COVID-19 laboratory findings: Difference between revisions

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__NOTOC__
__NOTOC__
{{SI}}
'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]'''<br>
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]'''<br>


{{CMG}}; {{AE}}
{{COVID-19}}
 
{{CMG}}; {{AE}} {{HK}} {{SHA}}
{{SK}}  


==Overview==
==Overview==
Laboratory tests can be done to confirm whether illness may be caused by human [[coronaviruses]]. Specific laboratory tests include [[serology]] for [[Virus|viral]] [[antigen]], [[molecular]] testing and [[viral]] culture. All these tests can be used to confirm infection with [[coronavirus]]. Non-specific laboratory findings in [[COVID-19]] include [[lymphocytopenia]], [[thrombocytopenia]], elevated [[C-reactive protein|C-Reactive protein]], elevated [[liver function tests]] ([[Alanine transaminase|ALT]], [[Aspartate transaminase|AST]]), increased [[creatine kinase]], increased [[D-dimer|D-Dimer]] and an increase in the levels of markers of cell damage e.g. [[troponin]], [[lactate dehydrogenase]], [[interleukin-4]], [[procalcitonin]].


== Other Laboratory Findings ==
==Tests to be Performed for Patients Meeting COVID-19 Case Definition==
 
[[Image:COVID-19_-_Dx_testing.png|left|500px]]
==== Leukocytosis ====
 
*
*
 
==== Increase in C-reactive protein (CRP)  ====
 
*
*
*
 
==== Increase in procalcitonin  ====
 
*
*
*
 
==== Increase in ferritin ====
 
*.
 
==== Increase in aspartate aminotransferase (AST)  ====
 
*
*
 
==== Increase in alanine aminotransferase (ALT)  ====
 
*
*
*
 
==== Increase in lactate dehydrogenase (LDH) ====
 
*
*
*
 
==== Increase in monocyte volume distribution width (MDW) ====
 
*
 
==== Increase in total bilirubin ====
 
*
*
*
 
==== Increase in creatinine ====
 
*
*
*
 
==== Increase in cardiac troponins ====
 
*In
*
 
==== Decrease in albumin ====
 
*
*
 
==== Increase in interleukin-6 (IL-6) ====
 
*
 
 
 
==Historical Perspective==
 
* [[COVID-19|Coronavirus disease 2019 (COVID-19)]] is caused by a novel [[coronavirus]] called [[SARS-CoV-2]], which caused a respiratory illness [[outbreak]] that was first detected in Wuhan, China.<ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/about/index.html|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref name="LuCui2020">{{cite journal|last1=Lu|first1=Jian|last2=Cui|first2=Jie|last3=Qian|first3=Zhaohui|last4=Wang|first4=Yirong|last5=Zhang|first5=Hong|last6=Duan|first6=Yuange|last7=Wu|first7=Xinkai|last8=Yao|first8=Xinmin|last9=Song|first9=Yuhe|last10=Li|first10=Xiang|last11=Wu|first11=Changcheng|last12=Tang|first12=Xiaolu|title=On the origin and continuing evolution of SARS-CoV-2|journal=National Science Review|year=2020|issn=2095-5138|doi=10.1093/nsr/nwaa036}}</ref>
 
* On January 30, 2020, the [[outbreak]] was declared a Public Health Emergency of International Concern.
* On March 12, 2020, the COVID-19 outbreak was declared a [[pandemic]] by the [[World Health Organization|World Health Organization (WHO)]].
 
== Other Hematological Findings ==
 
* Leukocytosis
* Increase in C-reactive protein (CRP)
* Increase in procalcitonin
* Increase in ferritin
* Increase in aspartate aminotransferase (AST)
*  Increase in alanine aminotransferase (ALT)
* Increase in lactate dehydrogenase (LDH)
* Increase in monocyte volume distribution width (MDW)
* Increase in total bilirubin
* Increase in creatinine
* Increase in cardiac troponins
* Decrease in albumin
* Increase in interleukin-6 (IL-6)
* Thrombocytosis
 
