Association of inflammatory markers with the severity of COVID-19: A meta-analysis

Abstract

Objectives: Studies reported associations of inflammatory markers with the severity of COVID-19, but conclusions were inconsistent. We aimed to provide an overview of the association of inflammatory markers with the severity of COVID-19. Methods: We searched PubMed, Embase, Cochrane Library, Wanfang and China National Knowledge Infrastructure (CNKI) database until March 20, 2020. Weighted mean difference (WMD) and 95% confidence intervals (CIs) were pooled using random or fixed-effects models. Results: A total of 16 studies comprising 3962 patients with COVID-19 were included in our analysis. Random-effect results demonstrated that patients with COVID-19 in the nonsevere group had lower levels for CRP (WMD = À41.78 mg/l, 95% CI = [À52.43, À31.13], P < 0.001), PCT (WMD = À0.13 ng/ml, 95% CI = [À0.20, À0.05], P < 0.001), IL-6 (WMD = À21.32 ng/l, 95% CI = [À28.34, À14.31], P < 0.001), ESR (WMD = À8 mm/h, 95% CI = [À14, À2], P = 0.005), SAA (WMD = À43.35 mg/ml, 95% CI = [À80.85, À5.85], P = 0.020) and serum ferritin (WMD = À398.80 mg/l, 95% CI = [À625.89, À171.71], P < 0.001), compared with those in the severe group. Moreover, survivors had a lower level of IL-6 than non-survivors (WMD = À4.80 ng/ml, 95% CI = [À5.87, À3.73], P < 0.001). These results were consistent through sensitivity analysis and publication bias assessment. Conclusions: The meta-analysis highlights the association of inflammatory markers with the severity of COVID-19. Measurement of inflammatory markers might assist clinicians to monitor and evaluate the severity and prognosis of COVID-19.

Prognostic value of liver biochemical parameters for COVID-19 mortality

“…In the case of heterogeneity among studies (I 2 > 50% or P < 0.1), random-effect model was used and would give a more conservative estimate of the 95% CI. In other cases, fixed-effect model was adopted (I 2 ≤ 50% and P ≥ 0.1) [22] . Sensitivity analysis was performed by omitting one study each time through influence analysis to assess the stability of results.…”

Anakinra After Corticosteroid and/or Tocilizumab Treatment in Patients with Severe COVID-19 Pneumonia and Moderate Hyperinflammation. A Retrospective Cohort Study.

“…No differences were found in serum ferritin levels at 1 month between the three groups, suggesting that hyperin ammatory state was controlled to a similar degree in all patients regardless of their immunosuppressive treatment [36]. Although elevated ferritin levels have been considered a clinical factor associated with a poor prognosis in patients with cytokine storm [37], we observed no betweengroup differences in the association between serum ferritin levels and mortality -a nding probably related in part to the fact that the elevation in ferritin was moderate in all patients in the present cohort.…”

Hypoalbuminemia&nbsp;in Severe COVID-19&nbsp;Post&nbsp;Recovery&nbsp;Patients

“…It has been reported that CRP levels are positively related to the severity of COVID-19 19 . Another study illustrated a high ESR level in patients suffering severe COVID-19 symptoms when compared to nonsevere groups, due to an increase in in ammation in severely affected patients 14 . In addition, other studies considered the serum albumin level as a vital indicator in severe COVID-19 patients 16,20 .…”

“…Several biological markers have been found to correlate with the severity of COVID-19, including high Creactive protein (CRP) level, high erythrocyte sedimentation rate (ESR) level and low level of serum albumin (hypoalbuminemia) 8, [14][15][16] . These biomarkers in parallel with the clinical symptoms can be used to interpret more con dently the likely progression and severity of the disease 17 .…”