The laboratory findings and different COVID-19 severities: a systematic review and meta-analysis.

BACKGROUND: Abnormal laboratory findings are common in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this systematic review was to investigate the effect of the level of some laboratory factors (C-reactive protein (CRP), creatinine, leukocyte count, hemoglobin, and platelet count) on the severity and outcome of coronavirus disease 2019 (COVID-19). METHODS: We searched PubMed, Web of Science, Scopus, and Google Scholar. We collected the articles published before May 26, 2020. We gathered the laboratory factors in groups of patients with COVID-19, and studied the relation between level of these factors with severity and outcome of the disease. RESULTS: Mean CRP level, creatinine, hemoglobin, and the leukocytes count in the critically ill patients were significantly higher than those of the other groups (non-critical patients); mean CRP = 54.81 mg/l, mean creatinine = 86.82 µmol/l, mean hemoglobin = 144.05 g/l, and mean leukocyte count = 7.41 × 109. The lymphocyte count was higher in patients with mild/moderate disease (mean: 1.32 × 109) and in the invasive ventilation group (mean value of 0.72 × 109), but it was considerably lower than those of the other two groups. The results showed that the platelet count was higher in critically ill patients (mean value of 205.96 × 109). However, the amount was lower in the invasive ventilation group compared with the other groups (mean level = 185.67 × 109). CONCLUSION: With increasing disease severity, the leukocyte count and the level of CRP increase significantly and the lymphocyte count decreases. There seems to be a significant relation between platelet level, hemoglobin, and creatinine level with severity of the disease. However, more studies are required to confirm this.

Diagnostic Accuracy of Rapid Ultrasound in Shock (RUSH) Exam; A Systematic Review and Meta-analysis.

OBJECTIVE: To perform a diagnostic accuracy of the rapid ultrasound in shock (RUSH) to diagnose the etiology of undifferentiated shock in patients presenting to the emergency department (ED). METHODS: We searched the Medline via PubMed, Scopus, and ISI Web of Knowledge till July 2017. Two independent reviewers screened studies for eligibility. Our study analysis is planned in accordance with the guidelines for meta-analysis of diagnostic studies. In the systematic search, of 397 references, 295 were excluded on the basis of the title and abstract. For the remaining 102 articles, the full text was retrieved and critically reviewed. After the selection process, five papers were included. RESULTS: The pooled estimate of all data showed that the RUSH protocol exhibited high sensitivity (0.87, 95% Confidence Interval (CI): 0.80-0.92, I2 = 46.7%) and specificity (0.98, 95% C. I.: 0.96-0.99, I2 = 30.8%). The AUC for SROC, a global measure of the RUSH protocol performance, was 0.98 ± 0.01, indicates the high accuracy of the test. Positive and negative likelihood ratios reported from the studies ranged from 9.83 to 51.32 and 0.04 to 0.33, respectively. The pooled estimate of all data showed that the RUSH protocol exhibited high positive likelihood ratio (19.19, 95% C. I.: 11.49-32.06, I2 = 14.1%) and low negative likelihood ratio (0.23, 95% C. I.: 0.15-0.34, I2 = 18.4%). CONCLUSION: This meta-analysis suggests that RUSH protocol has generally good role to distinguish the states of shock in patients with undifferentiated shock referred to the emergency department.