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The dynamics of inflammatory markers in coronavirus disease-2019 (COVID-19) patients: A systematic review and
Roshan Kumar Mahat1, Suchismita Panda1, Vedika Rathore2
1Department of Biochemistry, Pandit Raghunath Murmu Medical College and Hospital, Baripada, Mayurbhanj, Odisha, 757107, India.
Insights
Elevated inflammatory markers like C-reactive protein (CRP) and interleukin-6 (IL-6) are linked to severe COVID-19 and higher mortality. Measuring these inflammatory parameters can help identify severe cases early for prompt treatment.
Area of Science:
- Immunology
- Infectious Diseases
- Critical Care Medicine
Background:
- Coronavirus disease-2019 (COVID-19) pandemic characterized by significant mortality.
- Severe COVID-19 outcomes are associated with SARS-CoV-2-induced hyperinflammation and cytokine storms.
- Need to identify reliable inflammatory markers for predicting COVID-19 severity and mortality.
Purpose of the Study:
- To systematically review and meta-analyze published studies.
- To evaluate the association between inflammatory parameters and COVID-19 severity.
- To assess the relationship between inflammatory parameters and COVID-19 mortality.
Main Methods:
- Comprehensive literature search of PubMed/Medline, Europe PMC, and Google Scholar (Jan-June 2020).
- Inclusion of observational studies with extractable data on inflammatory markers in laboratory-confirmed COVID-19 patients.
- Independent screening, data extraction, and quality assessment by two authors; calculation of standardized mean difference (SMD) or mean difference (MD/WMD) with 95% confidence intervals (CIs) using random or fixed-effects models.
Main Results:
- Meta-analysis included 83 studies (54 by severity, 25 by mortality).
- Severe COVID-19 patients showed significantly higher levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-2R (IL-2R), serum amyloid A (SAA), and neutrophil-to-lymphocyte ratio (NLR) compared to non-severe cases.
- Non-survivors had significantly higher levels of CRP, PCT, IL-6, ferritin, and NLR compared to survivors.
Conclusions:
- Specific inflammatory parameters are significantly elevated in severe and fatal COVID-19 cases.
- Measurement of these markers can aid physicians in early identification of high-risk COVID-19 patients.
- Early identification facilitates timely initiation of effective therapeutic interventions.
Background:
Coronavirus disease-2019 (COVID-19) is a global pandemic and high mortality rate among severe or critical COVID-19 is linked with SARS-CoV-2 infection-induced hyperinflammation of the innate and adaptive immune systems and the resulting cytokine storm. This paper attempts to conduct a systematic review and meta-analysis of published articles, to evaluate the association of inflammatory parameters with the severity and mortality in COVID-19 patients.
Methods:
A comprehensive systematic literature search of medical electronic databases including Pubmed/Medline, Europe PMC, and Google Scholar was performed for relevant data published from January 1, 2020 to June 26, 2020. Observational studies reporting clear extractable data on inflammatory parameters in laboratory-confirmed COVID-19 patients were included. Screening of articles, data extraction and quality assessment were carried out by two authors independently. Standardized mean difference (SMD)/mean difference (MD/WMD) and 95% confidence intervals (CIs) were calculated using random or fixed-effects models.
Results:
A total of 83 studies were included in the meta-analysis. Of which, 54 studies were grouped by severity, 25 studies were grouped by mortality, and 04 studies were grouped by both severity and mortality. Random effect model results demonstrated that patients with severe COVID-19 group had significantly higher levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-2R (IL-2R), serum amyloid A (SAA) and neutrophil-to-lymphocyte ratio (NLR) compared to those in the non-severe group. Similarly, the fixed-effect model revealed significant higher ferritin level in the severe group when compared with the non-severe group. Furthermore, the random effect model results demonstrated that the non-survivor group had significantly higher levels of CRP, PCT, IL-6, ferritin, and NLR when compared with the survivor group.
Conclusion:
In conclusion, the measurement of these inflammatory parameters could help the physicians to rapidly identify severe COVID-19 patients, hence facilitating the early initiation of effective treatment.
Prospero Registration Number:
CRD42020193169.
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