The association between mean platelet volume and poor outcome in patients with COVID-19: Systematic review, meta-analysis, and meta-regression

Introduction: This study aims to assess the association between mean platelet volume (MPV) and poor outcome in patients with COVID-19. Methods: We performed a comprehensive literature search using the PubMed, Embase and Scopus databases with keywords “2019-nCoV” OR “SARS-CoV-2” OR “COVID-19” AND “mean platelet volume” OR “MPV” on 8 July 2021. The primary outcome was composite poor outcome, defined as severe COVID-19 or mortality. The pooled effect estimate was reported as mean differences in terms of MPV between the group with and without outcome. Results: There were 17 studies which consist of 4549 patients with COVID-19 were included in this study. The incidence of poor outcome was 25% (20%–30%). Mean MPV was found to be higher in the poor outcome group in compare to no poor outcome group (10.3 ± 1.9 fL vs 9.9 ± 1.7 fL). The mean MPV difference between both group was 0.47 fL [95% CI 0.27, 0.67], p < 0.001;I2: 62.91%, p < 0.001). In the sub-group analysis, patients with severe COVID-19 had higher MPV (mean difference 0.54 fL [95% CI 0.28, 0.80], p < 0.001;I2: 54.84%, p = 0.014). Furthermore, MPV was also higher in the mortality group (mean difference 0.54 fL [95% CI 0.29, 0.80], p = 0.020;I2: 71.11%, p = 0.004). Meta-regression analysis showed that the association between MPV and poor outcome was not affected by age (p = 0.789), gender (p = 0.167), platelets (p = 0.056), white blood cells (p = 0.639), and lymphocytes (p = 0.733). Conclusion: This meta-analysis indicated that increased MPV was associated with severity and mortality in patients with COVID-19. Further research is needed to determine the optimum cut-off point.

The association between serum prealbumin and poor outcome in COVID-19 - Systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the association between the prealbumin and severity and mortality in COVID-19. MATERIALS AND METHODS: We performed a systematic literature search from PubMed, Embase, and Scopus databases up until 2 February 2021. The primary outcome was the poor outcome, a composite of mortality and severity. Severe COVID-19 was defined as COVID-19 that fulfill the criteria for severe pneumonia or patients with acute respiratory distress syndrome/disease progression/need for intensive care unit or mechanical ventilation. The effect estimates were a mean difference between patients with and without a poor outcome in mg/dL and odds ratio (OR) per 1 mg/dL decrease in prealbumin level. The effect estimates were reported with their 95% confidence interval (95% CI). RESULTS: Nine studies comprising of 2104 patients were included in this systematic review and meta-analysis. Patients with poor outcome have lower prealbumin level (mean difference -71.48 mg/dL [95% CI -93.74, -49.22], p<0.001; I2: 85.9%). Every 1 mg/dL decrease in prealbumin level was associated with 1% increase in poor outcome (OR 0.992 [0.987, 0.997], p=0.004, I2: 81.7%). Meta-regression analysis showed that the association between the prealbumin level and poor outcome varies with gender (male) (coefficient: 3.50, R2: 100%, p<0.001), but not age, diabetes, hypertension, and chronic kidney disease. CONCLUSIONS: Low serum prealbumin was associated with poor outcomes in patients with COVID-19.

Effect of chronic obstructive pulmonary disease and smoking on the outcome of COVID-19.

OBJECTIVE: To investigate the association between chronic obstructive pulmonary disease (COPD) and smoking with outcome in patients with COVID-19.METHODS: A systematic literature search was performed using PubMed, EuropePMC, SCOPUS and the Cochrane Central Database. A composite of poor outcome, mortality, severe COVID-19, the need for treatment in an intensive care unit (ICU) and disease progression were the outcomes of interest.RESULTS: Data on 4603 patients were pooled from 21 studies. COPD was associated with an increased risk for composite poor outcome (OR 5.01, 95%CI 3.06-8.22; P < 0.001; I² 0%), mortality (OR 4.36, 95%CI 1.45-13.10; P = 0.009; I² 0%), severe COVID-19 (OR 4.62, 95%CI 2.49-8.56; P < 0.001; I² 0%), ICU care (OR 8.33, 95%CI 1.27-54.56; P = 0.03; I² 0%), and disease progression (OR 8.42, 95%CI 1.60-44.27; P = 0.01; I² 0%). Smoking was found to increase the risk of composite poor outcome (OR 1.52, 95%CI 1.16-2.00; P = 0.005; I² 12%), and subgroup analysis showed that smoking was significant for increased risk of severe COVID-19 (OR 1.65, 95%CI 1.17-2.34; P = 0.004; I² 11%). Current smokers were at higher risk of composite poor outcomes (OR 1.58, 95%CI 1.10-2.27; P = 0.01; I² 0%) than former/non-smokers.CONCLUSION: Our systematic review and meta-analysis revealed that COPD and smoking were associated with poor outcomes in patients with COVID-19.

Body mass index and outcome in patients with COVID-19: A dose-response meta-analysis.

BACKGROUND: There is mounting evidence related to the association between obesity and severity of COVID-19. However, the direct relationship of the increase in the severe COVID-19 risk factors, with an increase in body mass index (BMI), has not yet been evaluated. AIM: This meta-analysis aims to evaluate the dose-response relationship between body mass index (BMI) and poor outcome in patients with COVID-19. METHODS: A systematic literature search was conducted using PubMed, Europe PMC, ProQuest, and the Cochrane Central Database. The primary outcome was composite poor outcome composed of mortality and severity. The secondary outcomes were mortality and severity. RESULTS: A total of 34,390 patients from 12 studies were included in this meta-analysis. The meta-analysis demonstrated that obesity was associated with composite poor outcome (OR 1.73 [1.40, 2.14], P<0.001; I2: 55.6%), mortality (OR 1.55 [1.16, 2.06], P=0.003; I2: 74.4%), and severity (OR 1.90 [1.45, 2.48], P<0.001; I2: 5.2%) in patients with COVID-19. A pooled analysis of highest BMI versus reference BMI indicate that a higher BMI in the patients was associated with composite poor outcome (aOR 3.02 [1.82, 5.00], P<0.001; I2: 59.8%), mortality (aOR 2.85 [1.17, 6.92], P=0.002; I2: 79.7%), and severity (aOR 3.08 [1.78, 5.33], P<0.001; I2: 11.7%). The dose-response meta-analysis showed an increased risk of composite poor outcome by aOR of 1.052 [1.028, 1.077], P<0.001 for every 5kg/m2 increase in BMI (Pnon-linearity<0.001). The curve became steeper with increasing BMI. CONCLUSION: Dose-response meta-analysis demonstrated that increased BMI was associated with increased poor outcome in patients with COVID-19.