The role of biomarkers in diagnosis of COVID-19 – A systematic review

Kermali, Muhammed; Khalsa, Raveena Kaur; Pillai, Kiran; Ismail, Zahra; Harky, Amer

doi:10.1016/j.lfs.2020.117788

Cited by 619 publications

(653 citation statements)

References 57 publications

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“…Cardiac biomarkers are important in recognizing patients that might be presenting with early signs of myocardial injury secondary to COVID‐19, 50 as the presence of myocardial injury was associated with over 50% mortality 14 . We summarized studies looking at cardiac‐specific biomarkers (CK, CK‐MB, Troponin, Myoglobin, and BNP) in Table 6.…”

Section: Resultsmentioning

confidence: 99%

Cardiac manifestations in COVID‐19 patients—A systematic review

et al. 2020

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Objectives The coronavirus disease‐2019 (COVID‐19) pandemic has resulted in the worst global pandemic of our generation, affecting 215 countries with nearly 5.5 million cases. The association between COVID‐19 and the cardiovascular system has been well described. We sought to systematically review the current published literature on the different cardiac manifestations and the use of cardiac‐specific biomarkers in terms of their prognostic value in determining clinical outcomes and correlation to disease severity. Methods A systematic literature review across PubMed, Cochrane database, Embase, Google Scholar, and Ovid was performed according to PRISMA guidelines to identify relevant articles that discussed risk factors for cardiovascular manifestations, cardiac manifestations in COVID‐19 patients, and cardiac‐specific biomarkers with their clinical implications on COVID‐19. Results Sixty‐one relevant articles were identified which described risk factors for cardiovascular manifestations, cardiac manifestations (including heart failure, cardiogenic shock, arrhythmia, and myocarditis among others) and cardiac‐specific biomarkers (including CK‐MB, CK, myoglobin, troponin, and NT‐proBNP). Cardiovascular risk factors can play a crucial role in identifying patients vulnerable to developing cardiovascular manifestations of COVID‐19 and thus help to save lives. A wide array of cardiac manifestations is associated with the interaction between COVID‐19 and the cardiovascular system. Cardiac‐specific biomarkers provide a useful prognostic tool in helping identify patients with the severe disease early and allowing for escalation of treatment in a timely fashion. Conclusion COVID‐19 is an evolving pandemic with predominate respiratory manifestations, however, due to the interaction with the cardiovascular system; cardiac manifestations/complications feature heavily in this disease, with cardiac biomarkers providing important prognostic information.

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Section: Resultsmentioning

confidence: 99%

Cardiac manifestations in COVID‐19 patients—A systematic review

et al. 2020

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“…Lymphopenia and thrombocytopenia are also associated with severe COVID‐19 disease. There is a growing list of publications indicating that the assessment of lymphocyte subset counts, such as CD4 and CD8 T cells, B cells, and NK cells, may provide prognostic information for COVID‐19 disease severity and convalescence when considered in conjunction with other clinical information (4,5). To obtain a clearer picture of this emerging data, we performed a meta‐analysis of studies that included measurement of lymphocyte subset counts and disease severity in patients hospitalized with COVID‐19.…”

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confidence: 99%

Lymphocyte Subset Counts in COVID‐19 Patients: A Meta‐Analysis

et al. 2020

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A reduced peripheral blood absolute lymphocyte count with an elevated neutrophil count has been a consistent observation in hospitalized coronavirus disease 2019 (COVID‐19) patients. In this brief meta‐analysis, the reduction of lymphocyte subset counts in COVID‐19 patients was investigated across 20 peer‐reviewed studies meeting criteria for reporting lymphocyte subset counts and COVID‐19 disease severity. CD4+ T cell, CD8+ T cell, B cell, NK cell, and total lymphocyte cell counts all showed statistically significant reduction in patients with severe/critical COVID‐19 disease compared to mild/moderate disease. T‐cell subsets showed the largest standardized magnitude of change. In some studies, multivariate analysis has shown that CD4 and/or CD8 T‐cells counts are independently predictive of patient outcomes. © 2020 International Society for Advancement of Cytometry

