Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman Street, Karawaci, Tangerang, Banten, Indonesia.
Department of Internal Medicine, Faculty of Medicine, Pelita Harapan University, Boulevard Jendral Sudirman Street, Karawaci, Tangerang, Banten, Indonesia.
Am J Emerg Med. 2021 Mar;41:110-119. doi: 10.1016/j.ajem.2020.12.076. Epub 2020 Dec 30.
Laboratory testing is commonly performed in patients with COVID-19. Each of the laboratory parameters has potential value for risk stratification and prediction of COVID-19 outcomes. This systematic review and meta-analysis aimed to evaluate the difference between these parameters in severe and nonsevere disease and to provide the optimal cutoff value for predicting severe disease.
We performed a systematic literature search through electronic databases. The variables of interest were serum procalcitonin, albumin, C-reactive protein (CRP), D-dimer, and lactate dehydrogenase (LDH) levels in each group of severity outcomes from COVID-19.
There were a total of 4848 patients from 23 studies. Our meta-analysis suggest that patients with severe COVID-19 infections have higher procalcitonin, (mean difference 0.07; 95% CI 0.05-0.10; p < 0.00001), CRP (mean difference 36.88; 95% CI 29.10-44.65; p < 0.00001), D-Dimer (mean difference 0.43; 95% CI 0.31-0.56; p < 0.00001), and LDH (mean difference 102.79; 95% CI 79.10-126.49; p < 0.00001) but lower levels of albumin (mean difference -4.58; 95% CI -5.76 to -3.39; p < 0.00001) than those with nonsevere COVID-19 infections. The cutoff values for the parameters were 0.065 ng/mL for procalcitonin, 38.85 g/L for albumin, 33.55 mg/L for CRP, 0.635 μ/L for D-dimer, and 263.5 U/L for LDH, each with high sensitivity and specificity.
This meta-analysis suggests elevated procalcitonin, CRP, D-dimer, and LDH and decreased albumin can be used for predicting severe outcomes in COVID-19.
在 COVID-19 患者中，实验室检测通常是常规进行的。每个实验室参数对于 COVID-19 结果的风险分层和预测都具有潜在价值。本系统回顾和荟萃分析旨在评估这些参数在重症和非重症疾病中的差异，并为预测重症疾病提供最佳截断值。
我们通过电子数据库进行了系统文献检索。感兴趣的变量是 COVID-19 各组严重程度结局的血清降钙素原、白蛋白、C 反应蛋白（CRP）、D-二聚体和乳酸脱氢酶（LDH）水平。
共有来自 23 项研究的 4848 名患者。我们的荟萃分析表明，重症 COVID-19 感染患者的降钙素原（均数差 0.07；95%置信区间 0.05-0.10；p<0.00001）、CRP（均数差 36.88；95%置信区间 29.10-44.65；p<0.00001）、D-二聚体（均数差 0.43；95%置信区间 0.31-0.56；p<0.00001）和 LDH（均数差 102.79；95%置信区间 79.10-126.49；p<0.00001）水平较高，而白蛋白（均数差 -4.58；95%置信区间 -5.76 至 -3.39；p<0.00001）水平较低。这些参数的截断值分别为降钙素原 0.065ng/ml、白蛋白 38.85g/L、CRP 33.55mg/L、D-二聚体 0.635μ/L 和 LDH 263.5U/L，每个参数的灵敏度和特异性都较高。
本荟萃分析表明，升高的降钙素原、CRP、D-二聚体和 LDH 以及降低的白蛋白可用于预测 COVID-19 的严重结局。