== Pathophysiology and Causes ==
 
* CRP is an [[Acute phase protein|acute phase reactant]] that increases in conditions with inflammation.<ref name="pmid32311826">{{cite journal| author=Frater JL, Zini G, d'Onofrio G, Rogers HJ| title=COVID-19 and the clinical hematology laboratory. | journal=Int J Lab Hematol | year= 2020 | volume= 42 Suppl 1 | issue=  | pages= 11-18 | pmid=32311826 | doi=10.1111/ijlh.13229 | pmc=7264622 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32311826  }} </ref>
* In sepsis, the activation and adherence of [[Monocyte|monocytes]] increase [[procalcitonin]], therefore [[procalcitonin]] in a biomarker for sepsis and septic shock.<ref name="pmid24982830">{{cite journal| author=Meisner M| title=Update on procalcitonin measurements. | journal=Ann Lab Med | year= 2014 | volume= 34 | issue= 4 | pages= 263-73 | pmid=24982830 | doi=10.3343/alm.2014.34.4.263 | pmc=4071182 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24982830  }} </ref>
* [[Alanine transaminase|ALT]] is produced by liver cells and is increased in liver conditions.<ref name="pmid32311826" />
* LDH is expressed in almost all cells and an increase in [[LDH]] could be seen in damage to any of the cell types.<ref name="pmid32311826" />
* Bilirubin  is produced by liver cells and increases in liver and biliary conditions.<ref name="pmid32311826" />
* Creatinin is produced in the liver and excreted by the kidneys; [[creatinine]] increases when there is decrease in [[glomerular filtration rate]].<ref name="pmid32311826" />
* Increase in cardiac troponins are used for diagnosing myocardial infarction and [[Acute coronary syndromes|acute coronary syndrome]] .<ref name="pmid32311826" />
* [[Albumin]] may be decreased in many conditions such as [[sepsis]], renal disease or [[malnutrition]].<ref name="pmid32311826" />
 
== Epidemiology ==
 
* [[Leukocytosis]] is seen in 11.4% of patients with severe [[COVID-19]] infection compared to 4.8% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623">{{cite journal| author=Lippi G, Plebani M| title=The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks. | journal=Clin Chem Lab Med | year= 2020 | volume= 58 | issue= 7 | pages= 1063-1069 | pmid=32191623 | doi=10.1515/cclm-2020-0240 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32191623  }} </ref>
* Increase in CRP is seen in 81.5% of patients with severe [[COVID-19]] infection compared to 56.4% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623" />
* Increase in [[procalcitonin]] is seen in 13.7% of patients with severe [[COVID-19]] infection compared to 3.7% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623" />
* Increase in [[Aspartate transaminase|AST]] is seen in 39.4% of patients with severe [[COVID-19]] infection compared to 18.2% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623" />
* Increase in [[ALT]] is seen in 28.1% of patients with severe [[COVID-19]] infection compared to 19.8%  of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623" />
* Increase in [[Lactate dehydrogenase|LDH]] is seen in 58.1% of patients with severe [[COVID-19]] infection compared to 37.2% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623" />
* MDW was found to be increased in all patients with COVID-19 infection, particularly in those with the worst conditions.<ref name="pmid32191623" />
* Increase in total bilirubin is seen in 13.3% of patients with severe [[COVID-19]] infection compared to 9.9% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623" />
* Increase in [[creatinine]] is seen in 4.3% of patients with severe [[COVID-19]] infection compared to 1% of patients with non-severe infection.<ref name="pmid32109013" /><ref name="pmid32191623" />
*Thrombocytosis has been reported in 4% of patients with [[COVID-19]] infection.
 
== Clinical Significance ==
Laboratory findings in [[COVID-19]] infection may indicated clinical abnormalities, including:
 
* In patients with COVID-19 infection, leukocytosis may be an indication of a bacterial infection or superinfection.<ref name="pmid32191623" />
* In patients with COVID-19 infection, increase in [[CRP]] may be an indication of severe viral infection or [[sepsis]] and [[viremia]].<ref name="pmid32191623" />
* In patients with COVID-19 infection, increase in [[procalcitonin]] may be an indication of bacterial infection or [[superinfection]].<ref name="pmid32191623" />
* There have been different reports regarding the association of increase in [[ferritin]] with death in COVID-19 infection; for example, there has been a report that increase in [[ferritin]] is associated with [[Acute respiratory distress syndrome|acute respiratory distress syndrome (ARDS)]] but not death<ref name="pmid32167524">{{cite journal| author=Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S | display-authors=etal| title=Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. | journal=JAMA Intern Med | year= 2020 | volume=  | issue=  | pages=  | pmid=32167524 | doi=10.1001/jamainternmed.2020.0994 | pmc=7070509 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32167524  }} </ref>, while another one reports an association between increase in [[ferritin]] and death in COVID-19 infection<ref name="pmid32171076">{{cite journal| author=Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z | display-authors=etal| title=Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. | journal=Lancet | year= 2020 | volume= 395 | issue= 10229 | pages= 1054-1062 | pmid=32171076 | doi=10.1016/S0140-6736(20)30566-3 | pmc=7270627 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32171076  }} </ref>
* In patients with [[COVID-19]] infection, increase in [[aminotransferases]] may indicate injury to the [[liver]] or multi-system damage.<ref name="pmid32191623" />
* In patients with [[COVID-19]] infection, increase in [[aminotransferases]] may indicate injury to the liver or multi-system damage.<ref name="pmid32191623" />
* In patients with COVID-19 infection, increase in [[Lactate dehydrogenase|LDH]] may indicate injury to the lungs or multi-system damage.<ref name="pmid32191623" />
* In patients with COVID-19 infection, increase in total bilirubin may indicate injury to the liver.<ref name="pmid32191623" />
* In patients with COVID-19 infection, increase in [[creatinine]] may indicate injury to the kidneys.<ref name="pmid32191623" />
* In patients with COVID-19 infection, increase in cardiac troponins may indicate cardiac injury.<ref name="pmid32191623" />
* In patients with COVID-19 infection, decrease in [[albumin]] may indicate liver function abnormality.<ref name="pmid32191623" />
* Increase in [[IL-6]] has been reported to be associated with death in COVID-19 infection.<ref name="pmid32167524" />
 
*
 
==Classification==
There is no established system for the classification of [disease name].
 