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“…36 Lower Ct values were associated with lower lymphocyte levels in all three studies in which it was assessed, which is consistent with reports that lymphopaenia could act as a predictor of higher disease severity in patients with COVID-19. 35,37 Similarly, correlation of Ct values was also seen with high-sensitivity troponin I, which has been suggested as a marker of COVID-19 disease progression and mortality. 35 Both studies that investigated the correlation between SARS-CoV-2 Ct values and infectivity showed that samples with higher Ct values had lower culture positivity.…”

Section: Resultsmentioning

confidence: 82%

“…35,37 Similarly, correlation of Ct values was also seen with high-sensitivity troponin I, which has been suggested as a marker of COVID-19 disease progression and mortality. 35 Both studies that investigated the correlation between SARS-CoV-2 Ct values and infectivity showed that samples with higher Ct values had lower culture positivity. It has been shown that following resolution of COVID-19 symptoms, people can have prolonged positive SARS-CoV-2 real-time PCR results for several weeks 38 and at late time points, Ct values are often very high representing low copies of viral RNA.…”

Section: Resultsmentioning

confidence: 82%

“…Lower Ct values were associated with elevated LDH levels in all four studies in which it was assessed, which is consistent with reports that elevated LDH can act as in indicator of poor prognosis in patients with COVID-19. 34,35 Increased LDH re ects tissue destruction and in interstitial pulmonary brosis is seen as an important prognostic marker for lung injury. 36 Lower Ct values were associated with lower lymphocyte levels in all three studies in which it was assessed, which is consistent with reports that lymphopaenia could act as a predictor of higher disease severity in patients with COVID-19.…”

Section: Resultsmentioning

confidence: 99%

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Clinical utility of cycle threshold values in the context of COVID-19

Rao¹,

Manissero

Steele

et al. 2020

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BackgroundThe ability to predict likely prognosis and infectiousness for patients with COVID-19 would aid patient management decisions. Diagnosis is usually via real-time PCR and it is unclear whether the semi-quantitative capability of this method, determining viral load through cycle threshold (Ct) values, can be leveraged.ObjectivesWe aim to review available knowledge on correlations between SARS-COV-2 Ct values and patient- or healthcare-related outcomes to determine whether Ct values provide useful clinical information.SourcesA PubMed search was conducted on 1st June 2020 based on a search strategy of (Ct value OR viral load) AND SARS-CoV-2. Data was extracted from studies reporting on the presence or absence of an association between Ct values, or viral loads determined via Ct value, and clinical outcomes.ContentData from 18 studies were relevant for inclusion. One study reported on the correlation between Ct values and mortality and one study reported on the correlation between Ct values and progression to severe disease; both reported a significant association (p < 0.001 and p = 0.008, respectively). Fourteen studies reported on the correlation between Ct value or viral loads determined via Ct value and disease severity and an association was observed in 8 (57%) studies. Studies reporting on the correlation of viral load with biochemical and haematological markers showed an association with at least one marker, including increased lactate dehydrogenase (n = 4), decreased lymphocytes (n = 3) and increased high-sensitivity troponin I (n = 2). Two studies reporting on the correlation with infectivity showed that lower Ct values were associated with higher viral culture positivity.ImplicationsData suggest that lower Ct values may be associated with worse outcomes, and that Ct values may be useful in predicting the clinical course and prognosis of patients with COVID-19; however, further studies are warranted to confirm clinical value.

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The role of biomarkers in diagnosis of COVID-19 – A systematic review

Cited by 619 publications

References 57 publications

Cardiac manifestations in COVID‐19 patients—A systematic review

Cardiac manifestations in COVID‐19 patients—A systematic review

Lymphocyte Subset Counts in COVID‐19 Patients: A Meta‐Analysis

Clinical utility of cycle threshold values in the context of COVID-19

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