Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis

Wang, Xinhui; Fang, Xuexian; Cai, Zhaoxian; Wu, Xiaotian; Gao, Xiangjing; Min, Junxia; Wang, Fudi

doi:10.34133/2020/2402961

Cited by 328 publications

(355 citation statements)

References 113 publications

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“…For comorbidities, we found CVD, HTN and DM to be signi cantly associated with ICU mortality, which is consistent with ndings by a review that identi ed these same comorbidities to be correlated with disease severity and ICU admissions [49]. Separately, Wang et al also found HTM, DM, and CVD to correlate with COVID-19 severity and mortality [54].…”

Section: Discussionsupporting

confidence: 90%

COVID-19 ICU and Mechanical Ventilation Patient Characteristics and Outcomes - A Systematic Review and Meta-analysis

Chang

Elhusseiny

Yeh

et al. 2020

Preprint

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Background To characterize COVID-19 ICU admissions, their outcome and associated features, as well as identify their regional discrepancies. Methods Scopus, Embase, preprint servers bioRvix and medRvix and the Intensive Care National Audit and Research Center (ICNARC) website was searched for reports through May 1st 2020 on COVID-19 ICU admissions and outcomes using pre-defined search terms and eligibility criteria.Relevant data was extracted and pooled using fixed or random effects meta-analysis depending on heterogeneity. Study quality was assessed by the NIH tool and heterogeneity was assessed by I2 and Q tests. Baseline patient characteristics, ICU and IMV outcomes were pooled and meta-analyzed. Pooled odds ratios (pOR) were calculated for clinical features against ICU, MV mortality. Subgroup analysis was carried out based on patient regions.Results Twenty-eight studies comprising 12,437 COVID-19 ICU admissions from seven countries were meta-analyzed. Pooled ICU admission rate was 21%[95% CI 0.12 to 0.34] and 69% of cases needed IMV[95% CI 0.61-0.75]. ICU and IMV mortality were 28.3%[95% CI 0.25 to 0.32], 43%[95% CI 0.29 to 0.58] and ICU, IMV duration was 7.78[95% CI 6.99 to 8.63] and 10.12[95% CI 7.08 to 13.16] days respectively. Besides confirming the significance of comorbidities and clinical findings of COVID-19, major correlates with ICU mortality were found to be IMV [pOR 16.46, 95% CI 4.37 to 61.96], acute kidney injury (AKI) [pOR 12.47, 95% CI 1.52 to 102.7], and acute respiratory distress syndrome (ARDS) [pOR 6.52, 95% CI 2.66 to 16.01]. Subgroup analyses confirm significant regional discrepancies in outcomes.Conclusions This is the most comprehensive systematic review and meta-analysis of COVID-19 ICU and IMV cases and associated outcomes to date and the only analysis to analyze and associate IMV with COVID-19 ICU mortality. The significant association of AKI, ARDS and IMV with mortality has implications for ICU resource planning for AKI and ARDS as well as research into optimal ventilation strategies for patients. Regional differences in outcome implies a need to develop region specific protocols for ventilatory support as well as overall treatment.Study Registration PROSPERO registration number CRD42020182482.

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Section: Discussionsupporting

confidence: 90%

COVID-19 ICU and Mechanical Ventilation Patient Characteristics and Outcomes - A Systematic Review and Meta-analysis

Chang

Elhusseiny

Yeh

et al. 2020

Preprint

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“…Compared to COVID-19 patients without preexisting comorbidities, those with CVD, CKD, COPD or liver disease had greater excess death. The strength of correlation between different comorbidities and the prognosis, however, was inconsistent when compared with the previous researches (2,5,24). We do not nd signi cant risk increase in hypertension and diabetes.…”

Section: Discussioncontrasting

confidence: 96%

Mediating Effect of Deteriorated Kidney Function in Comorbidity-related Excess Deaths in COVID-19: A Retrospective Cohort Study

