Thrombocytopenia as a prognostic marker in COVID-19 patients: diagnostic test accuracy meta-analysis

• Published in: Epidemiology and infection Vol. 149; p. e40
• Main Authors: Pranata, Raymond, Lim, Michael Anthonius, Yonas, Emir, Huang, Ian, Nasution, Sally Aman, Setiati, Siti, Alwi, Idrus, Kuswardhani, Raden Ayu Tuty
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 29-01-2021
• Subjects: Aged; Biomarkers; Conditional probability; Coronaviruses; COVID-19; COVID-19 - diagnosis; COVID-19 - epidemiology; COVID-19 - mortality; COVID-19 - pathology; Diabetes mellitus; Diagnostic systems; Diagnostic tests; Diagnostic Tests, Routine; Dimers; Female; Humans; Hypertension; Intensive Care Units; Likelihood ratio; Lymphocytes; Male; Mechanical ventilation; Medical diagnosis; Medical prognosis; Meta-analysis; Middle Aged; Mortality; Nomograms; Odds Ratio; Original Paper; Prognosis; Regression analysis; Respiration, Artificial; SARS-CoV-2; Sensitivity and Specificity; Severity of Illness Index; Statistical analysis; Subgroups; Thrombocytopenia; Thrombocytopenia - diagnosis; Thrombocytopenia - epidemiology; Thrombocytopenia - mortality; Thrombocytopenia - pathology; Ventilation; Viral diseases; thrombocyte; mortality; platelet; Coronavirus; severe
• ISSN: 0950-2688; 1469-4409
• DOI: 10.1017/S0950268821000236

This systematic review and meta-analysis aimed to evaluate thrombocytopenia as a prognostic biomarker in patients with coronavirus disease 2019 (COVID-19). We performed a systematic literature search using PubMed, Embase and EuropePMC. The main outcome was composite poor outcome, a composite of mortality, severity, need for intensive care unit care and invasive mechanical ventilation. There were 8963 patients from 23 studies. Thrombocytopenia occurred in 18% of the patients. Male gender (P = 0.037) significantly reduce the incidence. Thrombocytopenia was associated with composite poor outcome (RR 1.90 (1.43–2.52), P < 0.001; I2: 92.3%). Subgroup analysis showed that thrombocytopenia was associated with mortality (RR 2.34 (1.23–4.45), P < 0.001; I2: 96.8%) and severity (RR 1.61 (1.33–1.96), P < 0.001; I2: 62.4%). Subgroup analysis for cut-off <100 × 109/l showed RR of 1.93 (1.37–2.72), P < 0.001; I2: 83.2%). Thrombocytopenia had a sensitivity of 0.26 (0.18–0.36), specificity of 0.89 (0.84–0.92), positive likelihood ratio of 2.3 (1.6–3.2), negative likelihood ratio of 0.83 (0.75–0.93), diagnostic odds ratio of 3 (2, 4) and area under curve of 0.70 (0.66–0.74) for composite poor outcome. Meta-regression analysis showed that the association between thrombocytopenia and poor outcome did not vary significantly with age, male, lymphocyte, d-dimer, hypertension, diabetes and CKD. Fagan's nomogram showed that the posterior probability of poor outcome was 50% in patients with thrombocytopenia, and 26% in those without thrombocytopenia. The Deek's funnel plot was relatively symmetrical and the quantitative asymmetry test was non-significant (P = 0.14). This study indicates that thrombocytopenia was associated with poor outcome in patients with COVID-19. PROSPERO ID: CRD42020213974