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Vol. 155. Issue 4.
Pages 143-151 (August 2020)
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Vol. 155. Issue 4.
Pages 143-151 (August 2020)
Original article
DOI: 10.1016/j.medcle.2020.05.004
Crucial laboratory parameters in COVID-19 diagnosis and prognosis: An updated meta-analysis
Parámetros cruciales de laboratorio en diagnóstico y pronóstico de COVID-19: un metaanálisis actualizado
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Gita Vita Sorayaa,1, Zulvikar Syambani Ulhaqb,1,
Corresponding author
a Department of Biochemistry, Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, 90245, Indonesia
b Department of Biochemistry, Faculty of Medicine and Health Sciences, Maulana Malik Ibrahim Islamic State University of Malang, Batu, East Java, 65151, Indonesia
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Table 1. Meta-analysis of laboratory findings between COVID-19 and Non-COVID-19 patients.
Table 2. Meta-analysis of laboratory findings between severe and non-severe patients with COVID-19.
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Abstract
Introduction and objectives

Common laboratory parameters are crucial in aiding coronavirus disease 2019 (COVID-19) case detection. This study aimed to determine the differences between laboratory parameters in (1) COVID-19 versus non-COVID-19 pneumonia, and (2) severe versus non-severe COVID-19 cases.

Methods

Studies were collected until March 2020, and retrieved parameters include leukocyte, neutrophil, thrombocyte, and lymphocyte counts in addition to C-reactive protein (CRP), procalcitonin (PCT) and D-dimer levels. In the presence of heterogeneity, the random-effect model (REM) was used instead of the fixed-effect model (FEM).

Results

Seven studies in the first analysis showed significantly lower leukocyte, neutrophil and platelet counts in COVID-19 pneumonia (SMD=−0.42, 95%CI −0.60 to −0.25, p<0.00001, SMD=−0.23, 95%CI −0.41 to −0.06, p=0.01, SMD=−0.54, 95%CI −0.91 to −0.16, p=0.0005) compared to non-COVID-19 pneumonia. Twenty-six studies in the second analysis showed significantly lower lymphocyte and thrombocyte counts (SMD=−0.56, 95%CI −0.71 to −0.40, p<0.0001, SMD=−0.32, 95%CI −0.49 to −0.15, p=0.0002) and significantly higher leukocyte, neutrophil, D-dimer, and CRP (SMD=0.31, 95%CI 0.07–0.56, p=0.01; SMD=0.44, 95%CI 0.24–0.64, p<0.0001; SMD=0.53, 95%CI 0.31–0.75, p<0.00001; SMD=0.97, 95%CI 0.70–1.24, p<0.00001) in severe COVID-19 compared to non-severe COVID-19.

Conclusions

In conclusion, thrombocyte count is key in both diagnosis and prognosis. Low leukocyte and neutrophil counts are markers of COVID-19 infection, but contrastingly higher counts indicate progressive COVID-19. And although lymphocyte, D-dimer and CRP levels did not demonstrate diagnostic value, all indicate severity of COVID-19. Confirmation of these findings should be performed in future studies.

Keywords:
Laboratory parameters
COVID-19
SARS-CoV-2
Diagnosis
Resumen
Introducción y objetivos

Los parámetros comunes de laboratorio son cruciales para ayudar a la detección de casos de enfermedad por coronavirus 2019 (COVID-19). Este estudio tuvo como objetivo determinar las diferencias entre los parámetros de laboratorio en: 1) COVID-19 versus neumonía no COVID-19, y 2) Casos severos versus no severos de COVID-19.

Métodos

Los estudios se recolectaron hasta marzo de 2020, y los parámetros recuperados incluyen recuentos de leucocitos, neutrófilos, trombocitos y linfocitos además de los niveles de proteína C reactiva (PCR), procalcitonina (PCT) y dímero-D. En presencia de heterogeneidad, se utilizó el modelo de efectos aleatorios en lugar del modelo de efectos fijos.

Resultados

Siete estudios en el primer análisis mostraron recuentos de leucocitos, neutrófilos y plaquetas significativamente más bajos en la neumonía por COVID-19 (SMD=−0,42; IC 95%: −0,60 a −0,25; p<0,00001; SMD=−0,23; IC 95%: −0,41 a −0,06; p=0,01; SMD=−0,54; IC 95%: −0,91 a −0,16; p=0,0005) en comparación con la neumonía no COVID-19. Veintiséis estudios en el segundo análisis mostraron recuentos de linfocitos y trombocitos significativamente más bajos (SMD=−0,56; IC 95%: −0,71 a −0,40; p<0,0001; SMD=−0,32; IC 95%: −0,49 a −0,15; p=0,0002) y leucocitos, neutrófilos, dímero D y PCR significativamente más altos (SMD=0,31; IC 95%: 0,07-0,56; p=0,01; SMD=0,44; IC 95%: 0,24-0,64; p<0,0001; SMD=0,53; IC 95%: 0,31-0,75; p<0,00001; SMD=0,97; IC 95%: 0,70-1,24; p<0,00001) en COVID-19 severo en comparación con COVID-19 no severo.

Conclusiones

En conclusión, el recuento de trombocitos es clave tanto en el diagnóstico como en el pronóstico. Los recuentos bajos de leucocitos y neutrófilos son marcadores de infección por COVID-19, pero los recuentos contrastantemente más altos indican COVID-19 progresivo. Y aunque los niveles de linfocitos, dímero D y PCR no mostraron valor diagnóstico, todos indican la gravedad de COVID-19. La confirmación de estos hallazgos debe realizarse en futuros estudios.

Palabras clave:
Parámetros de laboratorio
COVID-19
SARS-CoV-2
Diagnóstico

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