Highlights Obesity was associated with mortality and severity in patients with COVID-19. Dose–response meta-analysis demonstrate an increase of 5% risk for poor outcome for every 5 kg/mg 2 increase in body mass index. The relationship departed from linearity and became steeper from 30–35 kg/mg 2 onwards.

Background: Abnormalities in hematologic, biochemical, and immunologic biomarkers have been shown to be associated with severity and mortality in Coronavirus Disease 2019 (COVID-19). Therefore, early evaluation and monitoring of both liver and kidney functions, as well as hematologic parameters, are pivotal to forecast the progression of COVID-19. Objectives: In this study, we performed a systematic review and meta-analysis to investigate the association between several complications, including acute kidney injury (AKI), acute liver injury (ALI), and coagulopathy, with poor outcomes in COVID-19. Design: Systematic review and meta-analysis Setting: Observational studies reporting AKI, ALI, and coagulopathy along with the outcomes of clinically validated death, severe COVID-19, or intensive care unit (ICU) care were included in this study. The exclusion criteria were abstract-only publications, review articles, commentaries, letters, case reports, non-English language articles, and studies that did not report key exposures or outcomes of interest. Patients: Adult patients diagnosed with COVID-19. Measurements: Data extracted included author, year, study design, age, sex, cardiovascular diseases, hypertension, diabetes mellitus, respiratory comorbidities, chronic kidney disease, mortality, severe COVID-19, and need for ICU care. Methods: We performed a systematic literature search from PubMed, SCOPUS, EuropePMC, and the Cochrane Central Database. AKI and ALI follow the definition of the included studies. Coagulopathy refers to the coagulopathy or disseminated intravascular coagulation defined in the included studies. The outcome of interest was a composite of mortality, need for ICU care, and severe COVID-19. We used random-effects models regardless of heterogeneity to calculate risk ratios (RRs) for dichotomous variables. Heterogeneity was assessed using I2. Random effects meta-regression was conducted for comorbidities and the analysis was performed for one covariate at a time. Results: There were 3615 patients from 15 studies. The mean Newcastle-Ottawa scale of the included studies was 7.3 ± 1.2. The AKI was associated with an increased the composite outcome (RR: 10.55 [7.68, 14.50], P < .001; I2: 0%). Subgroup analysis showed that AKI was associated with increased mortality (RR: 13.38 [8.15, 21.95], P < .001; I2: 24%), severe COVID-19 (RR: 8.12 [4.43, 14.86], P < .001; I2: 0%), and the need for ICU care (RR: 5.90 [1.32, 26.35], P = .02; I2: 0%). The ALI was associated with increased mortality (RR: 4.02 [1.51, 10.68], P = .005; I2: 88%) in COVID-19. Mortality was higher in COVID-19 with coagulopathy (RR: 7.55 [3.24, 17.59], P < .001; I2: 69%). The AKI was associated with the composite outcome and was not influenced by age ( P = .182), sex ( P = .104), hypertension ( P = .788), cardiovascular diseases ( P = .068), diabetes ( P = .097), respiratory comorbidity ( P = .762), and chronic kidney disease ( P = .77). Limitations: There are several limitations of this study. Many of these studies did not define the extent of AKI (grade), which may affect the outcome. Acute liver injury and coagulopathy were not defined in most of the studies. The definition of severe COVID-19 differed across studies. Several articles included in the study were published at preprint servers and are not yet peer-reviewed. Most of the studies were from China; thus, some patients might overlap across the reports. Most of the included studies were retrospective in design. Conclusions: This meta-analysis showed that the presence of AKI, ALI, and coagulopathy was associated with poor outcomes in patients with COVID-19.

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Objective: The aim of the study was to evaluate the association between chronic kidney disease (CKD) and new onset renal replacement therapy (RRT) with the outcome of Coronavirus Disease 2019 (COVID-19) in patients. Methodology: A systematic literature search from several databases was performed on studies that assessed CKD, use of RRT, and the outcome of COVID-19. The composite of poor outcome consisted of mortality, severe COVID-19, acute respiratory distress syndrome (ARDS), need for intensive care, and use of mechanical ventilator. Results: Nineteen studies with a total of 7216 patients were included. CKD was associated with increased composite poor outcome (RR 2.63 [1.33, 5.17], P = .03; I2 = 51%, P = .01) and its subgroup, consisting of mortality (RR 3.47 [1.36, 8.86], P = .009; I2 = 14%, P = .32) and severe COVID-19 (RR 2.89 [0.98, 8.46], P = .05; I2 = 57%, P = .04). RRT was associated with increased composite poor outcome (RR 18.04 [4.44, 73.25], P < .001; I2 = 87%, P < .001), including mortality (RR 26.02 [5.01, 135.13], P < .001; I2 = 60%, P = .06), severe COVID-19 (RR 12.95 [1.93, 86.82], P = .008; I2 = 81%, P < .001), intensive care (IC) (RR 14.22 [1.76, 114.62], P < .01; I2 = 0%, P < .98), and use of mechanical ventilator (RR 34.39 [4.63, 255.51], P < .0005). Conclusion: CKD and new-onset RRT were associated with poor outcome in patients with COVID-19.

Introduction: A prolonged P-wave duration (PWD) in sinus rhythm pre-ablation has been hypothesized to be a non-invasive ECG marker associated with increased atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). This systematic review and meta-analysis will assess the latest evidence on the association of prolonged PWD pre-ablation with AF recurrence after PVI.Hypothesis: Prolonged PWD pre-ablation is associated with AF recurrence after PVI. Methods:The inclusion criteria for this study are all cohort studies that assess prolonged PWD on ECG during sinus rhythm pre-ablation and its association with AF recurrence in post-PVI patients.Results: There were 1,482 patients with AF post-PVI from twelve cohort studies. The cut-off points for prolonged PWD ranges from >120 ms to >150 ms. Meta-analysis on six studies showed a pooled mean difference of PWD in subjects with recurrent AF and non-recurring AF was 12.54 ms [8.76-16.31], p < 0.001; I 2 78%. Pooled odds ratio was 4.17 [2.10-8.31], p < 0.001; I 2 72% and pooled hazard ratio was 1.93 [1.10-3.39], p = 0.02; I 2 80%. Upon subgroup analysis, the association between prolonged PWD and AF recurrence was significant in signal-averaged ECG, 12-lead ECG, paroxysmal AF, >120-130 ms, and >140-150 ms PWD cut-off point subgroups.Conclusion: These findings suggest that prolonged PWD with a cutoff of >120 ms to >150 ms in sinus rhythm before ablation may be associated with AF recurrence after PVI regardless of age, gender, left atrial size, and the presence of structural heart disease. We also encouraged further studies that investigate predicting models to include prolonged PWD as one of their parameters. K E Y W O R D Satrial fibrillation, atrial fibrillation recurrence, catheter ablation, prolonged P-wave duration, pulmonary vein isolation