The Association of Lymphocyte count, CRP, D-Dimer, and LDH with Severe Coronavirus Disease 2019 (COVID-19): A Meta-Analysis

  1. Almigdad H. M. Ali
  2. Sagad Omer Obeid Mohamed
  3. Ibrahim H. E. Elkhidir
  4. Mohamed Elata Hassan Elbathani
  5. Abazr A. H. Ibrahim
  6. Almutasim B. E. Elhassan
  7. Mohammed Suliman Tawer Salman
  8. Mazin A.M. Elhassan
  9. Mahmoud Elnil
  10. Abdelhamid Ibrahim Hassan Abuzied

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Abstract

Background: The rapid progression of Coronavirus disease 2019 (COVID-19) and its increasing burden on health systems necessitate the identification of parameters of severe infection to help in monitoring, prognoses and development of treatment algorithms. Objectives: This review aims to investigate the association of lymphocyte count, CRP, LDH, and D-Dimer with the severity of COVID-19. Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases of MEDLINE/PubMed, WHO-Virtual Health Library (VHL), and ScienceDirect were used for the systematic search. Random effects model was used to estimate the pooled standardized mean differences (SMD) with the corresponding 95% confidence interval (CI), using OpenMeta Analyst software. Results: A total of 11 studies, with 2437 COVID-19 patients, which fulfilled the eligibility criteria were included in the meta-analysis. The analysis revealed that lymphocyte count was significantly lower in patients with the severe form of COVID-19 (SMD = - 1.025, P value <.001). Also, the analysis of SMD showed that patients with severe COVID-19 have a significantly higher serum levels of CRP (SMD = 3.363, P value <.001), D-Dimer (SMD = 1.073, P value <.001), and LDH (SMD = 3.345, P value <.001). Conclusion: Low lymphocyte count and high levels of CRP, LDH, and D-Dimer are associated with severe COVID-19. These laboratory markers could be used as clinical indicators of worsening illness and poor prognosis of COVID-19.

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  1. ScreenIT

    SciScore for 10.1101/2020.04.20.20072801: (What is this?)

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

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    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 findings of this study need to be considered in the context of some limitations. All studies that we found were in Asia, whereas nowadays the majority of cases are in the United States and Europe. Due to the limitedness of the available data and variable definition of disease severity among the studies, there is a need for further studies to explore and clarify the prognostic role, as well as the precise mechanisms underlying the changes in these biomarkers in patients with severe COVID-19.

    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.

    About SciScore

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  2. Version published to 10.18502/sjms.v15i5.7146
  3. Version published to 10.1101/2020.04.20.20072801v1 on medRxiv