C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis

Abstract

<jats:sec><jats:title>Background:</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> 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. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> 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 &lt; 0.001; I<jats:sup>2</jats:sup>: 96%] and its severe COVID-19 (RR 1.41; I<jats:sup>2</jats:sup>: 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 &lt; 0.001; I<jats:sup>2</jats:sup>: 85%] and its mortality (RR 6.26; I<jats:sup>2</jats:sup>: 96%) and severe COVID-19 (RR 3.93; I<jats:sup>2</jats:sup>: 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 &lt; 0.001; I<jats:sup>2</jats:sup>: 77%], including its mortality (RR 4.15; I<jats:sup>2</jats:sup>: 83%) and severe COVID-19 (RR 2.42; I<jats:sup>2</jats:sup>: 58%) subgroups. A D-dimer &gt;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 &lt; 0.0001; I<jats:sup>2</jats:sup>: 76%. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> 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. </jats:p></jats:sec>

Comparison of Clinical, Para-clinical and Laboratory Findings in Survived and Deceased Patients with COVID-19: Diagnostic Role of Inflammatory Indications in Determining the Severity of Illness

“…Therefore, indicators of systemic in ammation such as NLR, PLR and SII may be utilized to predict disease severity, outcome, and mortality of COVID-19. Acute phase proteins such as CRP, LDH, ferritin, procalcitonin, D-Dimer, ESR and IL-6 have also been well correlated with the disease severity, progression and poor outcome in COVID-19 [30]. In our study, CRP protein did not show any signi cant difference between survival and deceased groups.…”

Charlson comorbidity index and a composite of poor outcomes in COVID-19 patients: A systematic review and meta-analysis

“…Various biomarkers such as C-reactive protein (CRP), D-dimer, procalcitonin, and ferritin, are often elevated in severe COVID-19 cases and evaluation of these parameters can be useful in predicting severe outcomes and complications during such pandemic [ 47 ]. Lymphopenia was also shown to be associated with higher mortality [ 48 ].…”

The Association Between Chronic Kidney Disease and New Onset Renal Replacement Therapy on the Outcome of COVID-19 Patients: A Meta-analysis

“…In the context of cytokine storm syndrome (CSS) with AKI and multi-organ failure in severe COVID-19, 41,42 there is a growing interest in using cytokine filtration through the extracorporeal techniques, including the high cutoff (HCO) membrane and CytoSorb. 43 Both blood purification strategies are considered effective in reducing inflammatory cytokines (especially IL-6), 44 but whether these approaches can effectively reduce mortality and severity in patients with COVID-19 is still unknown.…”

“…Hypercoagulable state is considered as a hallmark of severe COVID-19 as depicted by the increased of serum D-dimer values and high rate of blood circuit failures in the process of RRT. 41,46,47 While regional citrate anticoagulation has been universally used in CRRT because of its efficacy in terms of prolonging the extracorporeal circuit lifespan and decreasing the risk of bleeding, 45 it has not been demonstrated to be as effective in COVID-19 as in other patients. 47 Furthermore, the discovery of the mortality benefits using heparin-based anticoagulation approach leads to a further question whether this citrate-based anticoagulation in CRRT is the best approach in patients with severe COVID-19.…”