The Prognostic Value of Thrombocytopenia in COVID-19 Patients; a Systematic Review and Meta-Analysis
Archives of Academic Emergency Medicine,
Vol. 8 No. 1 (2020),
1 January 2020
,
Page e75
https://doi.org/10.22037/aaem.v8i1.828
Abstract
Introduction: Multiple lines of evidence have attested that decreased numbers of platelets may serve as a surrogate marker for poor prognosis in a wide range of infectious diseases. Thus, to provide a well-conceptualized viewpoint demonstrating the prognostic value of thrombocytopenia in COVID-19, we performed a meta-analysis of pertinent literature.
Methods: The keywords “platelet” OR “thrombocytopenia” AND “COVID-19” OR “coronavirus 2019” OR “2019-nCoV” OR “SARS-CoV-2” were searched in National Library of Medicine Medline/PubMed and Scopus between December 30, 2019, and May 9, 2020 in English without any restriction. The initial search results were first screened by title and abstract, and then full texts of relevant articles representing information on the platelet count (main outcome) with a clinically validated definition of COVID-19 severity were finally selected. To assess the existence of bias in the included studies, the funnel plot and egger plot along with egger tests were used. Also, the heterogeneity among the included studies was tested using the Chi-square test.
Results: The results of our meta-analysis of 19 studies, totaling 3383 COVID-19 patients with 744 (21.9%) severe cases, revealed that non-severe cases have a significantly higher number of platelets and showed that the probability of the emergence of thrombocytopenia is significantly higher in the severe cases with the pooled mean difference of -21.5 (%95 CI: -31.57, -11.43).
Conclusion: Decreased number of platelets more commonly associates with severe COVID-19; however, whether the emergence of thrombocytopenia may result in diseases severity or the severity of the disease may decrease platelets, is open to debate.
- SARS-CoV-2; COVID-19; Prognosis; Blood Platelets; Thrombocytopenia; Meta-analysis
How to Cite
References
Organization WH. Director-General's remarks at the media briefing on 2019-nCoV on 11 February 2020. Internet] World Health Organization. 2020.
Jordan RE, Adab P, Cheng K. Covid-19: risk factors for severe disease and death. British Medical Journal Publishing Group; 2020.
Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. The Lancet respiratory medicine. 2020;8(4):420-2.
Organization WH. Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. http://www who int/csr/sars/country/table2004_04_21/en/index html. 2003.
Organization WH. Middle East respiratory syndrome coronavirus (MERS-CoV).(2016) http://www. who. int/emergencies/mers-cov/en. Erişim Tarihi.1.
Baud D, Qi X, Nielsen-Saines K, Musso D, Pomar L, Favre G. Real estimates of mortality following COVID-19 infection. The Lancet infectious diseases. 2020.
Assinger A. Platelets and infection–an emerging role of platelets in viral infection. Front Immunol. 2014;5:649.
Drosten C, Seilmaier M, Corman VM, Hartmann W, Scheible G, Sack S, et al. Clinical features and virological analysis of a case of Middle East respiratory syndrome coronavirus infection. The Lancet infectious diseases. 2013;13(9):745-51.
Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta. 2020.
Yang X, Yang Q, Wang Y, Wu Y, Xu J, Yu Y, et al. Thrombocytopenia and Its Association with Mortality in Patients with COVID‐19. J Thromb Haemost. 2020.
Eldredge J. Evidence-based librarianship: the EBL process. Library hi tech. 2006;24(3):341-54.
Cleyle S, Glynn L. A critical appraisal tool for library and information research. Library Hi Tech. 2006.
Van Aert RC, Wicherts JM, Van Assen MA. Publication bias examined in meta-analyses from psychology and medicine: A meta-meta-analysis. PLoS One. 2019;14(4).
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-60.
Singhal T. A review of coronavirus disease-2019 (COVID-19). The Indian Journal of Pediatrics. 2020:1-6.
Lippi G, Plebani M. A modern and pragmatic definition of Laboratory Medicine. Clinical Chemistry and Laboratory Medicine (CCLM). 2020;1(ahead-of-print).
Lippi G, Plebani M. The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks. Clinical Chemistry and Laboratory Medicine (CCLM). 2020;1(ahead-of-print).
