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Meta-Analysis
. 2020 Jul:96:467-474.
doi: 10.1016/j.ijid.2020.05.055. Epub 2020 May 18.

Association of inflammatory markers with the severity of COVID-19: A meta-analysis

Furong Zeng  1 , Yuzhao Huang  2 , Ying Guo  1 , Mingzhu Yin  1 , Xiang Chen  1 , Liang Xiao  3 , Guangtong Deng  4
Affiliations
Meta-Analysis

Association of inflammatory markers with the severity of COVID-19: A meta-analysis

Furong Zeng et al. Int J Infect Dis. 2020 Jul.

Abstract

Objectives: Studies reported associations of inflammatory markers with the severity of COVID-19, but conclusions were inconsistent. We aimed to provide an overview of the association of inflammatory markers with the severity of COVID-19.

Methods: We searched PubMed, Embase, Cochrane Library, Wanfang and China National Knowledge Infrastructure (CNKI) database until March 20, 2020. Weighted mean difference (WMD) and 95% confidence intervals (CIs) were pooled using random or fixed-effects models.

Results: A total of 16 studies comprising 3962 patients with COVID-19 were included in our analysis. Random-effect results demonstrated that patients with COVID-19 in the nonsevere group had lower levels for CRP (WMD = -41.78 mg/l, 95% CI = [-52.43, -31.13], P < 0.001), PCT (WMD = -0.13 ng/ml, 95% CI = [-0.20, -0.05], P < 0.001), IL-6 (WMD = -21.32 ng/l, 95% CI = [-28.34, -14.31], P < 0.001), ESR (WMD = -8 mm/h, 95% CI = [-14, -2], P = 0.005), SAA (WMD = -43.35 μg/ml, 95% CI = [-80.85, -5.85], P = 0.020) and serum ferritin (WMD = -398.80 mg/l, 95% CI = [-625.89, -171.71], P < 0.001), compared with those in the severe group. Moreover, survivors had a lower level of IL-6 than non-survivors (WMD = -4.80 ng/ml, 95% CI = [-5.87, -3.73], P < 0.001). These results were consistent through sensitivity analysis and publication bias assessment.

Conclusions: The meta-analysis highlights the association of inflammatory markers with the severity of COVID-19. Measurement of inflammatory markers might assist clinicians to monitor and evaluate the severity and prognosis of COVID-19.

Keywords: COVID-19; Inflammatory markers; Meta-analysis; SARS-CoV-2; Severity.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Literature search and filtering of studies.
Figure 2
Figure 2
Forest plot of inflammatory markers. (A–F) Forest plot between nonsevere and severe groups for levels of CRP (A), PCT (B), IL-6 (C), ESR (D), SAA (E), and serum ferritin (F); G. Forest plot between survivors group and non-survivors group for levels of IL-6.
Figure 3
Figure 3
Sensitivity analyses. (A–F) Sensitivity analyses between nonsevere and severe groups for levels of CRP (A), PCT (B), IL-6 (C), ESR (D), SAA (E), and serum ferritin (F).
Figure 4
Figure 4
Publication bias by Egger’s test. (A–F) Publication bias by Egger’s test between nonsevere and severe groups in CRP (A), PCT (B), IL-6 (C), ESR (D), SAA (E), and serum ferritin (F).
See this image and copyright information in PMC

References

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