OR
 
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
 
OR
 
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
 
OR
 
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
 
OR
 
If the staging system involves specific and characteristic findings and features:
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
 
OR
 
The staging of [malignancy name] is based on the [staging system].
 
OR
 
There is no established system for the staging of [malignancy name].
 
==Pathophysiology==
The exact pathogenesis of [disease name] is not fully understood.
 
OR
 
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
 
OR
 
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
 
OR
 
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
 
OR
 
 
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
 
OR
 
The progression to [disease name] usually involves the [molecular pathway].
 
OR
 
The pathophysiology of [disease/malignancy] depends on the histological subtype.
 
==Causes==
Disease name] may be caused by [cause1], [cause2], or [cause3].
 
OR
 
Common causes of [disease] include [cause1], [cause2], and [cause3].
 
OR
 
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
 
OR
 
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
 
==Differentiating ((Page name)) from other Diseases==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
 
OR
 
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].
 
==Epidemiology and Demographics==
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
 
OR
 
In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
 
OR
 
In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
 
 
 
Patients of all age groups may develop [disease name].
 
OR
 
The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
 
OR
 
[Disease name] commonly affects individuals younger than/older than [number of years] years of age.
 
OR
 
[Chronic disease name] is usually first diagnosed among [age group].
 
OR
 
[Acute disease name] commonly affects [age group].


=== Antigen tests ===
Abbott BinaxNOW Ag Card detects the SARS-CoV-2 nucleocapsid protein antigen but does not differentiate between SARS-CoV and SARS-CoV2.<ref>https://www.fda.gov/media/141570/download</ref>


=== Molecular tests ===
[[Molecular]] tests are used to diagnose active [[infection]] (presence of [[COVID-19]]) in people who are thought to be infected with [[COVID-19]] based on their clinical symptoms and having links to places where [[COVID-19]] has been reported.


There is no racial predilection to [disease name].
[[Real-time polymerase chain reaction|Real-time reverse-transcription]] [[polymerase chain reaction]] (rRT-[[Polymerase chain reaction|PCR]]) assays are [[Molecule|molecular]] tests that can be used to detect [[viral]] [[RNA]] in clinical samples.


OR
==== Nucleic acid amplification test ====


[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
* The importance of the need for confirmation of results of testing with pan-[[coronavirus]] primers is underscored by the fact that four human [[coronaviruses]] (HcoVs) are [[endemic]] globally: HCoV-229E, [[Human Coronavirus NL63|HCoV-NL63]], HCoV-HKU1 as well as HCoV-OC43. The latter two are betacoronaviruses. Two other betacoronaviruses that cause [[zoonotic]] infection in humans are [[MERS-CoV]], acquired by contact with dromedary camels and [[SARS]] arising from civets and cave-dwelling horseshoe bats.


* The accuracy of nucleic acid amplification tests have been systematically reviewed<ref name="pmid32422057">{{cite journal| author=Kucirka LM, Lauer SA, Laeyendecker O, Boon D, Lessler J| title=Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction-Based SARS-CoV-2 Tests by Time Since Exposure. | journal=Ann Intern Med | year= 2020 | volume=  | issue=  | pages=  | pmid=32422057 | doi=10.7326/M20-1495 | pmc=7240870 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32422057  }} </ref>.
* PCR has been used to test salivary specimens<ref name="pmid32857487">{{cite journal| author=Wyllie AL, Fournier J, Casanovas-Massana A, Campbell M, Tokuyama M, Vijayakumar P | display-authors=etal| title=Saliva or Nasopharyngeal Swab Specimens for Detection of SARS-CoV-2. | journal=N Engl J Med | year= 2020 | volume=  | issue=  | pages=  | pmid=32857487 | doi=10.1056/NEJMc2016359 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32857487  }} </ref><ref name="pmid32857591">{{cite journal| author=Caulley L, Corsten M, Eapen L, Whelan J, Angel JB, Antonation K | display-authors=etal| title=Salivary Detection of COVID-19. | journal=Ann Intern Med | year= 2020 | volume=  | issue=  | pages=  | pmid=32857591 | doi=10.7326/M20-4738 | pmc=7470212 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32857591  }} </ref>.


