scholarly journals Lymphocytopaenia is associated with severe SARS-CoV-2 disease: A Systematic Review and Meta-Analysis of Clinical Data

2020 ◽  
Author(s):  
Robin Brown ◽  
Jane Barnard ◽  
Eva Harris-Skillman ◽  
Bronwen Harbinson ◽  
Beata Dunne ◽  
...  
Keyword(s):  
Systematic Review ◽  
Lymphocyte Count ◽  
Distress Syndrome ◽  
Meta Analysis ◽  
Severe Disease ◽  
Wilcoxon Test ◽  
Laboratory Measure ◽  
Patients At Risk ◽  
Poor Outcomes ◽  
Definition Of

ABSTRACTBackgroundMost patients infected by SARS-CoV-2 have favourable outcomes, however some develop severe disease which may progress to acute respiratory distress syndrome, multi-organ failure, and death. Markers that could predict patients at risk of poor outcomes would be extremely useful clinically. Evidence has emerged that low lymphocyte count is associated with increased disease severity.MethodsWe performed a systematic review and meta-analysis to assess the association between lymphocyte count and severity of SARS-CoV-2 associated clinical disease.ResultsSeven papers were included in the meta-analysis. These papers included data from 2083 patients, 25% (n=521) with severe SAR-CoV-2 disease and 75% (n=1562) with non-severe SAR-CoV-2 disease. Heterogenicity was seen in the definition of severe disease. Metanalysis produced metamedians of 1×109/L (95% CI 1-1.1) and 0.7×109/L (95% CI 0.63-0.8) lymphocytes for patients with non-severe and severe disease respectively (p-value of p=0.006 Wilcoxon test). Calculation of metamedians from the two papers classifying severe disease according to death alone gave 1.1 1×109/L lymphocytes (95% CI 1.0-1.1) for ‘survivors’ (n=163) and 0.63 1×109/L lymphocytes (95% CI 0.60-0.63) for ‘non-survivors’ (n=253) of SAR-CoV-2 disease.ConclusionsLower lymphocyte counts are significantly associated with more severe disease in patients with SARS-CoV-2 infection. Lymphocytopenia may therefore be useful laboratory measure to allow prognostication of patients presenting with SARS-CoV-2 infection.

scholarly journals Biomarkers and outcomes of COVID-19 hospitalisations: systematic review and meta-analysis

2020 ◽  
pp. bmjebm-2020-111536
Author(s):  
Preeti Malik ◽  
Urvish Patel ◽  
Deep Mehta ◽  
Nidhi Patel ◽  
Raveena Kelkar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Severe Disease ◽  
Invasive Mechanical Ventilation ◽  
Mesh Terms ◽  
Hospitalised Patients ◽  
Poor Outcomes ◽  
D Dimer

ObjectiveTo evaluate association between biomarkers and outcomes in COVID-19 hospitalised patients. COVID-19 pandemic has been a challenge. Biomarkers have always played an important role in clinical decision making in various infectious diseases. It is crucial to assess the role of biomarkers in evaluating severity of disease and appropriate allocation of resources.Design and settingSystematic review and meta-analysis. English full text observational studies describing the laboratory findings and outcomes of COVID-19 hospitalised patients were identified searching PubMed, Web of Science, Scopus, medRxiv using Medical Subject Headings (MeSH) terms COVID-19 OR coronavirus OR SARS-CoV-2 OR 2019-nCoV from 1 December 2019 to 15 August 2020 following Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines.ParticipantsStudies having biomarkers, including lymphocyte, platelets, D-dimer, lactate dehydrogenase (LDH), C reactive protein (CRP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, procalcitonin (PCT) and creatine kinase (CK), and describing outcomes were selected with the consensus of three independent reviewers.Main outcome measuresComposite poor outcomes include intensive care unit admission, oxygen saturation <90%, invasive mechanical ventilation utilisation, severe disease, in-hospital admission and mortality. The OR and 95% CI were obtained and forest plots were created using random-effects models. Publication bias and heterogeneity were assessed by sensitivity analysis.Results32 studies with 10 491 confirmed COVID-19 patients were included. We found that lymphopenia (pooled-OR: 3.33 (95% CI: 2.51–4.41); p<0.00001), thrombocytopenia (2.36 (1.64–3.40); p<0.00001), elevated D-dimer (3.39 (2.66–4.33); p<0.00001), elevated CRP (4.37 (3.37–5.68); p<0.00001), elevated PCT (6.33 (4.24–9.45); p<0.00001), elevated CK (2.42 (1.35–4.32); p=0.003), elevated AST (2.75 (2.30–3.29); p<0.00001), elevated ALT (1.71 (1.32–2.20); p<0.00001), elevated creatinine (2.84 (1.80–4.46); p<0.00001) and LDH (5.48 (3.89–7.71); p<0.00001) were independently associated with higher risk of poor outcomes.ConclusionOur study found a significant association between lymphopenia, thrombocytopenia and elevated levels of CRP, PCT, LDH, D-dimer and COVID-19 severity. The results have the potential to be used as an early biomarker to improve the management of COVID-19 patients, by identification of high-risk patients and appropriate allocation of healthcare resources in the pandemic.

