Blood biochemical parameters as predictors of disease severity and mortality in COVID-19 patients- an updated systematic review and meta-analysis

Majid, A.; Mishra, P.; Parveen, R.; Bajpai, R.; Khan, M. A.; Agarwal, N. B.

Background: The outbreak of coronavirus disease 2019 (COVID-19) has been rapidly spreading across the globe and poses a great risk to human health. Patients with abnormalities in laboratory parameters are more susceptible to COVID-19. Therefore, we explored the association of blood biochemical parameters with severity and mortality of COVID-19 amongst 3695 patients across seventeen studies. Methods: We searched PubMed, Cochrane library and LitCOVID database until February 28, 2021. Seventeen studies were included in the meta-analysis with 3695 COVID-19 patients. Results: The pooled analysis showed that compared to non-severe group, severe group was characterised by significantly elevated alanine aminotransferase (ALT) (standardised mean difference [SMD]: 0.65, 95% confidence interval [CI]: 0.23 to 1.06; p<0.001, erythrocyte sedimentation rate (ESR) (SMD: 0.55, 95%CI: 0.02 to 1.07 p=0.004) and lymphopenia (SMD: -1.22, 95% CI: -2.15 to -0.30; p<0.01), decreased serum albumin (SMD: -1.60, 95% CI: -2.96 to -0.22 ; p<0.001), creatinine (SMD: 0.54, 95% CI: 0.17 to 0.90; p<0.001), lactate dehydrogenase (LDH)(SMD: -1.54, 95% CI: -2.27 to -0.80; p=0.002) and haemoglobin (SMD:-0.89, 95% CI: ; p<0.001). Additionally, in the non-survivor group, elevated lactate dehydrogenase (LDH) (SMD: 1.54 95% CI: -2.27 to 0.80; p=0.002), decreased serum albumin (SMD: 1.08, 95% CI: 0.75 to 1.42; p<0.001) were reported. There was no comorbidity which was found to be significant in the severe group. Conclusion: Serum albumin, ALT, ESR, lymphopenia, haemoglobin, and leucocytosis can reflect the severity of COVID-19, while the LDH, leucocytosis and albumin can be considered as risk factor to higher mortality. Keywords: COVID-19, laboratory parameters, SARS-CoV-2, disease severity, mortality