=== Serological testing ===


[Disease name] affects men and women equally.
*[[Serological testing|Serological]] testing may be useful to confirm immunologic response to a pathogen from a specific [[viral]] group, e.g. [[coronavirus]].
* Best results from [[Serological testing|serologic]] testing requires the collection of paired [[serum]] samples (in the acute and [[convalescent]] phase) from cases under investigation.
* The accuracy of serologic tests have been systematically reviewed<ref name="pmid32584464">{{cite journal| author=Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Spijker R, Taylor-Phillips S | display-authors=etal| title=Antibody tests for identification of current and past infection with SARS-CoV-2. | journal=Cochrane Database Syst Rev | year= 2020 | volume= 6 | issue=  | pages= CD013652 | pmid=32584464 | doi=10.1002/14651858.CD013652 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32584464  }} </ref><ref name="pmid32611558">{{cite journal| author=Lisboa Bastos M, Tavaziva G, Abidi SK, Campbell JR, Haraoui LP, Johnston JC | display-authors=etal| title=Diagnostic accuracy of serological tests for covid-19: systematic review and meta-analysis. | journal=BMJ | year= 2020 | volume= 370 | issue=  | pages= m2516 | pmid=32611558 | doi=10.1136/bmj.m2516 | pmc=7327913 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32611558  }} </ref>.


OR
{| class="wikitable" align="left"
|+
! colspan="3" |Tests to be performed for patients meeting case definition
|-
!Laboratory Test
!Source of Specimen
!Additional Comments
|-
|In laboratories that have validated broad [[coronavirus]] [[Reverse transcription polymerase chain reaction|RT-PCR]]


[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
assays it is advised to check the [[Primer (molecular biology)|primers]] against the published


2019-nCoV sequence and check if [[Primer (molecular biology)|primers]] are overlapping and


have the capacity to detect the 2019-nCoV. On a positive results


The majority of [disease name] cases are reported in [geographical region].
[[sequencing]] should be performed to determine the precise [[virus]]


OR
detected (e.g. on an [[Amplicons|amplicon]] of a non-conserved region).
|[[Respiratory]] secretions
|Collect on presentation. Done by an expert laboratory.
|-
|[[Nucleic acid test|NAAT]] for 2019n-CoV when it becomes available (assays currently under validation)
|[[Respiratory]] secretions
|Collect on presentation. Done by an expert laboratory until validation has been finalized.
|-
|[[Serology]], broad [[Coronavirus|corona virus]] serology on paired samples if available.
|Respiratory secretions
|Paired samples necessary for confirmation, the first sample collected in week 1 of illness, and the second collected 3-4 weeks later. If a single [[serum]] sample can be collected, collect at least 3 weeks after onset of [[symptoms]]. Done by the expert laboratory until more information on the performance of available assays.
|}


[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].
==Laboratory Findings==


==Risk Factors==
===Complete Blood Count===
There are no established risk factors for [disease name].
[[Complete blood count|Complete blood count]] may show the following:


OR
* [[COVID-19-associated anemia|Anemia]]


The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
* [[Leukocytosis]]
**[[Leukocytosis]] is seen in 11.4% of patients with severe [[COVID-19]] infection compared to 4.8% of patients with non-severe infection.<ref name="pmid32109013">{{cite journal| author=Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX | display-authors=etal| title=Clinical Characteristics of Coronavirus Disease 2019 in China. | journal=N Engl J Med | year= 2020 | volume= 382 | issue= 18 | pages= 1708-1720 | pmid=32109013 | doi=10.1056/NEJMoa2002032 | pmc=7092819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32109013  }} </ref>
**In patients with COVID-19 infection, leukocytosis may be an indication of a bacterial infection or superinfection.<ref name="pmid32191623">{{cite journal| author=Lippi G, Plebani M| title=The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks. | journal=Clin Chem Lab Med | year= 2020 | volume= 58 | issue= 7 | pages= 1063-1069 | pmid=32191623 | doi=10.1515/cclm-2020-0240 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32191623  }} </ref>


OR
* [[COVID-19-associated neutrophilia|Neutrophilia]]


Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
* [[COVID-19-associated lymphopenia|Lymphocytopenia]]


OR
* Increase in [[monocyte distribution width]] (MDW)
**MDW was found to be increased in all patients with COVID-19 infection, particularly in those with the worst conditions.<ref name="pmid32191623" />


Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.
* [[Thrombocytosis]]
**[[Thrombocytosis]] has been reported in 4% of patients with [[COVID-19]] infection.<ref name="pmid32007143">{{cite journal| author=Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y | display-authors=etal| title=Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. | journal=Lancet | year= 2020 | volume= 395 | issue= 10223 | pages= 507-513 | pmid=32007143 | doi=10.1016/S0140-6736(20)30211-7 | pmc=7135076 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32007143  }} </ref>


==Screening==
* [[COVID-19-associated thrombocytopenia|Thrombocytopenia]]
There is insufficient evidence to recommend routine screening for [disease/malignancy].


