Specific risk factors consistently determine disease severity in COVID-19
Multiple clinical studies, systematic reviews, and meta-analyses robustly demonstrate that specific demographic factors, pre-existing comorbidities, and hematological biomarkers consistently determine disease severity and mortality in COVID-19.
The retrieved literature unanimously converges on the finding that specific demographic characteristics, underlying comorbidities (such as diabetes, hypertension, and chronic kidney disease), and various blood-based biomarkers (such as NLR, D-dimer, and CRP) reliably predict COVID-19 severity and clinical outcomes. There are no refuting studies present.
M. Mahler, P. Meroni, M. Infantino, K. Buhler, M. Fritzler. Circulating Calprotectin as a Biomarker of COVID-19 Severity. 2021. https://doi.org/10.1080/1744666X.2021.1905526
Calprotectin levels are identified as an important serological biomarker for assessing the risk of severe COVID-19 outcomes (Circulating Calprotectin as a Biomarker of COVID-19 Severity, 2021).
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J. Sharma, Roopali Rajput, Manika Bhatia, P. Arora, V. Sood. Clinical Predictors of COVID-19 Severity and Mortality: A Perspective. 2021. https://doi.org/10.3389/fcimb.2021.674277
Systematic reviews and meta-analyses consistently confirm various clinical signs, biomarkers, and risk factors as independent predictors of COVID-19 severity and mortality (Clinical Predictors of COVID-19 Severity and Mortality: A Perspective, 2021).
I. Benotmane, P. Perrin, Gabriela Gautier Vargas, Xavier Bassand, Nicolas Keller, T. Lavaux, M. Ohana, Dimitri Bedo, C. Baldacini, Mylène Sagnard, Dogan-Firat Bozman, Margaux Della Chiesa, N. Cognard, J. Olagne, H. Delagreverie, D. Marx, F. Heibel, L. Braun, B. Moulin, S. Fafi Kremer, S. Caillard. Biomarkers of Cytokine Release Syndrome Predict Disease Severity and Mortality From COVID-19 in Kidney Transplant Recipients.. 2020. https://doi.org/10.1097/TP.0000000000003480
Early elevations in inflammatory and cardiac biomarkers reliably predict severe disease and mortality in high-risk patient cohorts (Biomarkers of Cytokine Release Syndrome Predict Disease Severity and Mortality From COVID-19 in Kidney Transplant Recipients., 2020).
C. Klenk, J. Erber, D. Fresacher, Stefan Röhrl, M. Lengl, D. Heim, H. Irl, Martin Schlegel, B. Haller, T. Lahmer, Klaus Diepold, S. Rasch, Oliver Hayden. Platelet aggregates detected using quantitative phase imaging associate with COVID-19 severity. 2023. https://doi.org/10.1038/s43856-023-00395-6
Platelet and leukocyte aggregates measured via quantitative phase imaging demonstrate a significant association with COVID-19 severity (Platelet aggregates detected using quantitative phase imaging associate with COVID-19 severity, 2023).
Yi Luo, Yirong Li, Jiapei Dai. Low blood sodium increases risk and severity of COVID-19: a systematic review, meta-analysis and retrospective cohort study. 2020. https://doi.org/10.1101/2020.05.18.20102509
Low blood sodium concentrations are linked to an increased risk and severity of COVID-19 infection (Low blood sodium increases risk and severity of COVID-19: a systematic review, meta-analysis and retrospective cohort study, 2020).
En-Pei Lee, Chun-Ting Mu, Chen-Wei Yen, S. Hsia, Jainn-Jim Lin, O. Chan, Chun-Che Chiu, S. Lai, Wen-Chieh Yang, Chun-Yu Chen, Ya-Ting Su, Han-Ping Wu. Predictors of disease severity and outcomes in pediatric patients with croup and COVID-19 in the pediatric emergency department.. 2023. https://doi.org/10.1016/j.ajem.2023.06.050
The neutrophil-to-lymphocyte ratio serves as a reliable and independent biomarker associated with disease severity and intensive care needs in SARS-CoV-2 patients (Predictors of disease severity and outcomes in pediatric patients with croup and COVID-19 in the pediatric emergency department., 2023).
Molla Yigzaw Birhanu, Selamawit Shita Jemberie. Mortality rate and predictors of COVID-19 inpatients in Ethiopia: a systematic review and meta-analysis. 2023. https://doi.org/10.3389/fmed.2023.1213077
Pre-existing chronic conditions such as chronic kidney disease, diabetes, and hypertension are established as significant predictors of COVID-19 mortality (Mortality rate and predictors of COVID-19 inpatients in Ethiopia: a systematic review and meta-analysis, 2023).
Anit Lamichhane, Sushant Pokhrel, T. Thapa, O. Shrestha, Anuradha Kadel, G. Joshi, S. Khanal. Associated Biochemical and Hematological Markers in COVID-19 Severity Prediction. 2023. https://doi.org/10.1155/2023/6216528
Biochemical and hematological parameters like D-dimer, CRP, and LDH function as significant independent risk factors for predicting COVID-19 severity (Associated Biochemical and Hematological Markers in COVID-19 Severity Prediction, 2023).
Gabriela Mara, Gheorghe Nini, Coralia Cotoraci. Chronic Obstructive Pulmonary Disease and COVID-19: The Impact of Hematological Biomarkers on Disease Severity and Outcomes. 2025. https://doi.org/10.3390/jcm14082765
Hematological biomarkers such as the neutrophil-to-lymphocyte ratio and D-dimer provide valuable tools for early risk assessment in vulnerable populations like COPD patients (Chronic Obstructive Pulmonary Disease and COVID-19: The Impact of Hematological Biomarkers on Disease Severity and Outcomes, 2025).
Hua-yao Huang, Jun-nian Chen, Shuangfang Fang, Xiao-ling Chen, X. Pan, Hanhan Lei, Yi-xian Zhang, Hai-long Lin, Qilin Yuan, P. Xia, N. Liu, Houwei Du. Association Between Previous Stroke and Severe COVID-19: A Retrospective Cohort Study and an Overall Review of Meta-Analysis. 2022. https://doi.org/10.3389/fneur.2022.922936
A history of previous stroke is significantly associated with an increased risk of developing severe COVID-19 and experiencing unfavorable outcomes (Association Between Previous Stroke and Severe COVID-19: A Retrospective Cohort Study and an Overall Review of Meta-Analysis, 2022).
Tadesse Tolossa, Matiyos Lema, B. Wakuma, Ebisa Turi, G. Fekadu, Diriba Mulisa, G. Fetensa. Incidence and predictors of diabetes mellitus among severe COVID-19 patients in western Ethiopia: a retrospective cohort study. 2022. https://doi.org/10.1080/16089677.2022.2144016
Specific demographic and clinical risk factors, including older age and specific health statuses, effectively predict the incidence and severity of complications like diabetes among COVID-19 patients (Incidence and predictors of diabetes mellitus among severe COVID-19 patients in western Ethiopia: a retrospective cohort study, 2022).
Gasmi M, Torabinasab K, Williams-Hooker R, Marsigliante S, Muscella A. The neutrophil-to-lymphocyte ratio as a marker of immunosenescence and COVID-19 outcomes in the elderly: A narrative review.. 2026. https://doi.org/10.14814/phy2.70682
Peripheral hematological markers such as the neutrophil-to-lymphocyte ratio consistently correlate with disease progression and mortality risk in older adults (The neutrophil-to-lymphocyte ratio as a marker of immunosenescence and COVID-19 outcomes in the elderly: A narrative review., 2026).
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