Laboratory biomarkers associated with COVID-19 severity and management

Keddie, Stephen; Ziff, Oliver J.; Chou, Michael; Taylor, Robert; Heslegrave, Amanda; Garr, Edmund; Lakdawala, Neghat; Church, Andrew J.; Ludwig, Dalia; Manson, Jessica; Scully, Marie; Nastouli, Eleni; Chapman, Mike; Hart, Melanie; Lunn, Michael P.

doi:10.1016/j.clim.2020.108614

Cited by 61 publications

(65 citation statements)

References 18 publications

(19 reference statements)

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“…[31][32][33][34][35][36][37][38] with a particular emphasis on the association of LDH, and creatinine as the variables most predictive of respiratory failure, whereas maximal IL-6 level showed the strongest association with the need for mechanical ventilation, followed by maximal CRP level. 11,[38][39][40][41] An analysis of cardiac makers revealed a much higher indicated a higher fatality risk associated with abnormal myocardial parameters. 42 A higher threshold for D-dimer was found to be associated with an increased risk of pulmonary embolism and other complications in COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

Trends of variation of the laboratory parameters during the course of COVID-19 Illness

et al. 2021

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Background: The coronavirus pandemic which had its origin in the Wuhan China has been spreading across the globe with far reaching complications and a variable clinical course. A variation of the laboratory parameters during the disease course remains a constant parameter to monitor the disease course and progression. Since the laboratory parameters are standardized globally, these may also act as uniform guidelines for the patients monitoring and treatment. Aims and Objectives: The aim of the study was to serial charting of the laboratory parameters in the recovered and expired patients of COVID-19 and to determine an associated prognostic significance. Materials and Methods: A retrospective observational study from the laboratory and medical records was conducted on the patients admitted from March 17, 2020, to May 31, 2020, at the tertiary care center dedicated to the treatment of RT-PCR confirmed COVID-19 positive patients. Results: The group of parameters showing a poor prognosis include a rising WBC count, high neutrophilic percentage, low lymphocyte percentage (<10) an NLR > 15, low lymphocyte monocyte ratio < 3, rising blood urea nitrogen, serum creatinine levels, and serum electrolyte levels. The liver function tests variation reflecting a poor metabolic activity of the liver, namely, a low serum albumin and albumin globulin ratio, rising SGOT levels, and total bilirubin levels. A highly significant variation in the acute phase reactants showing an exponential rise such as the serum lactate dehydrogenase levels, serum ferritin, fibrinogen, C-reactive protein, and IL 6 levels an increased level of D Dimer (>3) and a prolongation of the APTT. Conclusion: The variation of the laboratory parameters acts as a fair marker for the disease progression. Since the disease shows a variable progression with a sudden worsening of the clinical symptoms, a comprehensive monitoring of the laboratory parameters serves to diagnose and treat the disease progression.

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Section: Discussionmentioning

confidence: 99%

Trends of variation of the laboratory parameters during the course of COVID-19 Illness

et al. 2021

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“…CSF NFL was measured simultaneously in both COVID-19 and control samples using the Simoa™ NF-Light Kit (Quanterix Corporation, Lexington, MA, USA) on the Quanterix HD-X® platform. Acute phase reactants such as ferritin, C-reactive protein (CRP) and coagulation markers including D-dimer, fibrinogen and factor VIII, markers associated with disease severity in COVID-19 [ [43] , [44] , [45] , [46] ] were also evaluated in CSF of COVID-19 and control subjects. Ferritin and hsCRP were measured on Roche Diagnostics Cobas c 701 and e 801 analyzers, respectively.…”

Section: Methodsmentioning

confidence: 99%

Cerebrospinal fluid in COVID-19 neurological complications: Neuroaxonal damage, anti-SARS-Cov2 antibodies but no evidence of cytokine storm

