Zinellu Angelo, Mangoni Arduino A
Department of Biomedical Sciences, University of Sassari, Sassari, Italy.
Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Adelaide, SA, Australia.
Front Med (Lausanne). 2021 Jan 26;8:638529. doi: 10.3389/fmed.2021.638529. eCollection 2021.
Excessive inflammation and malnutrition are associated with coronavirus disease 2019 (COVID-19) severity and mortality. Combined biomarkers of malnutrition and inflammation, such as serum prealbumin, might be particularly attractive for early risk stratification. We conducted a systematic review and meta-analysis of studies reporting serum prealbumin in patients with COVID-19. We searched PubMed, Web of Science and Scopus, between January and November 2020, for studies reporting data on serum prealbumin, COVID-19 severity, defined as severe illness, prolonged viral load, receiving mechanical ventilation or admitted to intensive care unit (ICU), and mortality. Nineteen studies in 4,616 COVID-19 patients were included in the meta-analysis. Pooled results showed that serum prealbumin concentrations were significantly lower in patients with severe disease and non-survivors (standard mean difference, SMD, -0.92, 95% CI, -1.10 to -0.74, < 0.001). Extreme heterogeneity was observed ( = 77.9%; < 0.001). In sensitivity analysis, the effect size was not significantly affected when each study was in turn removed (range between -0.86 and -0.95). The Begg's ( = 0.06) and Egger's -tests ( = 0.26) did not show publication bias. Pooled SMD values were significantly and negatively associated with age ( = -2.18, = 0.045) and C-reactive protein ( = -3.85, = 0.002). In our meta-analysis, lower serum prealbumin concentrations were significantly associated with COVID-19 severity and mortality. This combined marker of malnutrition and inflammation might assist with early risk stratification and management in this group.
过度炎症反应和营养不良与2019冠状病毒病（COVID-19）的严重程度及死亡率相关。营养不良和炎症的联合生物标志物，如血清前白蛋白，可能对早期风险分层特别有吸引力。我们对报告COVID-19患者血清前白蛋白的研究进行了系统评价和荟萃分析。我们于2020年1月至11月在PubMed、科学网和Scopus上检索了报告血清前白蛋白、COVID-19严重程度（定义为重症疾病、病毒载量延长、接受机械通气或入住重症监护病房[ICU]）及死亡率数据的研究。荟萃分析纳入了4616例COVID-19患者的19项研究。汇总结果显示，重症患者和非幸存者的血清前白蛋白浓度显著降低（标准化均数差，SMD，-0.92，95%可信区间，-1.10至-0.74，<0.001）。观察到存在极大异质性（I² = 77.9%；P < 0.001）。在敏感性分析中，依次剔除每项研究时效应量未受到显著影响（范围在-0.86至-0.95之间）。Begg检验（P = 0.06）和Egger检验（P = 0.26）未显示发表偏倚。汇总的SMD值与年龄（r = -2.18，P = 0.045）和C反应蛋白（r = -3.85，P = 0.002）显著负相关。在我们的荟萃分析中，较低的血清前白蛋白浓度与COVID-19的严重程度及死亡率显著相关。这种营养不良和炎症的联合标志物可能有助于该群体的早期风险分层和管理。
