Value of leukocytosis and elevated C-reactive protein in predicting severe coronavirus 2019 (COVID-19): A systematic review and meta-analysis

Yamada, Takayuki; Wakabayashi, Mako; Yamaji, Takahiro; Chopra, Nitin; Mikami, Takahisa; Miyashita, Hirotaka; Miyashita, Satoshi

doi:10.1016/j.cca.2020.06.008

Cited by 87 publications

(86 citation statements)

References 36 publications

(56 reference statements)

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“…In this cohort of COVID-19 patients, some of the factors independently associated with of NIV failure were in line with those previously reported for other forms of acute hypoxemic respiratory failure 5,27 , like age and PaO 2 /FiO 2 , while others appear more specific of COVID 19, like serum levels of C-reactive protein 28 or platelet counts 29 , likely indicating an hyperinflammatory status or a progression towards multiple organ failure. Concerning the PaO 2 /FiO 2 ratio, the threshold value of 150 mmHg was highly predictive of NIV outcome, and, albeit this is still a speculation, it could probably be used as a simple criterion to decide which patients should undergo early intubation.…”

Section: Discussionsupporting

confidence: 90%

Noninvasive Ventilatory Support of Patients with COVID-19 outside the Intensive Care Units (WARd-COVID)

et al. 2021

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Rationale: Treatment with noninvasive ventilation (NIV) in coronavirus disease (COVID-19) is frequent. Shortage of intensive care unit (ICU) beds led clinicians to deliver NIV also outside ICUs. Data about the use of NIV in COVID-19 is limited. Objectives: To describe the prevalence and clinical characteristics of patients with COVID-19 treated with NIV outside the ICUs. To investigate the factors associated with NIV failure (need for intubation or death). Methods: In this prospective, single-day observational study, we enrolled adult patients with COVID-19 who were treated with NIV outside the ICU from 31 hospitals in Lombardy, Italy. Results: We collected data on demographic and clinical characteristics, ventilatory management, and patient outcomes. Of 8,753 patients with COVID-19 present in the hospitals on the study day, 909 (10%) were receiving NIV outside the ICU. A majority of patients (778/909; 85%) patients were treated with continuous positive airway pressure (CPAP), which was delivered by helmet in 617 (68%) patients. NIV failed in 300 patients (37.6%), whereas 498 (62.4%) patients were discharged alive without intubation. Overall mortality was 25%. NIV failure occurred in 152/284 (53%) patients with an arterial oxygen pressure (Pa O 2 )/fraction of inspired oxygen (F i O 2 ) ratio <150 mm Hg. Higher C-reactive protein and lower Pa O 2 /F i O 2 and platelet counts were independently associated with increased risk of NIV failure. Conclusions: The use of NIV outside the ICUs was common in COVID-19, with a predominant use of helmet CPAP, with a rate of success >60% and close to 75% in full-treatment patients. C-reactive protein, Pa O 2 /F i O 2 , and platelet counts were independently associated with increased risk of NIV failure. Clinical trial registered with ClinicalTrials.gov (NCT04382235).

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Section: Discussionsupporting

confidence: 90%

Noninvasive Ventilatory Support of Patients with COVID-19 outside the Intensive Care Units (WARd-COVID)

et al. 2021

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“…One of the most important laboratory parameters studied was WBC, which on average showed mild leukocytosis in patients, as previously found by studies (35,37,39). However, some studies have found leukopenia to be a more common finding in patients (36).…”

Section: Discussionsupporting

confidence: 62%

Intubation prognosis in COVID-19 patients and associated factors: a cross-sectional study