OR
=== Acute Phase Reactants ===
The following [[inflammatory]] markers may be altered:


According to the [guideline name], screening for [disease name] is not recommended.
* Increased [[C-reactive protein|C-reactive protein]]
**Increase in CRP is seen in 81.5% of patients with severe [[COVID-19]] infection compared to 56.4% of patients with non-severe infection.<ref name="pmid32109013" />
**CRP is an [[Acute phase protein|acute phase reactant]] that increases in conditions with inflammation.<ref name="pmid32311826">{{cite journal| author=Frater JL, Zini G, d'Onofrio G, Rogers HJ| title=COVID-19 and the clinical hematology laboratory. | journal=Int J Lab Hematol | year= 2020 | volume= 42 Suppl 1 | issue=  | pages= 11-18 | pmid=32311826 | doi=10.1111/ijlh.13229 | pmc=7264622 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32311826  }} </ref>
**In patients with COVID-19 infection, increase in [[CRP]] may be an indication of severe viral infection or [[sepsis]] and [[viremia]].<ref name="pmid32191623" />


OR
*Increased [[Interleukin 6|IL-6]]
**Increase in [[IL-6]] has been reported to be associated with death in COVID-19 infection.<ref name="pmid32167524" />
**Increased level of [[Interleukin 6|IL-6]] is an indicator of [[COVID-19-associated cytokine storm]].


According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].
* Increased [[procalcitonin]]
**Increase in [[procalcitonin]] is seen in 13.7% of patients with severe [[COVID-19]] infection compared to 3.7% of patients with non-severe infection.<ref name="pmid32109013" />
**In sepsis, the activation and adherence of [[Monocyte|monocytes]] increase [[procalcitonin]], therefore [[procalcitonin]] in a biomarker for sepsis and septic shock.<ref name="pmid24982830">{{cite journal| author=Meisner M| title=Update on procalcitonin measurements. | journal=Ann Lab Med | year= 2014 | volume= 34 | issue= 4 | pages= 263-73 | pmid=24982830 | doi=10.3343/alm.2014.34.4.263 | pmc=4071182 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24982830  }} </ref>
**In patients with COVID-19 infection, increase in [[procalcitonin]] may be an indication of bacterial infection or [[superinfection]].<ref name="pmid32191623" />


==Natural History, Complications, and Prognosis==
* Increased [[ferritin]]
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
**There have been different reports regarding the association of increase in [[ferritin]] with death in COVID-19 infection; for example, there has been a report that increase in [[ferritin]] is associated with [[Acute respiratory distress syndrome|acute respiratory distress syndrome (ARDS)]] but not death<ref name="pmid32167524">{{cite journal| author=Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S | display-authors=etal| title=Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. | journal=JAMA Intern Med | year= 2020 | volume=  | issue=  | pages=  | pmid=32167524 | doi=10.1001/jamainternmed.2020.0994 | pmc=7070509 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32167524  }} </ref>, while another one reports an association between increase in [[ferritin]] and death in COVID-19 infection.<ref name="pmid32171076">{{cite journal| author=Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z | display-authors=etal| title=Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. | journal=Lancet | year= 2020 | volume= 395 | issue= 10229 | pages= 1054-1062 | pmid=32171076 | doi=10.1016/S0140-6736(20)30566-3 | pmc=7270627 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32171076  }} </ref>
*Decreased [[albumin]]
**As a negative acute‐phase reactant, circulatory level of albumin may fall as a result of increased transcapillary leakage or reduced hepatic synthesis mediated by inflammatory cytokines such as [[IL-6|interleukin‐6]] and [[tumor necrosis factor alpha]]. <ref name="ChiGibson2019">Chi, Gerald; Gibson, C. Michael; Liu, Yuyin; Hernandez, Adrian F.; Hull, Russell D.; Cohen, Alexander T.; Harrington, Robert A.; Goldhaber, Samuel Z. (2019). "Inverse relationship of serum albumin to the risk of venous thromboembolism among acutely ill hospitalized patients: Analysis from the APEX trial". American Journal of Hematology. 94 (1): 21–28. doi:10.1002/ajh.25296. ISSN 0361-8609.</ref>Consequently, [[hypoalbuminemia]] may indicate a hyperinflammatory status associated with [[COVID-19]].
**[[Albumin]] may be decreased in many conditions such as [[sepsis]], renal disease or [[malnutrition]].<ref name="pmid32311826" />
**In patients with COVID-19 infection, decrease in [[albumin]] may indicate liver function abnormality.<ref name="pmid32191623" />


