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Clinical and Laboratory Predictors of Severity, Criticality, and Mortality in COVID-19: A Multisystem Disease
Bahareh Gholami1,2, Samira Gholami1,3, Amir Hossein Loghman1,4
1Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
Insights
Key laboratory markers like white blood cell count and D-dimer can help predict severe COVID-19 outcomes. Identifying these correlates aids in developing crucial risk stratification tools for the ongoing pandemic.
Area of Science:
- Medical Research
- Infectious Diseases
- Clinical Diagnostics
Background:
- The COVID-19 pandemic has severely impacted global healthcare systems.
- There is an urgent need for effective risk stratification tools for COVID-19 patients.
- Understanding laboratory and clinical correlates of adverse outcomes is crucial.
Purpose of the Study:
- To identify laboratory and clinical factors associated with severe, critical, and fatal outcomes in COVID-19 patients.
- To compare these parameters between different disease severity groups (severe vs. non-severe, critical vs. non-critical, survivors vs. non-survivors).
- To synthesize findings from multiple studies to inform risk prediction.
Main Methods:
- Systematic evaluation of 54 studies investigating laboratory abnormalities in COVID-19 patients.
- Comparative analysis of laboratory values and clinical conditions across different patient outcomes.
- Meta-analyses to identify predictive laboratory parameters.
Main Results:
- Severe COVID-19 cases showed elevated white blood cells (WBC), polymorphonuclear leukocytes (PMN), total bilirubin, alanine aminotransferase (ALT), creatinine, troponin, procalcitonin, lactate dehydrogenase (LDH), and D-dimer.
- Decreased platelet count, lymphocyte count, and albumin levels were observed in severe cases.
- Higher prevalence of comorbidities like diabetes, heart disease, COPD, CKD, and hypertension in severe and non-survivor groups.
- Non-survivors had elevated WBC, PMN, total bilirubin, ALT, procalcitonin, IL-6, creatinine, PT, lymphocyte count, platelet count, and albumin compared to survivors.
Conclusions:
- Several laboratory parameters, including WBC, PMN, bilirubin, ALT, creatinine, procalcitonin, LDH, and D-dimer, are significant correlates of severe COVID-19.
- These markers reflect immune system function, inflammation, coagulation, and organ function (liver, kidney).
- The identified correlates can aid in developing predictive models for COVID-19 severity and patient outcomes.
Abstract:
Coronavirus disease 2019 (COVID-19) pandemic continues devastating effects on healthcare systems. Such a crisis calls for an urgent need to develop a risk stratification tool. The present chapter aimed to identify laboratory and clinical correlates of adverse outcomes in patients with COVID-19. To this end, we conducted a systematic evaluation of studies that investigated laboratory abnormalities in patients with COVID-19 and compared i. patients with a severe form of disease and patients with a non-severe form of the disease, ii. patients who were in critical condition and patients who were not in critical condition, and iii. patients who survived and patients who died. We included 54 studies in the data synthesis. Compared to patients with a non-severe form of COVID-19, patients who had a severe form of disease revealed higher values for white blood cells (WBC), polymorphonuclear leukocytes (PMN), total bilirubin, alanine aminotransferase (ALT), creatinine, troponin, procalcitonin, lactate dehydrogenase (LDH), and D-dimer. By contrast, platelet count, lymphocyte count, and albumin levels were decreased in patients with a severe form of COVID-19. Also, patients with a severe phenotype of disease were more likely to have diabetes, chronic heart disease, chronic obstructive pulmonary disease (COPD), cerebrovascular disease, hypertension, chronic kidney disease (CKD), and malignancy. Compared to patients who survived, patients who died had higher WBC, PMN, total bilirubin, ALT, procalcitonin, IL-6, creatinine, PT, lymphocyte count, platelet count, and albumin. Also, non-survivors revealed a higher prevalence of diabetes, chronic heart disease, COPD, cerebrovascular disease, and CKD. Meta-analyses identified several laboratory parameters that might help the prediction of severe, critical, and lethal phenotypes of COVID-19. These parameters correlate with the immune system function, inflammation, coagulation, and liver and kidney function.
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