Procalcitonin Has Good Accuracy for Prognosis of Critical Condition  and Mortality in COVID-19:  A Diagnostic Test Accuracy Systematic Review and Meta-analysis

Mohammad Erfan Zare; Yanzhong Wang; Atefeh Nasir Kansestani; Afshin Almasi; Jun Zhang

doi:10.18502/ijaai.v19i6.4926

Mohammad Erfan Zare
Yanzhong Wang
Atefeh Nasir Kansestani
Afshin Almasi
Jun Zhang

DOI: https://doi.org/10.18502/ijaai.v19i6.4926

Keywords: COVID-19; Procalcitonin; Prognosis; Sensitivity and specificity

Abstract

Several reports have determined that changes in white blood cell counts and inflammatory biomarkers are related to disease outcome of coronavirus disease 2019 (COVID-19) and they can be utilized as prognostic biomarkers. For introducing a factor as a diagnostic/prognostic biomarker, diagnostic test accuracy (DTA) systematic review and meta-analysis are recommended. For the first time, we aimed to determine the accuracies of white blood cell counts and inflammatory biomarkers for prognosis of COVID-19 patient’s outcome by a DTA meta-analysis.

Until August 24, 2020, we searched Web of Sciences, Scopus, and MEDLINE/PubMed databases to achieve related papers. Summary points and lines of included studies were calculated from 2×2 tables by bivariate/hierarchical models. Critical condition and mortality were considered as outcomes.

A total of 13387 patients from 28 studies were included in this study. Six biomarkers containing leukocytosis, neutrophilia, lymphopenia, increased level of C-reactive protein, procalcitonin (PCT), and ferritin met the inclusion criteria. Analysis of the area under the curve (AUC_HSROC) indicated that the PCT was the only applicable prognostic biomarker for critical condition and mortality (AUC_HSROC=0.80 for both conditions). Pooled-diagnostic odds ratios were 6.78 (95% CI, 3.65-12.61) for prognosis of critical condition and 13.21 (95% CI, 3.95-44.19) for mortality. Other biomarkers had insufficient accuracies for both conditions (AUC_HSROC< 0.80).

Among evaluated biomarkers, only PCT has good accuracy for the prognosis of both critical condition and mortality in COVID-19 and it can be considered as a single prognostic biomarker for poor outcomes. Also, PCT has more accuracy for the prognosis of mortality in comparison to critical conditions.