OR
=== Liver Function Tests ===
The following abnormalities may be observed on [[Liver function tests|LFTs]]:
* Increased [[Aspartate aminotransferase|aspartate aminotrasnferase]] ([[Aspartate transaminase|AST]]):
**Increase in [[Aspartate transaminase|AST]] is seen in 39.4% of patients with severe [[COVID-19]] infection compared to 18.2% of patients with non-severe infection.<ref name="pmid32109013" />
**In patients with [[COVID-19]] infection, increase in [[aminotransferases]] may indicate injury to the [[liver]] or multi-system damage.<ref name="pmid32191623" />
* Increased [[alanine aminotransferase]] ([[Alanine transaminase|ALT]]):
**Increase in [[ALT]] is seen in 28.1% of patients with severe [[COVID-19]] infection compared to 19.8%  of patients with non-severe infection.<ref name="pmid32109013" />
**[[Alanine transaminase|ALT]] is produced by liver cells and is increased in liver conditions.<ref name="pmid32311826" />
**In patients with [[COVID-19]] infection, increase in [[aminotransferases]] may indicate injury to the liver or multi-system damage.<ref name="pmid32191623" />
*Increase in total [[bilirubin]]
**Increase in total bilirubin is seen in 13.3% of patients with severe [[COVID-19]] infection compared to 9.9% of patients with non-severe infection.<ref name="pmid32109013" />
**Bilirubin &nbsp;is produced by liver cells and increases in liver and biliary conditions.<ref name="pmid32311826" />
**In patients with COVID-19 infection, increase in total bilirubin may indicate injury to the liver.<ref name="pmid32191623" />


Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
=== Renal Function Tests ===
[[Renal function tests]] may show the following:


OR
* Increased [[Blood urea nitrogen|BUN]]
* Increased [[creatinine]]
**Increase in [[creatinine]] is seen in 4.3% of patients with severe [[COVID-19]] infection compared to 1% of patients with non-severe infection.<ref name="pmid32109013" />
**Creatinin is produced in the liver and excreted by the kidneys; [[creatinine]] increases when there is decrease in [[glomerular filtration rate]].<ref name="pmid32311826" />
**In patients with COVID-19 infection, increase in [[creatinine]] may indicate injury to the kidneys.<ref name="pmid32191623" />


Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
=== Markers of Cell Damage ===
 
The following markers of [[cellular]] damage may be altered:
==Diagnosis==
* Increased [[troponin]]
===Diagnostic Study of Choice===
**In myocardial infarction and [[Acute coronary syndromes|acute coronary syndrome]] are used for diagnosis.<ref name="pmid32311826" />
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
**In patients with COVID-19 infection, increase in cardiac troponins may indicate cardiac injury.<ref name="pmid32191623" />
 
* Increased [[myoglobin]]
OR
* Increased [[lactate dehydrogenase]] ([[Lactate dehydrogenase|LDH]])
 
**Increase in [[Lactate dehydrogenase|LDH]] is seen in 58.1% of patients with severe [[COVID-19]] infection compared to 37.2% of patients with non-severe infection.<ref name="pmid32109013" />
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
**LDH is expressed in almost all cells and an increase in [[LDH]] could be seen in damage to any of the cell types.<ref name="pmid32311826" />
 
**In patients with COVID-19 infection, increase in [[Lactate dehydrogenase|LDH]] may indicate injury to the lungs or multi-system damage.<ref name="pmid32191623" />
OR
* Increased [[Creatine kinase|creatine kinase]]
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
There are no established criteria for the diagnosis of [disease name].
 
===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.
 
OR
 
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
 
===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
 
OR
 
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 
===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
 
OR
 
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
 
OR
 
[Test] is usually normal among patients with [disease name].
 
OR
 
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
 
OR
 
There are no diagnostic laboratory findings associated with [disease name].
 
===Electrocardiogram===
There are no ECG findings associated with [disease name].
 
OR
 
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
===X-ray===
There are no x-ray findings associated with [disease name].
 
OR
 
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound  findings associated with [disease name].
 
OR
 
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===CT scan===
There are no CT scan findings associated with [disease name].
 
OR
 
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===MRI===
There are no MRI findings associated with [disease name].
 
OR
 
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
 
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
 
OR
 
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].
 
OR
 
[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
 
OR
 
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
 
==Treatment==
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
 
OR
 
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
 
OR
 
The majority of cases of [disease name] are self-limited and require only supportive care.
 
OR
 
[Disease name] is a medical emergency and requires prompt treatment.
 
OR
 
The mainstay of treatment for [disease name] is [therapy].
 
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
 
OR
 
[Therapy] is recommended among all patients who develop [disease name].
 
OR
 
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
 
OR
 
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
 
OR
 
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
 
OR
 
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].
 
===Surgery===
Surgical intervention is not recommended for the management of [disease name].
 
OR
 
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
 
OR
 
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
 
OR
 
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
 
OR
 
Surgery is the mainstay of treatment for [disease or malignancy].
 
===Primary Prevention===
There are no established measures for the primary prevention of [disease name].
 
OR
 
There are no available vaccines against [disease name].
 
OR
 
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
 
OR
 
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].
 
===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].
 
OR
 
Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].


==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 13:27, 1 April 2023

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2] Shakiba Hassanzadeh, MD[3]

Overview

Laboratory tests can be done to confirm whether illness may be caused by human coronaviruses. Specific laboratory tests include serology for viral antigen, molecular testing and viral culture. All these tests can be used to confirm infection with coronavirus. Non-specific laboratory findings in COVID-19 include lymphocytopenia, thrombocytopenia, elevated C-Reactive protein, elevated liver function tests (ALT, AST), increased creatine kinase, increased D-Dimer and an increase in the levels of markers of cell damage e.g. troponin, lactate dehydrogenase, interleukin-4, procalcitonin.

