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Ali, A. H. M., Mohamed, S. O. O., Elkhidir, I. H. E., Elbathani, M. E. H., Ibrahim, A. A. H., Elhassan, A. B. E., Tawer Salman, M. S., Elhassan, M. A., Elnil, M., & Hassan Abuzied, A. I. (2020). The Association of Lymphocyte count, CRP, D-Dimer, and LDH with Severe Coronavirus Disease 2019 (COVID-19): A Meta-Analysis. Sudan Journal of Medical Sciences (SJMS), 15(5), 9-19. https://doi.org/10.18502/sjms.v15i5.7146
https://doi.org/10.18502/sjms.v15i5.7146
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- Cited by 6 articles
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Almigdad H. M. Ali
Almigdad H. M. Ali
Faculty of Medicine, University of Khartoum, Sudan
-
Sagad Omer Obeid Mohamed
Sagad Omer Obeid Mohamed
Faculty of Medicine, University of Khartoum, Sudan
-
Ibrahim H. E. Elkhidir
Ibrahim H. E. Elkhidir
Faculty of Medicine, University of Khartoum, Sudan
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Mohamed Elata Hassan Elbathani
Mohamed Elata Hassan Elbathani
Faculty of Medicine, University of Khartoum, Sudan
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Abazr A. H. Ibrahim
Abazr A. H. Ibrahim
Faculty of Medicine, University of Khartoum, Sudan
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Almutasim B. E. Elhassan
Almutasim B. E. Elhassan
Faculty of Medicine, University of Khartoum, Sudan
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Mohammed Suliman Tawer Salman
Mohammed Suliman Tawer Salman
Faculty of Medicine, University of Khartoum, Sudan
-
Mazin A.M. Elhassan
Mazin A.M. Elhassan
Faculty of Medicine, University of Khartoum, Sudan
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Mahmoud Elnil
Mahmoud Elnil
Faculty of Medicine, University of Khartoum, Sudan
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Abdelhamid Ibrahim Hassan Abuzied
Abdelhamid Ibrahim Hassan Abuzied
Faculty of Medicine, University of Khartoum, Sudan
Published Date
- May 31, 2020
The Association of Lymphocyte count, CRP, D-Dimer, and LDH with Severe Coronavirus Disease 2019 (COVID-19): A 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.
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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].
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10. Kılıç, 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-events/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., et al. (2020). Clinical features and treatment of COVID-19 patients in northeast Chongqing. Journal of Medical Virology [Online ahead of print]. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/32198776/
17. Zhang, J., Dong, X., Cao, Y., et al. (2020). Clinical characteristics of 140 patients infected with SARS‐CoV‐2 in Wuhan, China. Allergy [Online ahead of print]. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/32077115/
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., et al. (2020). Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID‐19. Journal of Medical Virology [Online ahead of print]. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/32181911/
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 of Clinical Chemistry and Molecular Diagnostics, pp. 601–602. St. Louis, MO: Elsevier Saunders.