Luo

Liu

Xie

et al. 2020

Preprint

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Background In-hospital death risks vary in COVID-19 patients with comorbidities. Kidney function decline is prevalent in this course. Methods To explore the exact role of deteriorated kidney function, we applied a retrospective cohort study including 1266 participants in Wuhan Tongren Hospital between January 27 and March 3, 2020. Demographic characteristics, preexisting comorbidities history, organ function data and outcomes were extracted. Deteriorated kidney function was identified as the decline percentage, assessed by an increase in peak serum creatinine from the baseline. Mediating effect was calculated by mediation analysis. Key Results 1266 hospitalized COVID-19 patients (60±15 years, 47.8% are male) were included, with an overall in-hospital death rate of 4.42% (56/1266). For critical cases, 77.02% had at least one preexisting comorbidity. Patients with comorbidities suffered higher in-hospital death and more severe decline of kidney function. Compared to patients with minor function decline (<10%), significant risk increase was found in those with more severe one (OR 3.57; 95%CI 1.70 to 7.52; P=.001 for moderate with 10-50% decline, and 37.45; 95%CI 18.71 to 74.55; P＜.001 for severe with>50%). More interestingly, the mediation analysis found deteriorated kidney function played as an important mediator between different comorbidities and COVID-19 patients’ in-hospital death, with the mediation effect of 11%, 12%, 16% and 32% respectively for hypertension, COPD, CVD and CKD.Conclusions Deteriorated kidney function is strongly associated with increase of in-hospital death in COVID-19 and partially mediates the facilitating effect of preexisting comorbidities on in-hospital death. Thus, dynamic monitoring kidney function, preventing the deterioration of kidney function might be helpful to improve survival in COVID-19 patients, especially those with preexisting comorbidities.

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“…Ten percent of the sample had previously diagnosed chronic diseases, and systematic reviews demonstrated that one major determent of COVID-19 severity is preexisting chronic condition, which con rms the results of this study (22,23).…”

Section: Discussionsupporting

confidence: 85%

The Prevalence of COVID-19 Symptoms in Syria: A Cross-Sectional Study

Alhaffar

Abbas

Nassar

2020

Preprint

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Introduction: The corona virus disease 2019 is a disease caused by the newly discovered human infecting SARS-Co V-2 virus. The COVID-19 virus is highly transmittable, by August 14, 2020, more than 20 million people were confirmed to have COVID-19 worldwide, with more than 750,000 death. Syria was declared to have one of most vulnerable health systems in the world, with poor surveillance systems, unstable conditions, no standardized method for reporting infections, lack of sufficient public awareness, and a continued deterioration of humanitarian and socio-economic conditions across Syria.Objectives: to investigate the prevalence of COVID-19 symptoms among the Syrian population.Methods: this is a cross sectional study in Damascus – Syria, data were collected during August, 2020 using an online questionnaire that contained 3 section (demographic variables, awareness of COVID-19, symptoms of COVID-19) and analyzed using SPSS v.22.Results: 5212 people were included in the study, 59% females and 41% males, 9.6% had chronic medical conditions. 63.4% reported experiencing COVID-19 symptoms during the past 6 months, symptoms lasted 6.9 days on average, the most prevalent symptoms were as anosmia and dysgeusia (42.2%), headache (67.1%), fatigue (70%). Symptoms were significantly more prevalent in the past 14 days (P=0.000).Conclusion: Within the limits of this study, high prevalence of covid-19 symptoms was noticed in the Syrian population. Significant correlation was made between the severity and duration of the symptoms. Measures to slow down spread of COVID-19 need to be taken immediately.

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Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis

Cited by 328 publications

References 113 publications

COVID-19 ICU and Mechanical Ventilation Patient Characteristics and Outcomes - A Systematic Review and Meta-analysis

COVID-19 ICU and Mechanical Ventilation Patient Characteristics and Outcomes - A Systematic Review and Meta-analysis

Mediating Effect of Deteriorated Kidney Function in Comorbidity-related Excess Deaths in COVID-19: A Retrospective Cohort Study

The Prevalence of COVID-19 Symptoms in Syria: A Cross-Sectional Study

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