Abstract
Objective
To evaluate differences in thromboinflammatory biomarkers between patients with severe coronavirus disease 2019 (COVID-19) infection/death and mild infection.
Patients and Methods
MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, EBSCO, Web of Science, and CINAHL databases were searched for studies comparing thromboinflammatory biomarkers in COVID-19 among patients with severe COVID-19 disease or death (severe/nonsurvivors) and those with nonsevere disease or survivors (nonsevere/survivors) from January 1, 2020, through July 11, 2020. Inclusion criteria were (1) hospitalized patients 18 years or older comparing severe/nonsurvivors vs nonsevere/survivors and (2) biomarkers of inflammation and/or thrombosis. A random-effects model was used to estimate the weighted mean difference (WMD) between the 2 groups of COVID-19 severity.
Results
We included 75 studies with 17,052 patients. The severe/nonsurvivor group was older, had a greater proportion of men, and had a higher prevalence of hypertension, diabetes, cardiac or cerebrovascular disease, chronic kidney disease, malignancy, and chronic obstructive pulmonary disease. Thromboinflammatory biomarkers were significantly higher in patients with severe disease, including D-dimer (WMD, 0.60; 95% CI, 0.49 to 0.71; I2=83.85%), fibrinogen (WMD, 0.42; 95% CI, 0.18 to 0.67; I2=61.88%; P<.001), C-reactive protein (CRP) (WMD, 35.74; 95% CI, 30.16 to 41.31; I2=85.27%), high-sensitivity CRP (WMD, 62.68; 95% CI, 45.27 to 80.09; I2=0%), interleukin 6 (WMD, 22.81; 95% CI, 17.90 to 27.72; I2=90.42%), and ferritin (WMD, 506.15; 95% CI, 356.24 to 656.06; I2=52.02%). Moderate to significant heterogeneity was observed for all parameters (I2 > 25%). Subanalysis based on disease severity, mortality, and geographic region of the studies revealed similar inferences.
Conclusion
Thromboinflammatory biomarkers (D-dimer, fibrinogen, CRP, high-sensitivity CRP, ferritin, and interleukin 6) and marker of end-organ damage (high-sensitivity troponin I) are associated with increased severity and mortality in COVID-19 infection.
【저자키워드】 Coronavirus disease 2019, C-reactive protein, lactate dehydrogenase, interleukin 6, extracorporeal membrane oxygenation, Odds ratio, COVID-19coronavirus disease 2019, CRPC-reactive protein, LDHlactate dehydrogenase, OROdds Ratio, ECMOextracorporeal membrane oxygenation, hshigh-sensitivity, high-sensitivity, IL-6interleukin 6, WMDweighted mean difference, weighted mean difference, 【초록키워드】 COVID-19, Biomarker, Mortality, thrombosis, severity, disease severity, COVID-19 severity, CRP, D-dimer, ferritin, Chronic kidney disease, diabetes, hypertension, database, heterogeneity, Prevalence, COVID-19 infection, Patient, death, fibrinogen, troponin I, group, disease, patients, severe COVID-19 disease, mild infection, pulmonary disease, marker, severe disease, Cerebrovascular disease, malignancy, criteria, C-reactive protein (CRP, Older, Web of Science, 95% CI, severe coronavirus disease, CINAHL, mean difference, random-effects model, inferences, survivor, parameter, end-organ damage, men, objective, Result, greater, was used, evaluate, proportion, searched, hospitalized patient, significantly higher, Controlled, chronic obstructive, biomarkers of inflammation, 【제목키워드】 review,