Can we predict the severity of COVID-19 with a routine blood test?

Zeng, Furong; Li, Linfeng; Zeng, Jiling; Deng, Yuping; Huang, Huining; Chen, Bin; Deng, Guangtong

doi:10.20452/pamw.15331

Cited by 89 publications

(117 citation statements)

References 11 publications

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“…Therefore, NLR, a cost-effective marker can be easily calculated from peripheral blood routine tests, and may be associated with the progression and prognosis of COVID-19. There were few meta-analyses pointing out patients with severe COVID-19 had a higher NLR than those with non-severe COVID-19 [51][52][53][54]. However, none of them evaluated the predictive values of NLR on disease severity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis

Liu

Mao

et al. 2020

Preprint

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Background：Coronavirus disease 2019 (COVID-19), a highly infectious disease, has been rapidly spreading all over the world and posted a great threat to global public health. Patients diagnosed with severe or critical cases have a poor prognosis. Hence, it is crucial for us to identify potential severe or critical cases early, and give timely treatments for the targeted patients. In the clinical practice of treating COVID-19 patients, we have observed that the neutrophil-to-lymphocyte ratio (NLR) of severe patients is higher than that in mild patients. We performed this systematic review and meta-analysis to evaluate the predictive values of NLR on disease severity and mortality in COVID-19 patients. Methods: We searched PubMed, EMBASE, China National Knowledge Infrastructure (CNKI) and Wanfang databases to identify eligible studies (up to August 11, 2020). Two authors independently screened studies and extracted data. The methodological quality of the included studies was assessed by Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2).Results: Thirteen studies involving 1579 patients reported the predictive value of NLR on disease severity. The pooled sensitivity (SEN), specificity (SPE) and area under curve (AUC) were 0.78 (95% CI 0.70-0.84), 0.78 (95% CI 0.73-0.83) and 0.85 (95% CI 0.81-0.88), respectively. Ten studies involving 2967 patients reported the predictive value of NLR on mortality. The pooled SEN, SPE and AUC were 0.83 (95% CI 0.75-0.89), 0.83 (95% CI 0.74-0.89) and 0.90 (95% CI 0.87-0.92), respectively. Conclusions: NLR has good predictive values on disease severity and mortality in COVID-19 patients. Evaluating NLR can help clinicians identify potentially severe cases early, conduct early triage and initiate effective management in time, which may reduce the overall mortality of COVID-19. Moreover, we can better allocate scarce medical resources in this unprecedented time. Trial registration: This meta-analysis was prospectively registered on PROSPERO database (Registration number: CRD42020203612).

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Section: Discussionmentioning

confidence: 99%

Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis

Liu

Mao

et al. 2020

Preprint

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“…We did not apply any restriction on language or study design. We also manually reviewed the reference lists of all included studies and major review and meta-analyses for further potentially relevant articles [15] . The identifier of systematic review registration was PROSPERO CRD42020184995.…”

Section: Methodsmentioning

confidence: 99%

“…Sensitivity analysis was performed by omitting one study each time through influence analysis to assess the stability of results. Egger test was used to evaluate publication bias and the Duval and Tweedie trim-and-fill method was implemented to adjust for this bias [15] . P < 0.05 was considered statistically significant.…”

Section: Methodsmentioning

confidence: 99%

Prognostic value of liver biochemical parameters for COVID-19 mortality

Lin

Chen²,

Wang

et al. 2021

Annals of Hepatology

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Introduction Coronavirus Disease 2019 (COVID-19) has brought great challenges to global public health. However, a comprehensive analysis of the relationship between liver biochemical parameters and COVID-19 mortality is quite limited. Methods We searched the following electronic databases: PubMed, Embase, Cochrane Library, Web of Science, Scopus, Wanfang and China National Knowledge Infrastructure database until May 5, 2020. STATA software was used for the statistical analyses. Results A total of 25 studies involving 5971 COVID-19 patients were included in our analysis. Compared with non-survivors, survivors had lower levels of aspartate aminotransferase (AST) (weighted mean difference [WMD] = -16.71 U/L, 95%CI = [-21.03, -12.40], P < 0.001), alanine transaminase (ALT) (WMD = -5.20U/L, 95%CI = [-8.00, -2.41], P < 0.001), total bilirubin (TBIL) (WMD = 4.40μmol/L, 95%CI = [-5.11, -3.70], P < 0.001) and lactic dehydrogenase (LDH) (WMD = -252.44U/L, 95%CI = [-289.57, -215.30], P < 0.001), and higher albumin (ALB) level (WMD = 4.47 g/L, 95%CI = [3.47, 5.47], P < 0.001). Besides, survivors had lower proportions of these abnormally increased parameters (AST: OR = 0.25, 95%CI = [0.15, 0.41], P < 0.001; ALT: OR = 0.49, 95%CI = [0.37, 0.64], P < 0.001; TBIL: (OR = 0.20, 95%CI = [0.12, 0.34], P < 0.001; LDH, OR = 0.09, 95%CI = [0.06, 0.14], P < 0.001), and lower proportion of abnormally decreased ALB (OR = 0.16, 95%CI = [0.07, 0.38], P < 0.001). Meta-analysis based on standard mean difference and sensitivity analysis did not change the conclusions. Egger test did not detect the presence of publication bias. Conclusions Liver biochemical parameters were strongly correlated with COVID-19 mortality. Measurement of these liver biochemical parameters might assist clinicians to evaluate the prognosis of COVID-19.

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“…A recent meta-analysis (50) concluded that severe COVID-19 patients had higher neutrophil counts and NLR, and lower lymphocyte counts than those with non-severe COVID-19, and that these basic parameters might help clinicians to predict the severity and prognosis of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

A novel haemocytometric COVID-19 prognostic score developed and validated in an observational multicentre European hospital-based study

Linssen

Ermens

Berrevoets

et al. 2020

Preprint

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COVID-19 induces haemocytometric changes. Complete blood count changes, including new cell activation parameters, from 982 confirmed COVID-19 adult patients from 11 European hospitals were retrospectively analysed for distinctive patterns based on age, gender, clinical severity, symptom duration and hospital days. The observed haemocytometric patterns formed the basis to develop a multi-haemocytometric-parameter prognostic score to predict, during the first three days after presentation, which patients will recover without ventilation or deteriorate within a two-week timeframe, needing intensive care or with fatal outcome. The prognostic score, with ROC curve AUC at baseline of 0.753 (95% CI 0.723-0.781) increasing to 0.875 (95% CI 0.806-0.926) on day 3, was superior to any individual parameter at distinguishing between clinical severity. Findings were confirmed in a validation cohort. Aim is that the score and haemocytometry results are simultaneously provided by analyser software, enabling wide applicability of the score as haemocytometry is commonly requested in COVID-19 patients.

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Can we predict the severity of COVID-19 with a routine blood test?

Cited by 89 publications

References 11 publications

Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis

Predictive values of neutrophil-to-lymphocyte ratio on disease severity and mortality in COVID-19 patients: a systematic review and meta-analysis

Prognostic value of liver biochemical parameters for COVID-19 mortality

A novel haemocytometric COVID-19 prognostic score developed and validated in an observational multicentre European hospital-based study

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