Globally, the efficacy of COVID-19 mortality biomarkers varies

New meta-analysis posted on medrex sib* preprint server Several of the biomarkers used to predict mortality from coronavirus disease 2019 (COVID-19) have reported varying efficacy in different regions of the world. Therefore, these prognostic markers and scores cannot be generalized across regions.

study: Degeneralization of Mortality Biomarkers in SARS-COV-2: A Meta-Analysis SeriesImage credit: sfam_photo / Shutterstock.com

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, has infected more than 654 million people worldwide and killed more than 6.6 million. In addition to the significant morbidity and mortality caused by COVID-19 and the resulting strain on health systems, the COVID-19 pandemic has had significant economic and social impacts around the world.

With healthcare systems overburdened and resources limited, early prediction of disease outcome is essential to identify high-risk patients. In addition, such predictive biomarkers enable clinicians to customize treatment planning and care delivery.

About research

To date, several biomarkers have been shown to predict potential adverse effects of COVID-19. However, most prognostic models devised to predict in-hospital mortality for SARS-CoV-2 have not performed consistently when tested against clinically similar cohorts.

The authors of the current study examined possible reasons for these discrepancies by conducting a meta-analysis. Here, we searched for reliable single-parameter biomarkers that can be easily measured and used to predict mortality in COVID-19-positive patients. This was proposed because it is not always possible to calculate a perfect prognostic model.

The PubMed database was searched with several keywords such as ‘SARS-CoV-2’, ‘biomarker name’ and ‘mortality’. In addition, a survey of all studies published between 1 January 2019 and 30 June 2021 was conducted.

We reported overall means and 95% confidence intervals for the collected data using R’s meta-library. For European/North American, Asian, and global datasets, the authors fit random-effects models and obtained pooled areas under the curve (AUC) and his 95% confidence intervals.

A sensitivity analysis was performed by successively excluding each study so that the impact of individual studies on the pooled AUC could be determined.

Survey results

We found that the efficacy of biomarkers in predicting mortality from SARS-CoV-2 infection varied significantly by geographic location. C-reactive protein (CRP) levels at admission provided a reliable mortality prediction in Asian countries, with a pooled AUC of 0.83 from 34 studies and 0.67 from 21 studies. By comparison, this parameter was only an average predictor of mortality in Europe and North America.

at the time of admission, D-dimer and interleukin-6 (IL-6) levels were also well-predicted death biomarkers in Asian countries, but not in Europe and North America.

Nevertheless, two biomarkers, including troponin and urea, performed well across cohorts regardless of geographic location.

Troponin levels at admission were 0.81 in Asian countries and 0.79 in European and North American countries. Similarly, his pooled AUC for urea levels on admission was 0.79 in Asian countries and 0.78 in European and North American countries.

Therefore, end-organ damage during presentation may be effectively used to predict the severity of SARS-CoV-2.

Conclusion

SARS-CoV-2 biomarkers are in common use worldwide. However, its effectiveness varies by region. For example, CRP and IL-6 levels were good predictive markers of mortality in Asian countries, but these parameters are less effective in determining his COVID-19 outcome in Europe and North America. was.

The researchers conclude that combining findings from Asian, European, and North American studies may mislead the public about the efficacy of CRP, D-dimer, and IL-6 treatments. This finding is particularly useful for clinicians who use biomarkers and/or prognostic scores obtained in other regions to assist in decision-making, strategizing management, and planning admissions to critical care, particularly in the future of COVID-19. This is important when a wave of death threatens to overwhelm local medical resources.

*Important Notices

medrex sib We publish a non-peer-reviewed, preliminary scientific report and should not be taken as conclusive, to guide clinical practice/health-related actions, or to be treated as established information.