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

Authors

  • Almigdad H.M. Ali Faculty of Medicine, University of Khartoum, Sudan
  • Sagad Omer Obeid Mohamed Faculty of Medicine, University of Khartoum, Sudan
  • Ibrahim H. E. Elkhidir Faculty of Medicine, University of Khartoum, Sudan
  • Mohamed Elata Hassan Elbathani Faculty of Medicine, University of Khartoum, Sudan
  • Abazr A. H. Ibrahim Faculty of Medicine, University of Khartoum, Sudan
  • Almutasim B.E. Elhassan Faculty of Medicine, University of Khartoum, Sudan
  • Mohammed Suliman Tawer Salman Faculty of Medicine, University of Khartoum, Sudan
  • Mazin A.M. Elhassan Faculty of Medicine, University of Khartoum, Sudan
  • Mahmoud Elnil Faculty of Medicine, University of Khartoum, Sudan
  • Abdelhamid Ibrahim Hassan Abuzied Faculty of Medicine, University of Khartoum, Sudan

DOI:

https://doi.org/10.52981/sjms.v15i2.1518

Keywords:

COVID-19, lymphocyte count, CRP, D-Dimer, LDH, Meta-analysis

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.

References

[1] Singhal, T. (2020). A review of Coronavirus Disease-2019 (COVID-19). The Indian Journal of Pediatrics, vol. 87, no. 4, pp. 281–286. Retrieved from: https://doi.org/10.1007/s12098-020-03263-6
[2] WHO. (2020). Homepage. Retrieved from: https://www.who.int [accessed April 2,2020].
[3] WHO. (2020). Coronavirus (COVID-19) outbreak. Retrieved from: https://www.who.int/westernpacific/emergencies/covid-19 [accessed April 2, 2020].
[4] WHO. (2020). Coronavirus (COVID-2019) situation reports. Retrieved from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports[accessed April 2, 2020].
[5] Centers for Disease Control and Prevention. (2020). Coronavirus disease 2019 (COVID-19). Retrieved from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/
clinical-criteria.html [accessed April 2, 2020].
[6] Cascella, M., Rajnik, M., Cuomo, A., et al. (2020). Features, evaluation and treatment coronavirus (COVID-19) [Internet]. Treasure Island, FL: StatPearls Publishing. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/32150360 [accessed April 3,2020].
[7] BMJ Best Practice. (2020). Coronavirus disease 2019 (COVID-19) - Complications| BMJ Best Practice. Retrieved from: https://bestpractice.bmj.com/topics/en-us/
3000168/complications [accessed April 2, 2020].
[8] Coronavirus Disease 2019 (COVID-19) [Internet]. Centers for Disease Control and Prevention. 2020 [cited 27 May 2020]. Retrieved from: https://www.cdc.gov/
coronavirus/2019-ncov/need-extra-precautions/people-at-higher-risk.html
[9] Rhodes, A., Ferdinande, P., Flaatten, H., et al. (2012). The variability of critical care bed numbers in Europe. Intensive Care Medicine, vol. 38, pp. 1647–1653. Retrieved from: https://link.springer.com/content/pdf/10.1007/s00134-012-2627-8.pdf
[10] K????l????ç, M., Yüzkat, N., Soyalp, C., et al. (2019). Cost analysis on Intensive Care Unit costs based on the length of stay. Turkish Journal of Anaesthesiology & Reanimation , vol. 47, no. 2, pp. 142–145. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/31080956
[11] U.S. Food and Drug Administration. (2020). Coronavirus (COVID-19) update: daily roundup March 30, 2020. Retrieved from: http://www.fda.gov/news-event /press-announcements/coronavirus-covid-19-update-daily-roundup-march-30-2020 [accessed April 2, 2020].
[12] Lippi, G., Plebani, M., and Michael Henry, B. (2020). Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis. Clinica Chimica Acta, vol. 506, pp. 145–148. Retrieved from: https://doi.org/10.1016/j.cca.2020.03.022
[13] Lippi, G. and Plebani M. (2020). Procalcitonin in patients with severe coronavirus disease 2019 (COVID-19): a meta-analysis. Clinica Chimica Acta, vol. 505, pp. 190–191. Retrieved from: https://doi.org/10.1016/j.cca.2020.03.004
[14] Liberati, A., Altman, D. G., Tetzlaf, J., et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Journal of Clinical Epidemiology, vol. 62, no. 10, pp. e1–34.
