Laboratory features in severe vs. non-severe COVID-19 patients, a systematic review and meta-analysis

Abstract

OBJECTIVE: Understanding the common laboratory features of COVID-19 in severe cases versus non-severe patients could be quite useful for clinicians and might help to predict the model of disease progression. MATERIALS AND METHODS: Electronic databases were systematically searched in PubMed, EMBASE, Scopus, Web of ‎Science, and Google Scholar from inception to 3rd of March 2020. Heterogeneity across included ‎studies was determined using Cochrane’s Q test and the I2 statistic. We used the fixed or random-effect models to pool ‎the weighted mean differences (WMDs) or standardized mean differences and 95% confidence ‎intervals (CIs).‎RESULTS:‎ Out of a total of 3009 citations, 17 articles (22 studies, 21 from China and one study from Singapour) with 3396 ranging from 12-1099 patients, ‎were included. Our meta-analyses showed a significant decrease in ‎lymphocyte, monocyte, and eosinophil, hemoglobin, platelet, albumin, serum sodium, lymphocyte to C-reactive protein ratio (LCR), leukocyte to C-reactive protein ratio (LeCR), leukocyte to IL-6 ratio (LeIR), and an increase in the ‎neutrophil, alanine ‎aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, blood urea nitrogen (BUN), creatinine (Cr), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), procalcitonin (PCT), lactate dehydrogenase (LDH), fibrinogen, prothrombin time (PT), D-dimer, glucose ‎level, and neutrophil to lymphocyte ratio (NLR) in the severe group compared with the non-severe group. However, no significant changes were observed in white blood cells (WBC), ‎ creatine kinase (CK), troponin I, myoglobin, interleukin-6 (IL-6), and potassium (K) between the two groups.‎CONCLUSIONS: This meta-analysis provides evidence for the differentiation of severe cases of COVID-19 based on laboratory test results at the time of hospital admission. Future well-methodologically designed studies from other populations are strongly recommended.

Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis

“…Therefore, NLR, a cost-effective marker, can be easily calculated from peripheral blood routine tests and may be associated with the progression and prognosis of COVID-19. To date, four meta-analyses have reported that patients with severe COVID-19 infection had a higher NLR than those with non-severe COVID-19 infection [51][52][53][54]. However, none of them evaluated the predictive values of NLR on disease severity and mortality.…”

The role of cytokine profile and lymphocyte subsets in the severity of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis

“…It may be due to the direct contribution of the virus or redistribution of WBC via chemotaxis or apoptosis [ 16 , 41 , 60 ]. Compared to non-severe ones, severe cases are older and have comorbidity diseases [ [61] , [62] , [63] ], making them more susceptible to endothelial dysfunction and its associated lymphopenia. The fact that the present study showed elevated leukocyte levels in severe compared to non-severe patients across 42 studies is a novel and controversial finding.…”

Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis

“…Therefore, NLR, a cost-effective marker can be easily calculated from peripheral blood routine tests, and may be associated with the progression and prognosis of COVID-19. There were few meta-analyses pointing out patients with severe COVID-19 had a higher NLR than those with non-severe COVID-19 [51][52][53][54]. However, none of them evaluated the predictive values of NLR on disease severity and mortality.…”