tetano
Editor, Senior Moderator
Clin Chim Acta
. 2020 Jun 10;S0009-8981(20)30270-9.
doi: 10.1016/j.cca.2020.06.008. Online ahead of print.
Value of Leukocytosis and Elevated C-reactive Protein in Predicting Severe Coronavirus 2019 (COVID-19): A Systematic Review and Meta-Analysis
Takayuki Yamada[SUP] 1 [/SUP], Mako Wakabayashi[SUP] 2 [/SUP], Takahiro Yamaji[SUP] 3 [/SUP], Nitin Chopra[SUP] 4 [/SUP], Takahisa Mikami[SUP] 4 [/SUP], Hirotaka Miyashita[SUP] 4 [/SUP], Satoshi Miyashita[SUP] 4 [/SUP]
Affiliations
Abstract
Background: Since December 2019, coronavirus 2019 (COVID-19) has spread worldwide. Identifying poor prognostic factors is helpful for risk stratification. In this meta-analysis, we investigated the association between severe COVID-19 and a change in white blood cell (WBC) count, an elevation of C-reactive protein (CRP), and fever. Moreover, we aimed to evaluate the diagnostic accuracy of leukocytosis and an elevation of CRP.
Methods: We performed a systematic search of PubMed, EMBASE, Scopus, and the Cochrane Library through April 20[SUP]th[/SUP], 2020. The odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. A sensitivity analysis was conducted according to the study size (>200 or <200) and median age (>55 or <55). Meta-regression analyses were conducted to examine possible sources of heterogeneity. We calculated the diagnostic accuracy of leukocytosis and CRP.
Results: Eighteen studies with 3,278 patients were selected. Fever, leukocytosis, and elevated CRP were associated with poor outcomes (OR (95% CI) 1.63 (1.06 to 2.51), 4.51 (2.53 to 8.04), and 11.97 (4.97 to 28.8), respectively). Leukopenia was associated with a better prognosis (OR 0.56, 95% CI 0.40 to 0.78). Sensitivity analyses showed similar tendencies. Meta-regression analysis for leukocytosis indicated that age, dyspnea, and hypertension contributed to heterogeneity. The pooled area under the leukocytosis and CRP curves were 0.70 (0.64 to 0.76) and 0.89 (0.80 to 0.99), respectively.
Conclusion: In patients with COVID-19, fever, leukocytosis, and an elevated CRP were associated with severe outcomes. Leukocytosis and CRP on arrival may predict poor outcomes.
Keywords: COVID-19; CRP; critically ill; fever; luekocytosis; meta-analysis; prediction; white blood cell.
. 2020 Jun 10;S0009-8981(20)30270-9.
doi: 10.1016/j.cca.2020.06.008. Online ahead of print.
Value of Leukocytosis and Elevated C-reactive Protein in Predicting Severe Coronavirus 2019 (COVID-19): A Systematic Review and Meta-Analysis
Takayuki Yamada[SUP] 1 [/SUP], Mako Wakabayashi[SUP] 2 [/SUP], Takahiro Yamaji[SUP] 3 [/SUP], Nitin Chopra[SUP] 4 [/SUP], Takahisa Mikami[SUP] 4 [/SUP], Hirotaka Miyashita[SUP] 4 [/SUP], Satoshi Miyashita[SUP] 4 [/SUP]
Affiliations
- PMID: 32533986
- DOI: 10.1016/j.cca.2020.06.008
Abstract
Background: Since December 2019, coronavirus 2019 (COVID-19) has spread worldwide. Identifying poor prognostic factors is helpful for risk stratification. In this meta-analysis, we investigated the association between severe COVID-19 and a change in white blood cell (WBC) count, an elevation of C-reactive protein (CRP), and fever. Moreover, we aimed to evaluate the diagnostic accuracy of leukocytosis and an elevation of CRP.
Methods: We performed a systematic search of PubMed, EMBASE, Scopus, and the Cochrane Library through April 20[SUP]th[/SUP], 2020. The odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. A sensitivity analysis was conducted according to the study size (>200 or <200) and median age (>55 or <55). Meta-regression analyses were conducted to examine possible sources of heterogeneity. We calculated the diagnostic accuracy of leukocytosis and CRP.
Results: Eighteen studies with 3,278 patients were selected. Fever, leukocytosis, and elevated CRP were associated with poor outcomes (OR (95% CI) 1.63 (1.06 to 2.51), 4.51 (2.53 to 8.04), and 11.97 (4.97 to 28.8), respectively). Leukopenia was associated with a better prognosis (OR 0.56, 95% CI 0.40 to 0.78). Sensitivity analyses showed similar tendencies. Meta-regression analysis for leukocytosis indicated that age, dyspnea, and hypertension contributed to heterogeneity. The pooled area under the leukocytosis and CRP curves were 0.70 (0.64 to 0.76) and 0.89 (0.80 to 0.99), respectively.
Conclusion: In patients with COVID-19, fever, leukocytosis, and an elevated CRP were associated with severe outcomes. Leukocytosis and CRP on arrival may predict poor outcomes.
Keywords: COVID-19; CRP; critically ill; fever; luekocytosis; meta-analysis; prediction; white blood cell.