Laboratory Tests and Outcome for Patients with Coronavirus Disease 2019: A Systematic Review and Meta-Analysis

Abstract

Background Severe acute respiratory syndrome coronavirus 2 (COVID-19) poses substantial challenges for health care systems. With a vastly expanding amount of publications on COVID-19, clinicians need evidence synthesis to produce guidance for handling patients with COVID-19. In this systematic review and meta-analysis, we examine which routine laboratory tests are associated with severe COVID-19 disease. Content PubMed (Medline), Scopus, and Web of Science were searched until the 22nd of March 2020 for studies on COVID-19. Eligible studies were original articles reporting on laboratory tests and outcome of patients with COVID-19. Data were synthesised and we conducted random effects meta-analysis and estimated mean difference (MD) and standard mean difference at biomarker level for disease severity. Risk of bias and applicability concern was evaluated using the Quality Assessment of Diagnostic Accuracy Studies -2. Summary 45 studies were included, of which 21 publications were used for the meta-analysis. Studies were heterogeneous, but had low risk of bias and applicability concern in terms of patient selection and reference standard. Severe disease was associated with higher white blood cell count (MD 1.28 x 109/L), neutrophil count (MD 1.49 x 109/L), C-reactive protein (MD 49.2 mg/L), lactate dehydrogenase (MD 196 U/L), D-dimer (SMD 0.58), and aspartate aminotransferase (MD 8.5 U/L), all p < 0.001. Furthermore, low lymphocyte count (MD -0.32 x 109/L), platelet count (MD -22.4 x 109/L), and haemoglobin (MD -4.1 g/L), all p < 0.001, were also associated with severe disease. In conclusion, several routine laboratory tests are associated with disease severity in COVID-19.

Standard Blood Laboratory as a Clinical Support Tool to Distinguish between SARS-CoV-2 Positive and Negative Patients

“…Li et al [12] and our study showed an increased hemoglobin in COVID-19 positive patients, which is not in accordance with a lowered hemoglobin in patients with severe COVID-19 disease reported by two meta-analyses. [8,16] In our data, the median hemoglobin was 13.5 g/dL, which did not much differ from Li's data. [12] In several other trials assessing the severity of disease and blood patterns, hemoglobin was shown to be below normal ranges.…”

“…[12] In several other trials assessing the severity of disease and blood patterns, hemoglobin was shown to be below normal ranges. [8,9,16] It can only be hypothesized why our cohort presented with a comparably high level of hemoglobin.…”

“…Similar blood patterns were also detected regarding ALT, AST, and LDH. [8,9,12,16,17] Brinati et al included 279 patients and developed a score for SARS-Cov-2 detection with an accuracy between 82% and 86%, and sensitivity between 92% and 95%. .…”

US COVID-19 State Mortality and Case Progression - A Midterm Report Card

“…Other clinical reports showed that severe diseases among COVID-19 patients were associated with higher white blood cell and neutrophil counts, C-reactive protein, lactate dehydrogenase, D-dimer, and aspartate aminotransferase [26,27]. Additionally, CT imaging displayed ground-glass opacification patterns (80%) as well as bilateral involvement (69%).…”

Can COVID-19 be a risk for cachexia for patients during intensive care? Narrative review and nutritional recommendations

“…This finding does not prove the direct association, and the observed finding can be due to other confounding variables or poor patient detection in tropical countries. A systematic review shows that six studies described low hemoglobin in patients with COVID-19, while four studies found that all patients had hemoglobin within the reference interval (69) . However, a limitation for this alteration is that most studies reported laboratory analysis from the patients at admission.…”