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Role of Inflammatory Markers in Severity, ICU Admission, and Mortality in COVID-19: A Systematic Review and Meta-analysis of 79,934 Patients

Hiwa O. Abdullah
Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
Sadraldin A. Braim
Smart Health Tower (Raparin Branch), Karukh Street, Ranya, Sulaymaniyah, Kurdistan, Iraq
Maria A. Rasool
Smart Health Tower (Raparin Branch), Karukh Street, Ranya, Sulaymaniyah, Kurdistan, Iraq
Dashne M. Abdalla
Smart Health Tower (Raparin Branch), Karukh Street, Ranya, Sulaymaniyah, Kurdistan, Iraq
Dyari Q. Hamad
Smart Health Tower (Raparin Branch), Karukh Street, Ranya, Sulaymaniyah, Kurdistan, Iraq
Daban K. Ahmad
Smart Health Tower (Raparin Branch), Karukh Street, Ranya, Sulaymaniyah, Kurdistan, Iraq
Ayman M. Mustafa
Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
Fakher Abdullah
Kscien Organization for Scientific Research (Europe office), Rotterdam, Netherlands
Yousif M. Mahmood
Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
Dilan S. Hiwa
Smart Health Tower, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
Sasan M. Ahmed
Kscien Organization for Scientific Research (Middle East Office), Hamid Street, Azadi Mall, Sulaymaniyah, Kurdistan, Iraq
Karokh K. Mohammed
Smart Health Tower (Raparin Branch), Karukh Street, Ranya, Sulaymaniyah, Kurdistan, Iraq
Berun A. Abdalla
Department of Biology, College of Education, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
Shvan H. Mohammed
Xzmat Polyclinic, Rizgari, Kalar, Sulaymaniyah, Kurdistan, Iraq
Fahmi H. kakamad
College of Medicine, University of Sulaimani, Madam Mitterrand Street, Sulaymaniyah, Kurdistan, Iraq
Abstract
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Published: June 30, 2024
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Table 1 Table 2 Table 3
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Table 1 Table 2 Table 3

Abstract

Introduction

Despite extensive investigations into the roles of inflammatory biomarkers in the prognosis of COVID-19 through systematic reviews and meta-analyses, they are limited by small sample sizes and focus on a specific marker. This meta-analysis investigated the role of 11 inflammatory biomarkers in severity, intensive care unit (ICU) admission, and mortality among COVID-19 patients.

Methods

Studies up to October 25, 2023, were identified through a search of Google Scholar, limited to human studies published in English. Inclusion criteria required confirmed COVID-19 cases diagnosed via reliable laboratory methods, original articles from eligible journals, proper grouping of severity status, ICU admission, or mortality outcomes, and presentation of continuous data in mean and standard deviation, median with range, or interquartile range.

Results

A total of 241 studies, comprising 79,934 cases of COVID-19, were included in this study. Albumin levels significantly declined in severe, ICU, and dead cases compared to mild, moderate, non-ICU, and survived cases (p<0.001). C-reactive protein (CRP), D-dimer, erythrocyte sedimentation rate (ESR), ferritin, fibrinogen, Interleukin-6 (IL-6), lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), procalcitonin, and white blood cell (WBC) were all significantly (p<0.001) increased and correlated with the severity of COVID-19. CRP, D-dimer, ferritin, fibrinogen, IL-6, LDH, NLR, procalcitonin, and WBC were all significantly (p<0.05) elevated and correlated with the risk of ICU admission (except fibrinogen) and mortality in COVID-19 in both fixed and random effects.

Conclusion

Inflammatory biomarkers like albumin, CRP, D-dimer, ferritin, IL-6, LDH, NLR, procalcitonin, and WBC all significantly impact severity status, ICU admission, and mortality in COVID-19.

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