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Meta-Analysis
. 2021 Apr:105:668-674.
doi: 10.1016/j.ijid.2021.03.025. Epub 2021 Mar 15.

Serum amyloid A concentrations, COVID-19 severity and mortality: An updated systematic review and meta-analysis

Angelo Zinellu  1 , Panagiotis Paliogiannis  2 , Ciriaco Carru  3 , Arduino A Mangoni  4
Affiliations
Meta-Analysis

Serum amyloid A concentrations, COVID-19 severity and mortality: An updated systematic review and meta-analysis

Angelo Zinellu et al. Int J Infect Dis. 2021 Apr.

Abstract

Background and objectives: An excessive inflammatory response in patients with coronavirus disease 2019 (COVID-19) is associated with high disease severity and mortality. Specific acute phase reactants might be useful for risk stratification. A systematic review and meta-analysis was conducted of studies on serum amyloid A (SAA) in patients with COVID-19.

Methods: The PubMed, Web of Science, and Scopus databases were searched, covering the period January 2020 to December 2020, for studies reporting SAA concentrations, COVID-19 severity, and survival status.

Results: Nineteen studies involving 5617 COVID-19 patients were included in the meta-analysis. Pooled results showed that SAA concentrations were significantly higher in patients with severe disease and non-survivors (standard mean difference (SMD) 1.20, 95% confidence interval 0.91-1.49, P < 0.001). Extreme between-study heterogeneity was observed (I2 = 92.4%, P < 0.001). In the sensitivity analysis, the effect size was not significantly affected when each study was removed in turn (range 1.10-1.29). The Begg test (P = 0.030), but not the Egger test (P = 0.385), revealed the presence of publication bias. Pooled SMD values were significantly and positively associated with sex (t = 2.20, P = 0.047) and aspartate aminotransferase (t = 3.44, P = 0.014).

Conclusions: SAA concentrations were significantly and positively associated with higher COVID-19 severity and mortality. This acute phase reactant might assist with risk stratification and monitoring in this group.

Keywords: COVID-19; Disease severity; Mortality; Serum amyloid A.

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Figures

Figure 1
Figure 1
Flow chart of study selection.
Figure 2
Figure 2
Forest plot of studies examining serum amyloid A concentrations in patients with COVID-19.
Figure 3
Figure 3
Sensitivity analysis of the association between serum amyloid A concentrations and COVID-19 disease. The influence of individual studies on the overall standardized mean difference (SMD) is shown. The middle vertical axis indicates the overall SMD and the two vertical axes indicate the 95% confidence interval (CI). The hollow circles represent the pooled SMD when the remaining study is omitted from the meta-analysis. The two ends of each broken line represent the 95% CI.
Figure 4
Figure 4
Funnel plot of studies investigating low versus high severity or survivor versus non-survivor status after trimming and filling. Dummy studies are represented by enclosed circles and genuine studies by free circles.
Figure 5
Figure 5
Univariate meta-regression analysis between sex and effect size, and between aspartate aminotransferase and effect size.
See this image and copyright information in PMC

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