Laboratory findings in coronavirus disease 2019 (COVID-19) patients: a comprehensive systematic review and meta-analysis

Abstract

Background

In early December 2019, the first patient with COVID-19 pneumonia was found in Wuhan, Hubei Province, China. Recent studies have suggested the role of primary laboratory tests in addition to clinical symptoms for suspected patients, which play a significant role in the diagnosis of COVID-19. Therefore, the present study was conducted to evaluate laboratory findings in COVID-19 patients.

Data Sources

PubMed/Medline, Scopus, EMBASE, Web of Science (ISI), Cochrane Library, Ovid, Science Direct, CINAHL and EBSCO.

Study Selection

Cross-sectional of adverse outcomes stratified by the status of ICLs were selected.

Data Extraction

The prevalence of available variables for laboratory tests were extracted.

Results

Finally, 52 studies involving 5490 patients with COVID-19 entered the meta-analysis process. The prevalence of leukopenia, lymphopenia, elevated c-reactive protein (CRP), elevated erythrocyte sedimentation rate (ESR), elevated serum amyloid A, elevated ferritin was estimated to be 20.9% (95%CI: 17.9-24.3), 51.6% (95%CI: 44.0-59.1), 63.6% (95%CI: 57.0-69.8), 62.5% (95%CI: 50.1-73.5), 63.6% (95%CI: 57.0-69.8), 62.5% (95%CI: 50.1-73.5), 74.7% (95%CI: 50.0-89.7), and 72.6% (95%CI: 58.1-83.5), respectively. The prevalence of elevated interleukin-6 was 59.9% (95%CI: 48.2-70.5), CD3 was 68.3% (95%CI: 50.1-82.2), reduced CD4 was 62.0% (95%CI: 51.1-71.6), reduced CD8 was 42.7% (95%CI: 32.2-53.9). The prevalence of elevated troponin-I was 20.6% (95%CI: 9.0-40.5), elevated creatine kinase-MB (CKMB) was 14.7% (95%CI: 7.1-28.0), elevated brain natriuretic peptide (BNP) was 48.9% (95%CI: 30.4-67.7), elevated blood urea nitrogen was 13.1% (95%CI: 6.6-24.4),, elevated creatinine was 7.2% (95%CI: 4.4-11.8), elevated lactate dehydrogenase (LDH) was 53.1% (95%CI: 43.6-62.4), hyperglycemia was 41.1% (95% CI: 28.2-55.5), elevated total bilirubin was 48.9% (95%CI: 30.4-67.7), reduced albumin was 54.7% (95%CI: 38.1-70.2), reduced pre-albumin was 49.0% (95%CI: 26.6-71.8), and reduced PT was 53.1% (95% CI: 43.6-62.4), and D-dimer was 44.9% (95%CI: 31.0-59.6).

Conclusion

This study provides a comprehensive description of laboratory characteristics in patients with COVID-19. The results show that lymphopenia, elevated CRP, elevated ESR, elevated ferritin, elevated serum amyloid A, elevated BNP, reduced albumin, reduced pre-albumin, reduced CD3, reduced CD4, reduced CD8, elevated D-dimer, reduced PT, elevated interleukin-2, elevated interleukin-6, elevated LDH and hyperglycemia are the common findings at the time of admission.

SciScore for 10.1101/2020.06.07.20124602: (What is this?)

Please note, not all rigor criteria are appropriate for all manuscripts.

Table 1: Rigor

Institutional Review Board Statement	not detected.
Randomization	not detected.
Blinding	not detected.
Power Analysis	not detected.
Sex as a biological variable	Data extraction: Extracted data include: author’s name and year of publication, country and province, study source, study design, total sample size, number of men and women, mean age and standard deviation, patient description, number of patients referred to the intensive care unit (ICU), COVID-19 diagnostic method, test sample for COVID-19 diagnosis (respiratory secretions, blood, etc.), sample location (nasal, pharyngeal), and available laboratory findings (including CBC components, inflammatory markers, cellular immunity tests, cytokines, and cardiac, renal, hepatic, muscular, and coagulopathic tests).

Table 2: Resources

Software and Algorithms
Sentences	Resources
Literature review: We did a comprehensive literature review in databases PubMed/Medline, Scopus, EMBASE, Web of Science, Cochrane Library (Cochrane Database of Systematic Reviews - CDSR), Ovid, Science Direct, CINAHL and EBSCO to find citations from the beginning of January 2019 to the beginning of April 2020 without any restrictions.	EMBASE suggested: (EMBASE, RRID:SCR_001650) Cochrane Library suggested: (Cochrane Library, RRID:SCR_013000) Cochrane Database of Systematic Reviews suggested: None

Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:

The limitations of this study include the following: 1) All studies were conducted in China and laboratory manifestations may be influenced by ethnic factors. 2) Most patients are hospitalized and patients who have milder symptoms or patients who are not hospitalized may cause bias in the results. 3) In most early studies, laboratory findings were not considered separately for patients admitted to the intensive care unit or the isolated ward. Our results are based on laboratory findings at the time of admission, but patients may have experienced symptoms before admission (because laboratory findings are influenced by the clinical course of the disease), and during this time, the patient may receive antiviral or antibacterial drugs. 4) Since all studies were performed in China in 2020 using the similar diagnostic method, we were unable to determine the cause of the heterogeneity.

Results from TrialIdentifier: No clinical trial numbers were referenced.

Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

Results from JetFighter: We did not find any issues relating to colormaps.

Results from rtransparent:

Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
No protocol registration statement was detected.

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