García

Barreras

Lewis

et al. 2021

Journal of the Neurological Sciences

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Objective To study in cerebrospinal fluid (CSF) of COVID-19 subjects if a “cytokine storm” or neuroinflammation are implicated in pathogenesis of neurological complications. Methods Cross-sectional study of CSF neuroinflammatory profiles from 18 COVID-19 subjects with neurological complications categorized by diagnosis (stroke, encephalopathy, headache) and illness severity. COVID-19 CSF was compared with CSF from healthy, infectious and neuroinflammatory disorders and stroke controls ( n = 82). Cytokines (IL-6, TNFα, IFNγ, IL-10, IL-12p70, IL-17A), inflammation and coagulation markers (high-sensitivity-C Reactive Protein [hsCRP], ferritin, fibrinogen, D-dimer, Factor VIII) and neurofilament light chain (NF-L), were quantified. SARS-CoV2 RNA and SARS-CoV2 IgG and IgA antibodies in CSF were tested with RT-PCR and ELISA. Results CSF from COVID-19 subjects showed absence of pleocytosis or specific increases in pro-inflammatory markers (IL-6, ferritin, or D-dimer). Although pro-inflammatory cytokines (IL-6, TNFα, IL-12p70) and IL-10 were increased in CSF of stroke COVID-19 subjects, a similar increase was observed in non-COVID-19 stroke subjects. Anti-SARS-CoV2 antibodies in CSF of COVID-19 subjects (77%) were observed despite no evidence of SARS-CoV2 viral RNA. CSF-NF-L was elevated in subjects with stroke and critical COVID-19 as compared to controls and other COVID-19 severity categories. CSF-hsCRP was present in all subjects with critical stages of COVID-19 (7/18) but only in 1/82 controls. Conclusion The paucity of neuroinflammatory changes in CSF of COVID-19 subjects and lack of SARS-CoV2 RNA do not support the presumed neurovirulence of SARS-CoV2 or neuroinflammation in pathogenesis of neurological complications in COVID-19. The role of CSF SARS-CoV2 IgG antibodies and mechanisms of neuronal damage are still undetermined.

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“…A total of 35 clinical studies were singled out, through the initial literature search. Seventeen studies were excluded after a preliminary review, 3 studies [16][17][18] did not report the predictive value of IL-6 on severe disease or mortality, whereas, in 13 studies, the researchers were unable to extract a four-grid table of results. [19][20][21][22][23][24][25][26][27][28][29][30][31] 1 study cohort included healthy people, 32 and one study came from low-quality Chinese literature.…”

Section: Search Strategy and Characteristics Of Included Studiesmentioning

confidence: 99%

Association between IL-6 and severe disease and mortality in COVID-19 disease: a systematic review and meta-analysis

Liu

Wang

Shi

et al. 2021

Postgraduate Medical Journal

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BackgroundSo far, SARS-CoV-2 is the seventh coronavirus found to infect humans and cause disease with quite a strong infectivity. Patients diagnosed as severe or critical cases are prone to multiple organ dysfunction syndrome, acute respiratory distress syndrome and even death. Proinflammatory cytokine IL-6 has been reported to be associated with the severity of disease and mortality in patients with COVID-19.ObjectiveThis systematic review and meta-analysis were carried out to evaluate the association between IL-6 and severe disease and mortality in COVID-19 disease.MethodsA systematic literature search using China National Knowledge Infrastructure, Wanfang databases, China Science and Technology Journal Database, Chinese Biomedical Literature, Embase, PubMed and Cochrane Central Register of Controlled Trials was performed from inception until 16 January 2021.Results12 studies reported the value of IL-6 for predicting the severe disease in patients with COVID-19. The pooled area under the curve (AUC) was 0.85 (95% CI 0.821 to 0.931). 5 studies elaborated the predictive value of IL-6 on mortality. The pooled sensitivity, specificity and AUC were 0.15 (95% CI 0.13 to 0.17, I2=98.9%), 0.73 (95% CI 0.65 to 0.79, I2=91.8%) and 0.531 (95% CI 0.451 to 0.612), respectively. Meta-regression analysis showed that country, technique used, cut-off, sample, study design and detection time did not contribute to the heterogeneity of mortality.ConclusionIL-6 is an adequate predictor of severe disease in patients infected with the COVID-19. The finding of current study may guide clinicians and healthcare providers in identifying potentially severe or critical patients with COVID-19 at the initial stage of the disease. Moreover, we found that only monitoring IL-6 levels does not seem to predict mortality and was not associated with COVID-19’s mortality.PROSPERO registration numberCRD42021233649.

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Laboratory biomarkers associated with COVID-19 severity and management

Cited by 61 publications

References 18 publications

Trends of variation of the laboratory parameters during the course of COVID-19 Illness

Trends of variation of the laboratory parameters during the course of COVID-19 Illness

Cerebrospinal fluid in COVID-19 neurological complications: Neuroaxonal damage, anti-SARS-Cov2 antibodies but no evidence of cytokine storm

Association between IL-6 and severe disease and mortality in COVID-19 disease: a systematic review and meta-analysis

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