[15] Yudong, P., Kai, M., Hongquan, G., et al. (2020). Clinical characteristics and outcomes of 112 patients with cardiovascular disease infected with novel coronavirus pneumonia. Chinese Journal of Cardiovascular Diseases, vol. 48, p. E004. DOI:10.3760/cma.j.cn112148-20200220-00105.
[16] Wan S, Xiang Y, Fang W, Zheng Y, Li B, Hu Y, Lang C, Huang D, Sun Q, Xiong Y, Huang X. Clinical features and treatment of COVID-19 patients in northeast Chongqing. Journal of medical virology. 2020 Mar 21. Retrieved from: https://onlinelibrary.wiley.com/doi/abs/10.1002/jmv.25783
[17] Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, Akdis CA, Gao YD. Clinicalcharacteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020 Feb 19. Retrieved from: https://onlinelibrary.wiley.com/doi/full/10.1111/all.14238
[18] Guan, W., Ni, Z., Hu, Yu., et al. (). Clinical Characteristics of Coronavirus Disease 2019 in China. The New England Journal of Medicine, vol 382, pp. 1708–1720. DOI:10.1056/NEJMoa2002032
[19] Gao Y, Li T, Han M, Li X, Wu D, Xu Y, Zhu Y, Liu Y, Wang X, Wang L. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. Journal of medical virology. 2020 Mar 17. Retrieved from: https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.25770
[20] Qin, C., Zhou, L., Hu, Z., et al. (2020). Dysregulation of immune response in patients with COVID-19 in Wuhan, China. SSRN Electronic Journal. Retrieved from: https://dx.doi.org/10.2139/ssrn.3541136
[21] Zhou, F., Yu, T., Du, R., et al. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet, vol. 395, no. 10229, pp. 1054–1062.
[22] Liu, W., Tao, Z., Lei, W., et al. (2020). Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chinese
Medical Journal. DOI:10.1097/CM9.0000000000000775.
[23] Wang, Z., Yang, B., Li, Q., et al. (2020). Clinical features of 69 cases with coronavirus disease 2019 in Wuhan, China. Clinical Infectious Diseases [Online ahead of print]. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/32176772/
[24] Wang, D., Hu, B., Hu, C., et al. (2020). Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus–infected pneumonia in Wuhan, China. JAMA, vol. 323, no. 11, pp. 1061–1069. DOI:10.1001/jama.2020.1585
[25] Young, B. E., Ong, S. W. X., Kalimuddin, S., et al. (2020). Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA.
DOI:10.1001/jama.2020.3204 [26] Borenstein, M., Hedges, L. V., Higgins, J., et al. (2010). A basic introduction to fixed-effect and random-effects models for meta-analysis. Research Synthesis Methods.Vol. 1, no. 2, pp. 97–111.
[27] Rodriguez-Morales, A. J., Cardona-Ospina, J. A., Gutiérrez-Ocampo, E., et al. (2020).A systematic review and meta-analysis. Travel Medicine and Infectious Disease, vol.34, p. 101623. Retrieved from: https://doi.org/10.1016/j.tmaid.2020.101623.
[28] Abdulamir, A. S. and Hafidh, R. R. (2020). The possible immunological pathways for the variable immunopathogenesis of COVID–19 infections among healthy adults,elderly and children. Electronic Journal of General Medicine, vol. 17, no. 4.
[29] Burtis, C. A., Ashwood, E. R., and Bruns, D. E. (Ed.) (2006). Tietz Textbook ofClinical Chemistry and Molecular Diagnostics, pp. 601–602. St. Louis, MO: Elsevier
Saunders.
[30] Harenberg J, Favaloro E. COVID-19: progression of disease and intravascular coagulation – present status and future perspectives. Clinical Chemistry and
Laboratory Medicine (CCLM). 2020;0(0). Retrieved from: https://www.degruyter.com/view/journals/cclm/ahead-of-print/article-10.1515-cclm-2020-0502/article-10.
1515-cclm-2020-0502.xml.
[31] Sun Y, Dong Y, Wang L, Xie H, Li B, Chang C, Wang FS. Characteristics and prognostic factors of disease severity in patients with COVID-19: The Beijing experience. Journal of Autoimmunity. 2020 Apr 24:102473. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7180376/.

Downloads

Published

2021-09-02