Early changes in laboratory parameters are predictors of mortality and ICU admission in patients with COVID-19: a systematic review and meta-analysis

Kiss, Szabolcs; Gede, Noémi; Hegyi, Péter; Németh, Dávid; Földi, Mária; Dembrovszky, Fanni; Nagy, Bettina; Juhász, Márk Félix; Ocskay, Klementina; Zádori, Noémi; Molnár, Zsolt; Párniczky, Andrea; Hegyi, Péter Jenő; Szakács, Zsolt; Pár, Gabriella; Erőss, Bálint; Alizadeh, Hussain

Despite the growing knowledge of the clinicopathological features of COVID-19, the correlation between early changes in the laboratory parameters and the clinical outcomes of patients is not entirely understood. In this study, we aimed to assess the prognostic value of early laboratory parameters in COVID-19. We conducted a systematic review and meta-analysis based on the available literature in five databases. The last search was on July 26, 2020, with key terms related to COVID-19. Eligible studies contained original data of at least ten infected patients and reported on baseline laboratory parameters of patients. We calculated weighted mean differences (WMDs) for continuous outcomes and odds ratios (ORs) with 95% confidence intervals. 93 and 78 studies were included in quantitative and qualitative syntheses, respectively. Higher baseline total white blood cell count (WBC), C-reactive protein (CRP), lactate-dehydrogenase (LDH), creatine kinase (CK), D-dimer and lower absolute lymphocyte count (ALC) (WMD(ALC) = − 0.35 × 10(9)/L [CI − 0.43, − 0.27], p < 0.001, I(2) = 94.2%; < 0.8 × 10(9)/L, OR(ALC) = 3.74 [CI 1.77, 7.92], p = 0.001, I(2) = 65.5%) were all associated with higher mortality rate. On admission WBC, ALC, D-dimer, CRP, LDH, and CK changes could serve as alarming prognostic factors. The correct interpretation of laboratory abnormalities can guide therapeutic decisions, especially in early identification of potentially critical cases. This meta-analysis should help to allocate resources and save lives by enabling timely intervention. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00430-020-00696-w) contains supplementary material, which is available to authorized users.