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C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis
Ian Huang1,2, Raymond Pranata3, Michael Anthonius Lim2
1Department of Internal Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia.
Insights
Elevated biomarkers including C-reactive protein (CRP), procalcitonin (PCT), D-dimer, and ferritin are linked to poor outcomes in critically ill COVID-19 patients. These findings aid in risk stratification for coronavirus disease-2019 severity.
Area of Science:
- Biochemistry
- Clinical Medicine
- Epidemiology
Background:
- Critically ill patients with COVID-19 often exhibit hyperinflammation.
- Biomarkers may assist in stratifying risk among these patients.
- Investigating specific biomarkers for COVID-19 severity is crucial.
Purpose of the Study:
- To investigate the association between serum biomarkers and COVID-19 severity.
- To evaluate C-reactive protein (CRP), procalcitonin (PCT), D-dimer, and serum ferritin as predictors of poor outcomes.
Main Methods:
- A systematic literature search was conducted across electronic databases.
- A meta-analysis was performed pooling data from 25 studies.
- The composite poor outcome (mortality, ARDS, ICU admission, severe COVID-19) was the primary endpoint.
Main Results:
- Elevated CRP, PCT, and D-dimer were significantly associated with increased composite poor outcomes in COVID-19 patients.
- Higher serum ferritin levels were also observed in patients with poor outcomes.
- Specific thresholds for CRP, PCT, and D-dimer demonstrated diagnostic utility for predicting severe COVID-19 outcomes.
Conclusions:
- Elevated serum CRP, PCT, D-dimer, and ferritin are associated with poor outcomes in COVID-19.
- These biomarkers can be valuable tools for risk stratification in COVID-19 patients.
- Further research can refine the use of these biomarkers in clinical decision-making.
Background:
Patients critically ill with coronavirus disease-2019 (COVID-19) feature hyperinflammation, and the associated biomarkers may be beneficial for risk stratification. We aimed to investigate the association between several biomarkers, including serum C-reactive protein (CRP), procalcitonin (PCT), D-dimer, and serum ferritin, and COVID-19 severity.
Methods:
We performed a comprehensive systematic literature search through electronic databases. The outcome of interest for this study was the composite poor outcome, which comprises mortality, acute respiratory distress syndrome, need for care in an intensive care unit, and severe COVID-19.
Results:
A total of 5350 patients were pooled from 25 studies. Elevated CRP was associated with an increased composite poor outcome [risk ratio (RR) 1.84 (1.45, 2.33), p < 0.001; I2: 96%] and its severe COVID-19 (RR 1.41; I2: 93%) subgroup. A CRP ⩾10 mg/L has a 51% sensitivity, 88% specificity, likelihood ratio (LR) + of 4.1, LR- of 0.5, and an area under curve (AUC) of 0.84. An elevated PCT was associated with an increased composite poor outcome [RR 3.92 (2.42, 6.35), p < 0.001; I2: 85%] and its mortality (RR 6.26; I2: 96%) and severe COVID-19 (RR 3.93; I2: 63%) subgroups. A PCT ⩾0.5 ng/ml has an 88% sensitivity, 68% specificity, LR+ of 2.7, LR- of 0.2, and an AUC of 0.88. An elevated D-dimer was associated with an increased composite poor outcome [RR 2.93 (2.14, 4.01), p < 0.001; I2: 77%], including its mortality (RR 4.15; I2: 83%) and severe COVID-19 (RR 2.42; I2: 58%) subgroups. A D-dimer >0.5 mg/L has a 58% sensitivity, 69% specificity, LR+ of 1.8, LR- of 0.6, and an AUC of 0.69. Patients with a composite poor outcome had a higher serum ferritin with a standardized mean difference of 0.90 (0.64, 1.15), p < 0.0001; I2: 76%.
Conclusion:
This meta-analysis showed that an elevated serum CRP, PCT, D-dimer, and ferritin were associated with a poor outcome in COVID-19. The reviews of this paper are available via the supplemental material section.
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