Case fatality rate in COVID-19: a systematic review and meta-analysis

Abstract

Background: Estimating the prevalence of severe or critical illness and case fatality of COVID-24 19 outbreak in December, 2019 remains a challenge due to biases associated with surveillance, 25 data synthesis and reporting. We aimed to address this limitation in a systematic review and 26 meta-analysis and to examine the clinical, biochemical and radiological risk factors in a meta-27 regression. 28Methods: PRISMA guidelines were followed. PubMed, Scopus and Web of Science were 29 searched using pre-specified keywords on March 07, 2020. Peer-reviewed empirical studies 30 examining rates of severe illness, critical illness and case fatality among COVID-19 patients 31 were examined. Numerators and denominators to compute the prevalence rates and risk factors 32 were extracted. Random-effects meta-analyses were performed. Results were corrected for 33 publication bias. Meta-regression analyses examined the moderator effects of potential risk 34 factors. 35Results: The meta-analysis included 29 studies representing 2,090 individuals. Pooled rates of 36 severe illness, critical illness and case fatality among COVID-19 patients were 15%, 5% and 37 0.8% respectively. Adjusting for potential underreporting and publication bias, increased these 38 estimates to 26%, 16% and 7.4% respectively. Increasing age and elevated LDH consistently 39 predicted severe / critical disease and case fatality. Hypertension; fever and dyspnea at 40 presentation; and elevated CRP predicted increased severity. 41 Conclusions: Risk factors that emerged in our analyses predicting severity and case fatality 42 should inform clinicians to define endophenotypes possessing a greater risk. Estimated case 43 All rights reserved. No reuse allowed without permission.was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. : medRxiv preprint 3 fatality rate of 7.4% after correcting for publication bias underscores the importance of strict 44 adherence to preventive measures, case detection, surveillance and reporting. 45 46 A novel corona virus, first identified in Wuhan, China in late 2019, resulted in a 64 pandemic by the first quarter of 2020, contributed by the prolonged survival of the virus in the 65 environment and extended length of pre-or post-symptomatic and potential asymptomatic 66shedding. 1-4 While the virus is known to cause only a mild illness in a majority, severe illness 67 characterized by respiratory distress requiring hospital admission is not uncommon. 5 68 Furthermore, the virus has the potential to precipitate a life-threatening critical illness, 69 characterized by respiratory failure, circulatory shock, sepsis or other organ failure, requiring 70 intensive care. 6, 7

A model of disparities: risk factors associated with COVID-19 infection

“…This retrospective study of the risk of COVID-19 infection identified several clinical risk factors also associated with serious illness in prior studies, including older age [3], male gender [15], diabetes [7], chronic kidney disease [16], high BMI [17], and immunosuppression [18]. However, some factors previously found to increase mortality risk, such as hypertension [3], and cardiovascular disease, liver disease, lung disease, or asthma [8], were not significant factors associated with initial COVID-19 infection.…”

“…While statistical models have been built to predict severity of illness and mortality related to COVID-19 infection [1], less has been done to predict the risk of initial infection in community settings. Studies to date have contained limited demographic information, have focused on hospitalized patients, and have not been representative of U.S. populations [2][3][4][5][6][7].…”

“…Most studies are limited to known clinical risk factors for severe illness and mortality, such older age [3,4] and chronic health conditions such as hypertension [3], cardiovascular disease [4], and diabetes [7]. More recent research by the U.S. Centers for Disease Control and Prevention (CDC) has identified specific groups at higher risk for severe illness, such as older adults living in long term care facilities, those with a BMI of forty or higher, and immunosuppressed individuals, including people withHIV/AIDS [8].…”

A Model of Disparities: Risk Factors Associated with COVID-19 Infection

“…7 chronic kidney disease, 16 high BMI, 17 and immunosuppression. 18 However, some factors previously found to increase mortality risk, such as hypertension, 3 and cardiovascular disease, liver disease, lung disease, or asthma, 8 were not signi cant factors associated with initial COVID-19 infection.. Surprisingly, being prescribed more than ten medications or having a greater number of chronic conditions was associated with less infection risk, suggesting possible risk reduction behavior based on perceived risk.…”

Recording COVID-19 consultations: review of symptoms, risk factors, and proposed SNOMED CT terms

“…In total, 25 health conditions were identified with COVID-19 vulnerability and/or complications, reported by two guidelines, 15 , 20 16 published reviews 5 , 25 – 28 , 30 – 33 , 54 , 61 – 66 and 10 preprint reviews. 37 , 39 , 42 , 45 , 47 , 57 , 59 , 60 , 67 , 68 The list of conditions included the ’high-risk‘ or ’extremely vulnerable from COVID-19’ criteria based on guidelines issued by Public Health England and Health Protection Scotland. 69 , 70 The list included a breadth of conditions ranging from cardiovascular, respiratory, immunosuppressed conditions, and previous cancer (see Table 2 for the list of medical conditions and the proposed examples of corresponding SNOMED CT codes).…”