TY - JOUR
T1 - Serum ferritin as a predictive biomarker in COVID-19. A systematic review, meta-analysis and meta-regression analysis
AU - Kaushal, Karanvir
AU - Kaur, Hardeep
AU - Sarma, Phulen
AU - Bhattacharyya, Anusuya
AU - Sharma, Dibya Jyoti
AU - Prajapat, Manisha
AU - Pathak, Mona
AU - Kothari, Ashish
AU - Kumar, Subodh
AU - Rana, Satyavati
AU - Kaur, Manpreet
AU - Prakash, Ajay
AU - Mirza, Anissa Atif
AU - Panda, Prasan Kumar
AU - Vivekanandan, S.
AU - Omar, Balram Ji
AU - Medhi, Bikash
AU - Naithani, Manisha
N1 - Funding Information:
Nil.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/2
Y1 - 2022/2
N2 - Ferritin is a known inflammatory biomarker in COVID-19. However, many factors and co-morbidities can confound the level of serum ferritin. This current metaanalysis evaluates serum ferritin level in different severity levels in COVID-19. Studies evaluating serum ferritin level in different clinical contexts (COVID-19 vs. control, mild to moderate vs. severe to critical, non-survivor vs. survivor, organ involvement, ICU and mechanical ventilation requirement) were included (total 9 literature databases searched). Metaanalysis and metaregression was carried out using metaphor “R” package. Compared to control (COVID-19 negative), higher ferritin levels were found among the COVID-19 patients [SMD −0.889 (95% C.I. −1.201, −0.577), I2 = 85%]. Severe to critical COVID-19 patients showed higher ferritin levels compared to mild to moderate COVID-19 patients [SMD 0.882 (0.738, 1.026), I2 = 85%]. In meta-regression, high heterogeneity was observed could be attributed to difference in “mean age”, and “percentage of population with concomitant co-morbidities”. Non-survivors had higher serum ferritin level compared to survivors [SMD 0.992 (0.672, 1.172), I2 = 92.33%]. In meta-regression, high heterogeneity observed could be attributed to difference in “mean age” and “percentage of male sex”. Patients requiring ICU [SMD 0.674 (0.515 to 0.833), I2 = 80%] and mechanical ventilation [SMD 0.430 (0.258, 0.602), I2 = 32%] had higher serum ferritin levels compared to those who didn't. To conclude, serum ferritin level may serve as an important biomarker which can aid in COVID-19 management. However, presence of other co-morbid conditions/confounders warrants cautious interpretation.
AB - Ferritin is a known inflammatory biomarker in COVID-19. However, many factors and co-morbidities can confound the level of serum ferritin. This current metaanalysis evaluates serum ferritin level in different severity levels in COVID-19. Studies evaluating serum ferritin level in different clinical contexts (COVID-19 vs. control, mild to moderate vs. severe to critical, non-survivor vs. survivor, organ involvement, ICU and mechanical ventilation requirement) were included (total 9 literature databases searched). Metaanalysis and metaregression was carried out using metaphor “R” package. Compared to control (COVID-19 negative), higher ferritin levels were found among the COVID-19 patients [SMD −0.889 (95% C.I. −1.201, −0.577), I2 = 85%]. Severe to critical COVID-19 patients showed higher ferritin levels compared to mild to moderate COVID-19 patients [SMD 0.882 (0.738, 1.026), I2 = 85%]. In meta-regression, high heterogeneity was observed could be attributed to difference in “mean age”, and “percentage of population with concomitant co-morbidities”. Non-survivors had higher serum ferritin level compared to survivors [SMD 0.992 (0.672, 1.172), I2 = 92.33%]. In meta-regression, high heterogeneity observed could be attributed to difference in “mean age” and “percentage of male sex”. Patients requiring ICU [SMD 0.674 (0.515 to 0.833), I2 = 80%] and mechanical ventilation [SMD 0.430 (0.258, 0.602), I2 = 32%] had higher serum ferritin levels compared to those who didn't. To conclude, serum ferritin level may serve as an important biomarker which can aid in COVID-19 management. However, presence of other co-morbid conditions/confounders warrants cautious interpretation.
KW - Biomarker
KW - COVID-19
KW - Diagnosis
KW - Ferritin
KW - Hyperferritin
KW - Prognosis
KW - SARS-CoV2
UR - http://www.scopus.com/inward/record.url?scp=85119593428&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2021.09.023
DO - 10.1016/j.jcrc.2021.09.023
M3 - Article
C2 - 34808527
AN - SCOPUS:85119593428
SN - 0883-9441
VL - 67
SP - 172
EP - 181
JO - Journal of Critical Care
JF - Journal of Critical Care
ER -