Blood biochemical parameters as predictors of disease severity and mortality in COVID-19 patients- an updated systematic review and meta-analysis

  1. Afsha Majid
  2. Pinki Mishra
  3. Rizwana Parveen
  4. Ram Bajpai
  5. Mohd. Ashif Khan
  6. Nidhi Bharal Agarwal

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Abstract

Background

The outbreak of coronavirus disease 2019 (COVID-19) has been rapidly spreading across the globe and poses a great risk to human health. Patients with abnormalities in laboratory parameters are more susceptible to COVID-19. Therefore, we explored the association of blood biochemical parameters with severity and mortality of COVID-19 amongst 3695 patients across seventeen studies.

Methods

We searched PubMed, Cochrane library and LitCOVID database until February 28, 2021. Seventeen studies were included in the meta-analysis with 3695 COVID-19 patients.

Results

The pooled analysis showed that compared to non-severe group, severe group was characterised by significantly elevated alanine aminotransferase (ALT) (standardised mean difference [SMD]: 0.65, 95% confidence interval [CI]: 0.23 to 1.06; p<0.001, erythrocyte sedimentation rate (ESR) (SMD: 0.55, 95%CI: 0.02 to 1.07 p=0.004) and lymphopenia (SMD: -1.22, 95% CI: -2.15 to -0.30; p<0.01), decreased serum albumin (SMD: -1.60, 95% CI: -2.96 to -0.22 ; p<0.001), creatinine (SMD: 0.54, 95% CI: 0.17 to 0.90; p<0.001), lactate dehydrogenase (LDH)(SMD: -1.54, 95% CI: - 2.27 to -0.80; p=0.002) and haemoglobin (SMD:-0.89, 95% CI: ; p<0.001). Additionally, in the non-survivor group, elevated lactate dehydrogenase (LDH) (SMD: 1.54 95% CI: -2.27 to 0.80; p=0.002), decreased serum albumin (SMD: 1.08, 95% CI: 0.75 to 1.42; p<0.001) were reported. There was no comorbidity which was found to be significant in the severe group.

Conclusion

Serum albumin, ALT, ESR, lymphopenia, haemoglobin, and leucocytosis can reflect the severity of COVID-19, while the LDH, leucocytosis and albumin can be considered as risk factor to higher mortality.

Summary

Our manuscript discusses the various blood biochemical markers as potential predictors of disease severity and mortality in COVID-19 patients. The timely detection of these parameters can help in providing appropriate course of treatment and reducing the mortality rate in the patients. We have found an association between the blood biochemical markers and disease severity and mortality in COVID-19 patients. Serum albumin, alanine aminotransferase (ALT), Erythrocyte Sedimentation Rate (ESR), lymphopenia, hemoglobin, and leukocytosis can reflect the severity of the disease, while the LDH, leukocytosis and albumin can be considered as risk factor to higher mortality.

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  1. ScreenIT

    SciScore for 10.1101/2021.09.16.21263675: (What is this?)

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

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variablenot detected.
    RandomizationMantel-Haenszel random-effects meta-analysis using DerSimonian and Laird method was used to pool ORs (28).
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    2.1 Data sources and searches: We searched PubMed/Medline, Cochrane Central Register of Controlled Trials and Clinical Trial Registry-India until February
    PubMed/Medline
    suggested: None
    We also searched grey literature using Google Scholar and reference list of eligible articles with the aim of identifying additional potential eligible studies.
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)

    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:
    There are several limitations that needs to be mentioned. There was heterogeneity amongst individual studies because of which there was a deviation of some of our results from usual findings. Additionally, case-series were included in the present meta-analysis. Although we did an extensive search, we may have inadvertently missed relevant studies. Exclusion of studies in languages other than English (ie. Chinese) may have resulted in missing of relevant studies. Certain parameters such as IL-6 ad IL-10 which are strong indicators of cytokine storm were not included in this meta-analysis due to lack of available data as not all parameters were reported in each patient. As most of the articles were published in Chinese, findings should interpret with caution, thereby ensuring the generalizability of the results. Also, not all studies included all the desired parameters.

    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.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2021.09.16.21263675v1 on medRxiv