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Can we predict the severity of coronavirus disease 2019 with a routine blood test?
Furong Zeng1, Linfeng Li2, Jiling Zeng3
1National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
Insights
Routine blood tests can help predict coronavirus disease 2019 (COVID-19) severity. Lower lymphocyte and platelet counts, along with higher neutrophil counts and neutrophil-to-lymphocyte ratio (NLR), indicate more severe COVID-19 cases.
Area of Science:
- Hematology
- Infectious Diseases
- Public Health
Background:
- The COVID-19 pandemic presents a significant global health challenge.
- The utility of routine blood test markers for predicting COVID-19 severity remains under-investigated.
Purpose of the Study:
- To conduct a meta-analysis assessing the association between routine blood test markers and COVID-19 severity.
- To determine if specific blood markers can aid in monitoring and predicting patient outcomes.
Main Methods:
- A systematic literature search was performed across multiple databases (PubMed, Embase, Cochrane Library, Wanfang, CNKI) up to March 20, 2020.
- Meta-analysis was conducted using STATA software on data from 15 studies involving 3090 COVID-19 patients.
Main Results:
- Severe COVID-19 cases exhibited higher white blood cell, neutrophil, and platelet counts compared to non-severe cases.
- Non-severe cases showed higher lymphocyte counts and a lower neutrophil-to-lymphocyte ratio (NLR).
- Monocyte counts did not significantly differ between severity groups.
Conclusions:
- Elevated neutrophils, higher NLR, and lower lymphocytes are associated with severe COVID-19.
- Routine blood markers can potentially assist clinicians in monitoring and predicting COVID-19 severity and prognosis.
Introduction:
The ongoing worldwide pandemic of coronavirus disease 2019 (COVID‑19) has posed a huge threat to global public health. However, the issue as to whether routine blood tests could be used to monitor and predict the severity and prognosis of COVID‑19 has not been comprehensively investigated so far.
Objectives:
This study aimed to provide an overview of the association of markers in the routine blood test with the severity of COVID‑19.
Methods:
PubMed, Embase, Cochrane Library, Wanfang, and China National Knowledge Infrastructure (CNKI) databases were searched to identify studies reporting data on markers in the routine blood test and the severity of COVID‑19, published until March 20, 2020. The STATA software was used for meta‑analysis.
Results:
A total of 15 studies with 3090 patients with COVID‑19 were included in this analysis. Patients in the nonsevere group, compared with those in the severe group, had lower counts of white blood cells (weighted mean difference [WMD], -0.85 [×109/l]; 95% CI, -1.54 to -0.16; P = 0.02) and neutrophils (WMD, -1.57 [×109/l]; 95% CI, -2.6 to -0.54; P = 0.003), greater counts of lymphocytes (WMD, 0.29 [×109/l]; 95% CI, 0.22-0.36; P <0.001) and platelets (WMD, 19.05 [×109/l]; 95% CI, 3.04-35.06; P = 0.02), and a lower neutrophil‑to‑lymphocyte (NLR) ratio (WMD, -2.48; 95% CI, -3.81 to -1.15; P <0.001). There was no difference in the monocyte count (WMD, 0.01 [×109/l]; 95% CI, -0.01 to 0.03; P = 0.029) between these 2 groups. Sensitivity analysis and meta‑analysis based on standard mean difference did not change the conclusions regarding neutrophils, lymphocytes, and NLR, but yielded inconsistent results for white blood cells and platelets.
Conclusions:
Severe patients had more neutrophils, higher NLR level, and fewer lymphocytes than non-severe patients with COVID-19. Measurement of these markers might assist clinicians to monitor and predict the severity and prognosis of COVID-19.