Tests to be Performed for Patients Meeting COVID-19 Case Definition

Antigen tests

Abbott BinaxNOW Ag Card detects the SARS-CoV-2 nucleocapsid protein antigen but does not differentiate between SARS-CoV and SARS-CoV2.[1]

Molecular tests

Molecular tests are used to diagnose active infection (presence of COVID-19) in people who are thought to be infected with COVID-19 based on their clinical symptoms and having links to places where COVID-19 has been reported.

Real-time reverse-transcription polymerase chain reaction (rRT-PCR) assays are molecular tests that can be used to detect viral RNA in clinical samples.

Nucleic acid amplification test

  • The importance of the need for confirmation of results of testing with pan-coronavirus primers is underscored by the fact that four human coronaviruses (HcoVs) are endemic globally: HCoV-229E, HCoV-NL63, HCoV-HKU1 as well as HCoV-OC43. The latter two are betacoronaviruses. Two other betacoronaviruses that cause zoonotic infection in humans are MERS-CoV, acquired by contact with dromedary camels and SARS arising from civets and cave-dwelling horseshoe bats.
  • The accuracy of nucleic acid amplification tests have been systematically reviewed[2].
  • PCR has been used to test salivary specimens[3][4].

Serological testing

  • Serological testing may be useful to confirm immunologic response to a pathogen from a specific viral group, e.g. coronavirus.
  • Best results from serologic testing requires the collection of paired serum samples (in the acute and convalescent phase) from cases under investigation.
  • The accuracy of serologic tests have been systematically reviewed[5][6].
Tests to be performed for patients meeting case definition
Laboratory Test Source of Specimen Additional Comments
In laboratories that have validated broad coronavirus RT-PCR

assays it is advised to check the primers against the published

2019-nCoV sequence and check if primers are overlapping and

have the capacity to detect the 2019-nCoV. On a positive results

sequencing should be performed to determine the precise virus

detected (e.g. on an amplicon of a non-conserved region).

Respiratory secretions Collect on presentation. Done by an expert laboratory.
NAAT for 2019n-CoV when it becomes available (assays currently under validation) Respiratory secretions Collect on presentation. Done by an expert laboratory until validation has been finalized.
Serology, broad corona virus serology on paired samples if available. Respiratory secretions Paired samples necessary for confirmation, the first sample collected in week 1 of illness, and the second collected 3-4 weeks later. If a single serum sample can be collected, collect at least 3 weeks after onset of symptoms. Done by the expert laboratory until more information on the performance of available assays.

Laboratory Findings

Complete Blood Count

Complete blood count may show the following:

  • Leukocytosis
    • Leukocytosis is seen in 11.4% of patients with severe COVID-19 infection compared to 4.8% of patients with non-severe infection.[7]
    • In patients with COVID-19 infection, leukocytosis may be an indication of a bacterial infection or superinfection.[8]
  • Increase in monocyte distribution width (MDW)
    • MDW was found to be increased in all patients with COVID-19 infection, particularly in those with the worst conditions.[8]

Acute Phase Reactants

The following inflammatory markers may be altered:

  • Increased C-reactive protein
    • Increase in CRP is seen in 81.5% of patients with severe COVID-19 infection compared to 56.4% of patients with non-severe infection.[7]
    • CRP is an acute phase reactant that increases in conditions with inflammation.[10]
    • In patients with COVID-19 infection, increase in CRP may be an indication of severe viral infection or sepsis and viremia.[8]

Liver Function Tests

The following abnormalities may be observed on LFTs:

  • Increased aspartate aminotrasnferase (AST):
    • Increase in AST is seen in 39.4% of patients with severe COVID-19 infection compared to 18.2% of patients with non-severe infection.[7]
    • In patients with COVID-19 infection, increase in aminotransferases may indicate injury to the liver or multi-system damage.[8]
  • Increased alanine aminotransferase (ALT):
    • Increase in ALT is seen in 28.1% of patients with severe COVID-19 infection compared to 19.8% of patients with non-severe infection.[7]
    • ALT is produced by liver cells and is increased in liver conditions.[10]
    • In patients with COVID-19 infection, increase in aminotransferases may indicate injury to the liver or multi-system damage.[8]
  • Increase in total bilirubin
    • Increase in total bilirubin is seen in 13.3% of patients with severe COVID-19 infection compared to 9.9% of patients with non-severe infection.[7]
    • Bilirubin  is produced by liver cells and increases in liver and biliary conditions.[10]
    • In patients with COVID-19 infection, increase in total bilirubin may indicate injury to the liver.[8]

Renal Function Tests

Renal function tests may show the following:

Markers of Cell Damage

The following markers of cellular damage may be altered:

  • Increased troponin
    • In myocardial infarction and acute coronary syndrome are used for diagnosis.[10]
    • In patients with COVID-19 infection, increase in cardiac troponins may indicate cardiac injury.[8]
  • Increased myoglobin
  • Increased lactate dehydrogenase (LDH)
    • Increase in LDH is seen in 58.1% of patients with severe COVID-19 infection compared to 37.2% of patients with non-severe infection.[7]
    • LDH is expressed in almost all cells and an increase in LDH could be seen in damage to any of the cell types.[10]
    • In patients with COVID-19 infection, increase in LDH may indicate injury to the lungs or multi-system damage.[8]
  • Increased creatine kinase

References

  1. ↑ https://www.fda.gov/media/141570/download
  2. ↑ Kucirka LM, Lauer SA, Laeyendecker O, Boon D, Lessler J (2020). "Variation in False-Negative Rate of Reverse Transcriptase Polymerase Chain Reaction-Based SARS-CoV-2 Tests by Time Since Exposure". Ann Intern Med. doi:10.7326/M20-1495. PMC 7240870 Check |pmc= value (help). PMID 32422057 Check |pmid= value (help).
  3. ↑ Wyllie AL, Fournier J, Casanovas-Massana A, Campbell M, Tokuyama M, Vijayakumar P; et al. (2020). "Saliva or Nasopharyngeal Swab Specimens for Detection of SARS-CoV-2". N Engl J Med. doi:10.1056/NEJMc2016359. PMID 32857487 Check |pmid= value (help).
  4. ↑ Caulley L, Corsten M, Eapen L, Whelan J, Angel JB, Antonation K; et al. (2020). "Salivary Detection of COVID-19". Ann Intern Med. doi:10.7326/M20-4738. PMC 7470212 Check |pmc= value (help). PMID 32857591 Check |pmid= value (help).
  5. ↑ Deeks JJ, Dinnes J, Takwoingi Y, Davenport C, Spijker R, Taylor-Phillips S; et al. (2020). "Antibody tests for identification of current and past infection with SARS-CoV-2". Cochrane Database Syst Rev. 6: CD013652. doi:10.1002/14651858.CD013652. PMID 32584464 Check |pmid= value (help).
  6. ↑ Lisboa Bastos M, Tavaziva G, Abidi SK, Campbell JR, Haraoui LP, Johnston JC; et al. (2020). "Diagnostic accuracy of serological tests for covid-19: systematic review and meta-analysis". BMJ. 370: m2516. doi:10.1136/bmj.m2516. PMC 7327913 Check |pmc= value (help). PMID 32611558 Check |pmid= value (help).
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX; et al. (2020). "Clinical Characteristics of Coronavirus Disease 2019 in China". N Engl J Med. 382 (18): 1708–1720. doi:10.1056/NEJMoa2002032. PMC 7092819 Check |pmc= value (help). PMID 32109013 Check |pmid= value (help).
  8. ↑ 8.00 8.01 8.02 8.03 8.04 8.05 8.06 8.07 8.08 8.09 8.10 Lippi G, Plebani M (2020). "The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks". Clin Chem Lab Med. 58 (7): 1063–1069. doi:10.1515/cclm-2020-0240. PMID 32191623 Check |pmid= value (help).
  9. ↑ Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y; et al. (2020). "Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study". Lancet. 395 (10223): 507–513. doi:10.1016/S0140-6736(20)30211-7. PMC 7135076 Check |pmc= value (help). PMID 32007143 Check |pmid= value (help).
  10. ↑ 10.0 10.1 10.2 10.3 10.4 10.5 10.6 Frater JL, Zini G, d'Onofrio G, Rogers HJ (2020). "COVID-19 and the clinical hematology laboratory". Int J Lab Hematol. 42 Suppl 1: 11–18. doi:10.1111/ijlh.13229. PMC 7264622 Check |pmc= value (help). PMID 32311826 Check |pmid= value (help).
  11. ↑ 11.0 11.1 Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S; et al. (2020). "Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China". JAMA Intern Med. doi:10.1001/jamainternmed.2020.0994. PMC 7070509 Check |pmc= value (help). PMID 32167524 Check |pmid= value (help).
  12. ↑ Meisner M (2014). "Update on procalcitonin measurements". Ann Lab Med. 34 (4): 263–73. doi:10.3343/alm.2014.34.4.263. PMC 4071182. PMID 24982830.
  13. ↑ Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z; et al. (2020). "Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study". Lancet. 395 (10229): 1054–1062. doi:10.1016/S0140-6736(20)30566-3. PMC 7270627 Check |pmc= value (help). PMID 32171076 Check |pmid= value (help).
  14. ↑ Chi, Gerald; Gibson, C. Michael; Liu, Yuyin; Hernandez, Adrian F.; Hull, Russell D.; Cohen, Alexander T.; Harrington, Robert A.; Goldhaber, Samuel Z. (2019). "Inverse relationship of serum albumin to the risk of venous thromboembolism among acutely ill hospitalized patients: Analysis from the APEX trial". American Journal of Hematology. 94 (1): 21–28. doi:10.1002/ajh.25296. ISSN 0361-8609.
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