scholarly journals Risk Factors for Severe Disease and Efficacy of Treatment in Patients Infected With COVID-19: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis

2020 ◽  
Vol 71 (16) ◽  
pp. 2199-2206 ◽  
Author(s):  
John J Y Zhang ◽  
Keng Siang Lee ◽  
Li Wei Ang ◽  
Yee Sin Leo ◽  
Barnaby Edward Young
Keyword(s):  
Systematic Review ◽  
Distress Syndrome ◽  
Leukocyte Count ◽  
Meta Analysis ◽  
Severe Disease ◽  
Icu Admission ◽  
Meta Regression ◽  
Meta Regression Analysis ◽  
In The Beginning ◽  
Elevated Lactate

Abstract The coronavirus disease 2019 (COVID-19) pandemic spread globally in the beginning of 2020. At present, predictors of severe disease and the efficacy of different treatments are not well understood. We conducted a systematic review and meta-analysis of all published studies up to 15 March 2020, which reported COVID-19 clinical features and/or treatment outcomes. Forty-five studies reporting 4203 patients were included. Pooled rates of intensive care unit (ICU) admission, mortality, and acute respiratory distress syndrome (ARDS) were 10.9%, 4.3%, and 18.4%, respectively. On meta-regression, ICU admission was predicted by increased leukocyte count (P &lt; .0001), alanine aminotransferase (P = .024), and aspartate transaminase (P = .0040); elevated lactate dehydrogenase (LDH) (P &lt; .0001); and increased procalcitonin (P &lt; .0001). ARDS was predicted by elevated LDH (P &lt; .0001), while mortality was predicted by increased leukocyte count (P = .0005) and elevated LDH (P &lt; .0001). Treatment with lopinavir-ritonavir showed no significant benefit in mortality and ARDS rates. Corticosteroids were associated with a higher rate of ARDS (P = .0003).

scholarly journals Multiorgan Failure With Emphasis on Acute Kidney Injury and Severity of COVID-19: Systematic Review and Meta-Analysis

2020 ◽  
Vol 7 ◽  
pp. 205435812093857 ◽  
Author(s):  
Michael Anthonius Lim ◽  
Raymond Pranata ◽  
Ian Huang ◽  
Emir Yonas ◽  
Arto Yuwono Soeroto ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Cardiovascular Diseases ◽  
Acute Liver Injury ◽  
Meta Analysis ◽  
Kidney Injury ◽  
Composite Outcome ◽  
Poor Outcomes ◽  
Definition Of

