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Review
. 2020 Nov 20;99(47):e23315.
doi: 10.1097/MD.0000000000023315.

Association of elevated inflammatory markers and severe COVID-19: A meta-analysis

Pan Ji  1 , Jieyun Zhu, Zhimei Zhong, Hongyuan Li, Jielong Pang, Bocheng Li, Jianfeng Zhang
Affiliations
Review

Association of elevated inflammatory markers and severe COVID-19: A meta-analysis

Pan Ji et al. Medicine (Baltimore). .

Abstract

Our study aimed to assess the existing evidence on whether severe coronavirus disease 2019 (COVID-19) is associated with elevated inflammatory markers.The PubMed, Embase, Web of Science, Scopus, Chinese National Knowledge Infrastructure, WanFang, and China Science and Technology Journal databases were searched to identify studies published between January 1 and April 21, 2020 that assayed inflammatory markers in COVID-19 patients. Three reviewers independently examined the literature, extracted relevant data, and assessed the risk of publication bias before including the meta-analysis studies.Fifty-six studies involving 8719 COVID-19 patients were identified. Meta-analysis showed that patients with severe disease showed elevated levels of white blood cell count (WMD: 1.15, 95% CI: 0.78-1.52), C-reactive protein (WMD: 38.85, 95% CI: 31.19-46.52), procalcitonin (WMD: 0.08, 95% CI: 0.06-0.11), erythrocyte sedimentation rate (WMD: 10.15, 95% CI: 5.03-15.46), interleukin-6 (WMD: 23.87, 95% CI: 15.95-31.78), and interleukin-10 (WMD: 2.12, 95% CI: 1.97-2.28). Similarly, COVID-19 patients who died during follow-up showed significantly higher levels of white blood cell count (WMD: 4.11, 95% CI: 3.25-4.97), C-reactive protein (WMD: 74.18, 95% CI: 56.63-91.73), procalcitonin (WMD: 0.26, 95% CI: 0.11-0.42), erythrocyte sedimentation rate (WMD: 10.94, 95% CI: 4.79-17.09), and interleukin-6 (WMD: 59.88, 95% CI: 19.46-100.30) than survivors.Severe COVID-19 is associated with higher levels of inflammatory markers than a mild disease, so tracking these markers may allow early identification or even prediction of disease progression.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flowchart of literature screening.
Figure 2
Figure 2
Meta-analysis of the difference in white blood cell count (×1012/L) between patients with mild or severe COVID-19. WMD = weighted mean difference, COVID-19 = coronavirus disease 2019.
Figure 3
Figure 3
Meta-analysis of the difference in CRP (mg/L) between COVID-19 patients with mild or severe disease. WMD = weighted mean difference, COVID-19 = coronavirus disease 2019, CRP = C-reactive protein.
Figure 4
Figure 4
Meta-analysis of the difference in IL-6 (pg/mL) between COVID-19 patients with mild or severe disease. WMD = weighted mean difference, COVID-19 = coronavirus disease 2019, L-6 = interleukin-6.
Figure 5
Figure 5
Meta-analysis of the difference in PCT (ng/mL) between COVID-19 patients with mild or severe disease. WMD = weighted mean difference. COVID-19 = coronavirus disease 2019, PCT = procalcitonin.
Figure 6
Figure 6
Sensitivity analysis of white blood cell count between patients with mild or severe COVID-19. COVID-19 = coronavirus disease 2019.
See this image and copyright information in PMC

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References

    1. WHO. Coronavirus disease 2019 (COVID-19) Situation Dashboard[Internet]. Available at: https://covid19.who.int/ [Accessed April 27, 2020].
    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497–506. - PMC - PubMed
    1. Wan S, Yi Q, Fan S, et al. Relationships among lymphocyte subsets, cytokines, and the pulmonary inflammation index in coronavirus (COVID-19) infected patients. Br J Haematol 2020;189:428–37. - PMC - PubMed
    1. Qin C, Zhou L, Hu Z, et al. Dysregulation of immune response in patients with COVID-19 in Wuhan, China. Clin Infect Dis 2020;ciaa248. - PMC - PubMed
    1. Xiao KH, Shui LL, Pang XH, et al. Clinical features of coronavirus disease 2019 in Northeast area of Chongqing: analysis of 143 cases. J Third Mil Med Univ 2020;42:549–54.

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