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Published on: November 10, 2023
A meta-analysis of potential biomarkers associated with severity of coronavirus disease 2019 (COVID-19)
Celestin Danwang1, Francky Teddy Endomba2,3, Jan René Nkeck4
1Epidemiology and Biostatistics Unit, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.
Insights
Certain inflammatory, hematologic, and biochemical markers are linked to severe Coronavirus disease 2019 (COVID-19). These indicators can aid in assessing patient prognosis and risk stratification for COVID-19.
Area of Science:
- Medical research
- Clinical diagnostics
- Infectious disease epidemiology
Background:
- Prognostic factors for Coronavirus disease 2019 (COVID-19) require further elucidation.
- Understanding these factors is crucial for effective patient management and outcome prediction.
Purpose of the Study:
- To systematically review and synthesize data on the association between COVID-19 severity and common hematological, inflammatory, and biochemical parameters.
- To identify key biomarkers indicative of severe COVID-19 cases.
Main Methods:
- A comprehensive literature search was conducted across EMBASE, MEDLINE, and Web of Science databases.
- Random-effects meta-analysis was employed to pool effect sizes from eligible studies.
Main Results:
- Meta-analysis revealed significantly elevated levels of CK-MB, troponin I, D-dimer, procalcitonin, CRP, ASAT, LDH, and other markers in severe COVID-19 cases.
- Conversely, lymphocyte counts, proportion of lymphocytes, thrombocytes, eosinophils, hemoglobin, and albuminemia were significantly lower in severe cases.
- Severe COVID-19 patients exhibited a higher risk of lymphopenia, thrombocytopenia, and elevated procalcitonin, CRP, ASAT, CK, creatininemia, and LDH levels.
Conclusions:
- Specific inflammatory (procalcitonin, CRP), hematologic (lymphocyte, thrombocytes), and biochemical (CK-MB, Troponin I, D-dimer, ASAT, ALAT, LDH, γ-GT) biomarkers are strongly associated with severe COVID-19.
- These identified biomarkers hold potential for prognostic risk stratification in patients diagnosed with COVID-19.
Background:
Prognostic factors for the Coronavirus disease 2019 (COVID1-9) are not well established. This study aimed to summarize the available data on the association between the severity of COVID-19 and common hematological, inflammatory and biochemical parameters.
Methods:
EMBASE, MEDLINE, Web of sciences were searched to identify all published studies providing relevant data. Random-effects meta-analysis was used to pool effect sizes.
Results:
The bibliographic search yielded 287 citations, 31 of which were finally retained. Meta-analysis of standardized mean difference (SMD) between severe and non-severe COVID-19 cases showed that CK-MB (SMD = 0.68,95%CI: 0.48;0.87; P-value:< 0.001), troponin I (SMD = 0.71, 95%CI:0.42;1.00; P-value:< 0.001), D-dimer (SMD = 0.54,95%CI:0.31;0.77; P-value:< 0.001), prothrombin time (SMD = 0.48, 95%CI:0.23;0.73; P-value: < 0.001), procalcitonin (SMD = 0.72, 95%CI: 0.34;1,11; P-value:< 0.001), interleukin-6 (SMD = 0.93, 95%CI: 0.25;1.61;P-value: 0.007),C-reactive protein (CRP) (SMD = 1.34, 95%CI:0.83;1.86; P-value:< 0.001), ALAT (SMD = 0.53, 95%CI: 0.34;0,71; P-value:< 0.001), ASAT (SMD = 0.96, 95%CI: 0.58;1.34; P-value: < 0.001), LDH (SMD = 1.36, 95%CI: 0.75;1.98; P-value:< 0.001), CK (SMD = 0.48, 95%CI: 0.10;0.87; P-value:0.01), total bilirubin (SMD = 0.32, 95%CI: 0.18;0.47;P-value: < 0.001), γ-GT (SMD = 1.03, 95%CI: 0.83;1.22; P-value: < 0.001), myoglobin (SMD = 1.14, 95%CI: 0.81;1.47; P-value:< 0.001), blood urea nitrogen (SMD = 0.32, 95%CI: 0.18;0.47;P-value:< 0.001) and Creatininemia (SMD = 0.18, 95%CI: 0.01;0.35; P-value:0.04) were significantly more elevated in severe cases, in opposition to lymphocyte count (SMD = -0.57, 95%CI:-0.71; - 0.42; P-value: < 0.001) and proportion of lymphocytes (SMD = -0.81, 95%CI: - 1.12; - 0.49; P-value:< 0.001) which were found to be significantly lower in severe patients with other biomarker such as thrombocytes (SMD = -0.26, 95%CI: - 0.48; - 0.04; P-value:0.02), eosinophils (SMD = - 0.28, 95%CI:-0.50; - 0.06; P-value:0.01), haemoglobin (SMD = -0.20, 95%CI: - 0.37,-0.03; P-value:0.02), albuminemia (SMD-1.67,95%CI -2.40; - 0.94; P-value:< 0.001), which were also lower. Furthermore, severe COVID-19 cases had a higher risk to have lymphopenia (RR =1.66, 95%CI: 1.26;2.20; P-value:0.002), thrombocytopenia (RR = 1.86, 95%CI: 1.59;2.17; P-value: < 0.001), elevated procalcitonin level (RR = 2.94, 95%CI: 2.09-4.15; P-value:< 0.001), CRP (RR =1.41,95%CI: 1.17-1.70; P-value:0.003), ASAT(RR =2.27, 95%CI: 1.76;2.94; P-value:< 0.001), CK(RR = 2.61, 95%CI: 1.35;5.05; P-value: 0.01), Creatininemia (RR = 3.66, 95%CI: 1.53;8.81; P-value: 0.02) and LDH blood level (RR = 2.03, 95%CI: 1.42;290; P-value: 0.003).
Conclusion:
Some inflammatory (procalcitonin, CRP), haematologic (lymphocyte, Thrombocytes), and biochemical (CK-MB, Troponin I, D-dimer, ASAT, ALAT, LDH, γ-GT) biomarkers are significantly associated with severe COVID-19. These biomarkers might help in prognostic risk stratification of patients with COVID-19.
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