swab anal.</em></p></div>
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