Background: Abnormalities in hematologic, biochemical, and immunologic biomarkers have been shown to be associated with severity and mortality in Coronavirus Disease 2019 (COVID-19). Therefore, early evaluation and monitoring of both liver and kidney functions, as well as hematologic parameters, are pivotal to forecast the progression of COVID-19. Objectives: In this study, we performed a systematic review and meta-analysis to investigate the association between several complications, including acute kidney injury (AKI), acute liver injury (ALI), and coagulopathy, with poor outcomes in COVID-19. Design: Systematic review and meta-analysis Setting: Observational studies reporting AKI, ALI, and coagulopathy along with the outcomes of clinically validated death, severe COVID-19, or intensive care unit (ICU) care were included in this study. The exclusion criteria were abstract-only publications, review articles, commentaries, letters, case reports, non-English language articles, and studies that did not report key exposures or outcomes of interest. Patients: Adult patients diagnosed with COVID-19. Measurements: Data extracted included author, year, study design, age, sex, cardiovascular diseases, hypertension, diabetes mellitus, respiratory comorbidities, chronic kidney disease, mortality, severe COVID-19, and need for ICU care. Methods: We performed a systematic literature search from PubMed, SCOPUS, EuropePMC, and the Cochrane Central Database. AKI and ALI follow the definition of the included studies. Coagulopathy refers to the coagulopathy or disseminated intravascular coagulation defined in the included studies. The outcome of interest was a composite of mortality, need for ICU care, and severe COVID-19. We used random-effects models regardless of heterogeneity to calculate risk ratios (RRs) for dichotomous variables. Heterogeneity was assessed using I2. Random effects meta-regression was conducted for comorbidities and the analysis was performed for one covariate at a time. Results: There were 3615 patients from 15 studies. The mean Newcastle-Ottawa scale of the included studies was 7.3 ± 1.2. The AKI was associated with an increased the composite outcome (RR: 10.55 [7.68, 14.50], P < .001; I2: 0%). Subgroup analysis showed that AKI was associated with increased mortality (RR: 13.38 [8.15, 21.95], P < .001; I2: 24%), severe COVID-19 (RR: 8.12 [4.43, 14.86], P < .001; I2: 0%), and the need for ICU care (RR: 5.90 [1.32, 26.35], P = .02; I2: 0%). The ALI was associated with increased mortality (RR: 4.02 [1.51, 10.68], P = .005; I2: 88%) in COVID-19. Mortality was higher in COVID-19 with coagulopathy (RR: 7.55 [3.24, 17.59], P < .001; I2: 69%). The AKI was associated with the composite outcome and was not influenced by age ( P = .182), sex ( P = .104), hypertension ( P = .788), cardiovascular diseases ( P = .068), diabetes ( P = .097), respiratory comorbidity ( P = .762), and chronic kidney disease ( P = .77). Limitations: There are several limitations of this study. Many of these studies did not define the extent of AKI (grade), which may affect the outcome. Acute liver injury and coagulopathy were not defined in most of the studies. The definition of severe COVID-19 differed across studies. Several articles included in the study were published at preprint servers and are not yet peer-reviewed. Most of the studies were from China; thus, some patients might overlap across the reports. Most of the included studies were retrospective in design. Conclusions: This meta-analysis showed that the presence of AKI, ALI, and coagulopathy was associated with poor outcomes in patients with COVID-19.

scholarly journals Electrocardiography on admission is associated with poor outcomes in coronavirus disease 2019 (COVID‐19) patients: A systematic review and meta‐analysis

2021 ◽  
Author(s):  
Mochamad Yusuf Alsagaff ◽  
Yudi Her Oktaviono ◽  
Budi Baktijasa Dharmadjati ◽  
Achmad Lefi ◽  
Makhyan Jibril Al‐Farabi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Poor Outcomes

scholarly journals Cardiac biomarkers in acute respiratory distress syndrome: a systematic review and meta-analysis

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Dilip Jayasimhan ◽  
Simon Foster ◽  
Catherina L. Chang ◽  
Robert J. Hancox
Keyword(s):  
Systematic Review ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Cardiac Dysfunction ◽  
Distress Syndrome ◽  
Troponin I ◽  
Meta Analysis ◽  
Cardiac Injury ◽  
Cardiac Biomarkers ◽  
Risk Of Death

Abstract Background Acute respiratory distress syndrome (ARDS) is a leading cause of morbidity and mortality in the intensive care unit. Biochemical markers of cardiac dysfunction are associated with high mortality in many respiratory conditions. The aim of this systematic review is to examine the link between elevated biomarkers of cardiac dysfunction in ARDS and mortality. Methods A systematic review of MEDLINE, EMBASE, Web of Science and CENTRAL databases was performed. We included studies of adult intensive care patients with ARDS that reported the risk of death in relation to a measured biomarker of cardiac dysfunction. The primary outcome of interest was mortality up to 60 days. A random-effects model was used for pooled estimates. Funnel-plot inspection was done to evaluate publication bias; Cochrane chi-square tests and I2 tests were used to assess heterogeneity. Results Twenty-two studies were included in the systematic review and 18 in the meta-analysis. Biomarkers of cardiac stretch included NT-ProBNP (nine studies) and BNP (six studies). Biomarkers of cardiac injury included Troponin-T (two studies), Troponin-I (one study) and High-Sensitivity-Troponin-I (three studies). Three studies assessed multiple cardiac biomarkers. High levels of NT-proBNP and BNP were associated with a higher risk of death up to 60 days (unadjusted OR 8.98; CI 4.15-19.43; p<0.00001). This association persisted after adjustment for age and illness severity. Biomarkers of cardiac injury were also associated with higher mortality, but this association was not statistically significant (unadjusted OR 2.21; CI 0.94-5.16; p= 0.07). Conclusion Biomarkers of cardiac stretch are associated with increased mortality in ARDS.

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