Early prediction keys for COVID-19 cases progression: A meta-analysis

Abstract

BACKGROUNDː: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), within few months of being declared as a global pandemic by WHO, the number of confirmed cases has been over 75 million and over 1.6 million deaths since the start of the Pandemic and still counting, there is no consensus on factors that predict COVID-19 case progression despite the diversity of studies that reported sporadic laboratory predictive values predicting severe progression. We review different biomarkers to systematically analyzed these values to evaluate whether are they are correlated with the severity of COVID-19 disease and so their ability to be a predictor for progression.

Methods: The current meta-analysis was carried out to identify relevant articles using eight different databases regarding the values of biomarkers and risk factors of significance that predict progression of mild or moderate cases into severe and critical cases. We defined the eligibility criteria using a PICO model.

Results: Twenty-two relevant articles were selected for meta-analysis the following biomarkers C-reactive protein, interleukin-6, LDH, neutrophil, %PD-1 expression, D-dimer, creatinine, AST and Cortisol all recorded high cut-off values linked to severe and critical cases while low lymphocyte count, and low Albumin level were recorded. Also, we meta- analyzed age and comorbidities as a risk factors of progression as hypertension, Diabetes and chronic obstructive lung diseases which significantly correlated with cases progression (p < 0.05).

Conclusions: ː The current meta-analysis is the first step for analysing and getting cut-off references values of significance for prediction COVID-19 case progression. More studies are needed on patients infected with SARS-CoV-2 and on a larger scale to establish clearer threshold values that predict progression from mild to severe cases. In addition, more biomarkers testing also help in building a scoring system for the prediction and guiding for proper timely treatment.

Keywords: Biomarkers of risk for COVID-19 case progression; COVID-19; Comorbidity of risk for COVID-19 case progression; Meta-analysis; Prediction of critical cases; Prediction of severe cases; SARS-CoV-2.

Fig. 1

Systematic review flow chart for literature refinement.

Fig. 2

(A–F): Meta-analysis of the difference between COVID-19 patients with severe vs mild disease in: (A) Mean age (B) Albumin level (C) Aspartate aminotransferase (D) Creatinine (E) C-reactive protein (F) D-Ddimer. (G–L): Meta-analysis of the difference between COVID-19 patients with severe vs mild disease in: (G) Interleukin-6 (H) LDH (I) Lymphocytes (J) Neutrophil count (K) %PD-1 expression on T cells (L) Cortisol.

Fig. 3

(A–C): Meta-analysis of the difference between COVID-19 patients with severe vs mild disease in: (A) Hypertension (B) Diabetes (C) Chronic obstructive lung disease.