Mohammadi

Varpaei

Amini

2020

Preprint

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Background: In December 2019, a new pathogen, HCoV, or New Corona Virus 2019 (2019-nCoV), was recognized in Wuhan, China, causing a pandemic. COVID-19 has a wide range of clinical severity. Approximately 3.2% of patients within some periods of the disease require intubation and invasive ventilation. Methods: This study was descriptive-analytical and was conducted in the Imam Khomeini Hospital. Patients with Covid-19 who required endotracheal intubation were identified and their clinical signs and laboratory parameters were recorded. SPSS23 software was used for statistical analysis. Results: 120 patients with coronavirus with different conditions were evaluated. The mean age was 55±14. 30 patients had cardiovascular disease (hypertension) and 20 endocrine disease(diabetes). Respiratory acidosis, decreased oxygen saturation, lymphopenia, and increased CRP were the most common finding before intubation. 31 patients had no comorbidity conditions. However, 27 patients had more than one comorbidity condition, and 23 experienced acute respiratory distress syndrome. The mortality rate was 49.2%. Discussion: Although all laboratory parameters and patients symptoms can affect the treatment outcome, it was found that WBC and absolute lymphocyte count, BUN, SOFA and APACHE scores, inflammatory index ratio CRP / LDH % CRP / ESR% and ESR / LDH%, arterial blood gas indices, pulse rate, and patient temperature before intubation are among the parameters that can affect the patient's 14-day prognosis. Conclusion: Except for the mentioned items, CRP / LDH% ratio seems to be a good indicator for checking the prognosis of discharge or death of patients within 14 days, However, CRP / ESR% and ESR / LDH% are appropriate criteria for determining the prognosis for discharge or stay in the ICU for more than 14 days.

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“…Temperature above 38°5 C at admission was also associated with a poor outcome in our cohort. We studied this variable, already described as a prognostic factor in COVID-19 (16,17), and especially as hyponatremia may be associated with fever. We found signi cant association between these two variables, but after multivariate analysis, only hyponatremia remains an independent risk factor.…”

Section: Discussionmentioning

confidence: 99%

Hyponatremia is Associated with Poor Outcome in COVID-19

Carvalho

Letellier

Karakachoff

et al. 2020

Preprint

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Background Hyponatremia has been described in severe acute respiratory syndrome. Our objective was to describe the impact of hyponatremia on COVID-19 patients’ outcome (intensive care unit [ICU] admission, mechanic ventilation or death). Methods According to natremia at admission, two groups were retrospectively screened: hyponatremic (< 135 mM, n = 101) or normonatremic (natremia ≥ 135 mM, n = 222) patients. Pearson’s chi-2 (qualitative variables) and Student tests (quantitative variables) were used to compare the two groups. A multiple logistic regression model was used to assess the association of outcome and patients’ data. Results Hyponatremia was generally mild. There were more male patients in the hyponatremic group (p = 0.005). Pulmonary lesions on the first thoracic CT-scanner performed during the hospitalization were significantly more extended in the hyponatremic group (p = 0.03). ICU admission, mechanic ventilation or death were significantly higher in hyponatremic compared to normonatremic patients (34 versus 14%; p < 0.001; 16% versus 5%; p = 0.002; 19 versus 9%, p = 0.021, respectively). Hyponatremia was an independent predictor of poor outcome (adjusted Odds-ratio: 2.49 [1.18–5.33, p = 0.017]). Conclusions Our study showed an independent relationship between hyponatremia at admission and transfer to ICU, use of mechanic ventilation or death in COVID-19. Hyponatremia may reflect the potential severity of underlying pulmonary lesions. Our results support the use of natremia as a simple bedside screening tool for early identification of SARS-CoV-2 infected patients at high risk of poor outcome.

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Value of leukocytosis and elevated C-reactive protein in predicting severe coronavirus 2019 (COVID-19): A systematic review and meta-analysis

Abstract: Highlights Fever was associated with poor outcomes in patients with COVID-19. Leukocytosis was associated with severe disease. Leukopenia was associated with a better prognosis. CRP was associated with poor prognosis. Leuocytosis and CRP on arrival may predict severe COVID-19.

Cited by 87 publications

References 36 publications

Noninvasive Ventilatory Support of Patients with COVID-19 outside the Intensive Care Units (WARd-COVID)

Noninvasive Ventilatory Support of Patients with COVID-19 outside the Intensive Care Units (WARd-COVID)

Intubation prognosis in COVID-19 patients and associated factors: a cross-sectional study

Hyponatremia is Associated with Poor Outcome in COVID-19

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