Association of serum C-reactive protein (CRP) and D-dimer concentration on the severity of COVID-19 cases with or without diabetes: a systematic review and meta-analysis

ABSTRACT

Introduction

Coronavirus disease (COVID-19) is a highly contagious disease that poses major public health risks. Fewer studies link high CRP and D-dimer levels to severe COVID-19 infection. Therefore, this study investigates the association of serum CRP and D-dimer concentration with COVID-19 severity in diabetic and non-diabetic patients.

Areas covered

Relevant published articles were identified using electronic search engines, such as Google Scholar, PubMed, Springer, Science Direct, and Researchgate. A total of 29 articles reporting on 15,282 patients (4,733 diabetes and 10,549 non-diabetes) were included in this systematic review and meta-analysis. RevMan V5.4, STATA V14 software, and SPSS V25 were used for the meta-analysis. Egger’s regression and Begg-Mazumdar’s test were used for assessing publication bias. The pooled result of all studies revealed that serum CRP (Standard mean difference (SMD) 0.41 mg/L; P < 0.0001; I² 93%) and D-dimer (SMD 0.32 mg/L; P < 0.0001; I² 83%) concentration was significantly higher in COVID-19 diabetic patients. The prevalence of COVID-19 infection was comparatively higher in male diabetic patients (OR 2.41; P < 0.00001; I² 88%). There was no publication bias. CRP and D-dimer rose with age in COVID-19 diabetic and non-diabetic patients.

Expert opinion

Overall, the serum CRP and D-dimer concentration in COVID-19 diabetic patients was significantly higher than non-diabetic patients indicating severe illness.

KEYWORDS:

• CRP
• COVID-19
• D-Dimer
• diabetes
• non-diabetes
• meta-analysis

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The authors have no funding to report.