Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 Oct 1:258:118167.
doi: 10.1016/j.lfs.2020.118167. Epub 2020 Jul 29.

The role of cytokine profile and lymphocyte subsets in the severity of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis

Hamed Akbari  1 , Reza Tabrizi  2 , Kamran B Lankarani  2 , Hamid Aria  3 , Sina Vakili  4 , Fatemeh Asadian  5 , Saam Noroozi  6 , Pedram Keshavarz  7 , Sanaz Faramarz  8
Affiliations
Meta-Analysis

The role of cytokine profile and lymphocyte subsets in the severity of coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis

Hamed Akbari et al. Life Sci. .

Abstract

Aims: This study aimed to make a comparison between the clinical laboratory-related factors, complete blood count (CBC) indices, cytokines, and lymphocyte subsets in order to distinguish severe coronavirus disease 2019 (COVID-19) cases from the non-severe ones.

Materials and methods: Relevant studies were searched in PubMed, Embase, Scopus, and Web of Science databases until March 31, 2020. Cochrane's Q test and the I2 statistic were used to determine heterogeneity. We used the random-effect models to pool the weighted mean differences (WMDs) and 95% confidence intervals (CIs).

Key findings: Out of a total of 8557 initial records, 44 articles (50 studies) with 7865 patients (ranging from 13 to 1582), were included. Our meta-analyses with random-effect models showed a significant decrease in lymphocytes, monocyte, CD4+ T cells, CD8+ T cells, CD3 cells, CD19 cells, and natural killer (NK) cells and an increase in the white blood cell (WBC), neutrophils, neutrophil to lymphocyte ratio (NLR), C-reactive protein (CRP)/hs-CRP, erythrocyte sedimentation rate (ESR), ferritin, procalcitonin (PCT), and serum amyloid A (SAA), interleukin-2 (IL-2), IL-2R, IL-4, IL-6, IL-8, IL-10, tumor necrosis factor-alpha (TNF-α), and interferon-gamma (INF-γ) in the severe group compared to the non-severe group. However, no significant differences were found in IL-1β, IL-17, and CD4/CD8 T cell ratio between the two groups.

Significance: Decrease in total lymphocytes and lymphocyte subsets as well as the elevation of CRP, ESR, SAA, PCT, ferritin, and cytokines, but not IL-1β and IL-17, were closely associated with COVID-19 severity, implying reliable indicators of severe COVID-19.

Keywords: COVID-19; Cytokine; Laboratory findings; Lymphocyte subsets; Meta-analysis; Novel coronavirus; SARS-CoV-2.

PubMed Disclaimer

Conflict of interest statement

Declaration of competing interest None.

Figures

Unlabelled Image
Graphical abstract
Fig. 1
Fig. 1
The flowchart of study identification and study selection process.
See this image and copyright information in PMC

References

    1. Forouzesh M., Rahimi A., Valizadeh R., Dadashzadeh N., Mirzazadeh A. Clinical display, diagnostics and genetic implication of novel coronavirus (COVID-19) epidemic. Eur. Rev. Med. Pharmacol. Sci. 2020;24:4607–4615. - PubMed
    1. Vakili S., Akbari H., Ghahramani S., Jamalnia S. 2020. Report of an Iranian COVID-19 Case in a Laparoscopic Cholecystectomy Patient: Case Report and Insights. - DOI
    1. COVID-19 coronavirus pandemic, (n.d.). https://www.worldometers.info/coronavirus/.
    1. Ye Q., Wang B., Mao J. The pathogenesis and treatment of the ‘cytokine storm’ in COVID-19. J. Inf. Secur. 2020;80:607–613. doi: 10.1016/j.jinf.2020.03.037. - DOI - PMC - PubMed
    1. Wang W., He J., Wu S. 2020. The Definition and Risks of Cytokine Release Syndrome-like in 11 COVID-19-infected Pneumonia Critically Ill Patients: Disease Characteristics and Retrospective Analysis. Medrxiv. - PMC - PubMed