Pourbagheri-Sigaroodi A, Bashash D, Fateh F, Abolghasemi H. Laboratory Findings in COVID-19 Diagnosis and Prognosis. Clin Chim Acta. 2020.
Wynants L, Van Calster B, Bonten MM, Collins GS, Debray TP, De Vos M, et al. Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal. BMJ. 2020;369.
Xu P, Zhou Q, Xu J. Mechanism of thrombocytopenia in COVID-19 patients. Ann Hematol. 2020:1-4.
Bashash D, Abolghasemi H, Salari S, Olfatifar M, Eshghi P, Akbari ME. Iranian Journal of Blood & Cancer.
Amgalan A, Othman M. Exploring possible mechanisms for COVID‐19 induced thrombocytopenia: Unanswered Questions. J Thromb Haemost. 2020.
Yang M, Ng MH, Li CK. Thrombocytopenia in patients with severe acute respiratory syndrome. Hematology. 2005;10(2):101-5.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020;395(10223):497-506.
Wang R, Pan M, Zhang X, Fan X, Han M, Zhao F, et al. Epidemiological and clinical features of 125 Hospitalized Patients with COVID-19 in Fuyang, Anhui, China. Int J Infect Dis. 2020.
Young BE, Ong SWX, Kalimuddin S, Low JG, Tan SY, Loh J, et al. Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA. 2020;323(15):1488-94.
Liu Y, Sun W, Guo Y, Chen L, Zhang L, Zhao S, et al. Association between platelet parameters and mortality in coronavirus disease 2019: Retrospective cohort study. Platelets. 2020:1-7.
Cao M, Zhang D, Wang Y, Lu Y, Zhu X, Li Y, et al. Clinical Features of Patients Infected with the 2019 Novel Coronavirus (COVID-19) in Shanghai, China. medRxiv. 2020.
Zhang G-q, Hu C, Luo L-j, Fang F, Chen Y-f, Li J-g, et al. Clinical features and treatment of 221 patients with COVID-19 in Wuhan, China. China (2/27/2020). 2020.
Organization WH. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected, Interim guidance, 13 March 2020. 2020.
Wan S, Xiang Y, Fang W, Zheng Y, Li B, Hu Y, et al. Clinical Features and Treatment of COVID‐19 Patients in Northeast Chongqing. J Med Virol. 2020.
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020.
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020.
Gong J, Ou J, Qiu X, Jie Y, Chen Y, Yuan L, et al. A Tool to Early Predict Severe Corona Virus Disease 2019 (COVID-19): A Multicenter Study using the Risk Nomogram in Wuhan and Guangdong, China. Clin Infect Dis. 2020.
Jian-ya G. Clinical characteristics of 51 patients discharged from hospital with COVID-19 in Chongqing, China. medRxiv. 2020.
Qian G-Q, Yang N-B, Ding F, Ma AHY, Wang Z-Y, Shen Y-F, et al. Epidemiologic and Clinical Characteristics of 91 Hospitalized Patients with COVID-19 in Zhejiang, China: A retrospective, multi-centre case series. QJM: An International Journal of Medicine. 2020.
Guan W-j, Ni Z-y, Hu Y, Liang W-h, Ou C-q, He J-x, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020.
Wang Z, Yang B, Li Q, Wen L, Zhang R. Clinical Features of 69 Cases With Coronavirus Disease 2019 in Wuhan, China. Clin Infect Dis. 2020.
Fan BE, Chong VCL, Chan SSW, Lim GH, Lim KGE, Tan GB, et al. Hematologic parameters in patients with COVID‐19 infection. Am J Hematol. 2020.
Chen G, Wu D, Guo W. Clinical and immunologic features in severe and moderate forms of Coronavirus Disease 2019. medRxiv 2020. DOI.10(2020.02):16.20023903.
Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020.
Yang X, Yu Y, Xu J, Shu H, Liu H, Wu Y, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine. 2020.
Liu W, Tao Z-W, Lei W, Ming-Li Y, Kui L, Ling Z, et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin Med J. 2020.
Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Med. 2020:1-3.
- Abstract Viewed: 503 times
- pdf Downloaded: 202 times