COVID-19 Clinical Characteristics, and Sex-Specific Risk of Mortality: Systematic Review and Meta-Analysis

Nasiri, Mohammad Javad; Haddadi, Sara; Tahvildari, Azin; Farsi, Yeganeh; Arbabi, Mahta; Hasanzadeh, Saba; Jamshidi, Parnian; Murthi, Mukunthan; Mirsaeidi, Mehdi

doi:10.3389/fmed.2020.00459

Cited by 118 publications

(88 citation statements)

References 66 publications

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“…Cox regression was performed to determine risk factors associated with in-hospital mortality. Clinically relevant factors were found based on our and other studies and added into the models [18][19][20][21] . We used the Charlson comorbidity index because we expected a low number of outcomes for each outcome variable and were able to include only a limited number of potential confounders from the comorbidities in the model (CCI) 22 .…”

Section: Statistical Analysis Categorical Variables Were Presented Amentioning

confidence: 99%

Role of IgG against N-protein of SARS-CoV2 in COVID19 clinical outcomes

Batra

Tian

Zhang

et al. 2021

Sci Rep

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The Nucleocapsid Protein (N Protein) of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV2) is located in the viral core. Immunoglobulin G (IgG) targeting N protein is detectable in the serum of infected patients. The effect of high titers of IgG against N-protein on clinical outcomes of SARS-CoV2 disease has not been described. We studied 400 RT-PCR confirmed SARS-CoV2 patients to determine independent factors associated with poor outcomes, including Medical Intensive Care Unit (MICU) admission, prolonged MICU stay and hospital admissions, and in-hospital mortality. We also measured serum IgG against the N protein and correlated its concentrations with clinical outcomes. We found that several factors, including Charlson comorbidity Index (CCI), high levels of IL6, and presentation with dyspnea were associated with poor clinical outcomes. It was shown that higher CCI and higher IL6 levels were independently associated with in-hospital mortality. Anti-N protein IgG was detected in the serum of 55 (55%) patients at the time of admission. A high concentration of antibodies, defined as signal to cut off ratio (S/Co) > 1.5 (75 percentile of all measurements), was found in 25 (25%) patients. The multivariable logistic regression models showed that between being an African American, higher CCI, lymphocyte counts, and S/Co ratio > 1.5, only S/Co ratio were independently associated with MICU admission and longer length of stay in hospital. This study recommends that titers of IgG targeting N-protein of SARS-CoV2 at admission is a prognostic factor for the clinical course of disease and should be measured in all patients with SARS-CoV2 infection.

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Section: Statistical Analysis Categorical Variables Were Presented Amentioning

confidence: 99%

Role of IgG against N-protein of SARS-CoV2 in COVID19 clinical outcomes

Batra

Tian

Zhang

et al. 2021

Sci Rep

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“…As of December 8, 2020, WHO declared a death ratio of [9]. In a meta-analysis by Nasiri et al, the mortality rate was reported as 6.6% [10]. As we included the patients with SARI symptoms and indication for hospitalization, our results might not be not comparable with previous reports.…”

Section: Discussionmentioning

confidence: 75%

“…Bilinski and Emanuel reported 60.3 COVID-19 deaths per 100.000 for the US, 86.8 for Belgium, 65.0 for Spain, 62.6 for the UK, 59.1 for Italy, 57.4 for Sweden, 46.6 for France, and 36.2 for the Netherlands [ 9 ]. In a meta-analysis by Nasiri et al, the mortality rate was reported as 6.6% [ 10 ]. As we included the patients with SARI symptoms and indication for hospitalization, our results might not be not comparable with previous reports.…”

Section: Discussionmentioning

confidence: 99%

“…This finding is thought to be due to more significant angiotensin-converting enzyme-2 (ACE2) expression reported in Asian men [ 5 ]. Other suggestions are that there may be alleles located in ACE2 on the X-chromosome that render resistance to COVID-19 and testosterone has an immunosuppressive effect and moreover, estrogen enhances the immunity [ 10 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

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Variables Affecting Mortality Among COVID-19 Patients With Lung Involvement Admitted to the Emergency Department

Saçak¹,

Karacabey²,

Sanri³

et al. 2021

Cureus

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Introduction: A cluster of atypical pneumonia cases in Wuhan, China, turned out to be a highly contagious disease, swept across most of the countries, and soon after was announced as a pandemic. Therefore we aimed to investigate the demographics and factors associated with the disease outcome. Methods: In this retrospective chart review, we screened patients admitted to the emergency department with severe acute respiratory infection due to coronavirus disease 2019 (COVID-19) between March 15, 2020 and April 30, 2020. Age, gender, symptoms, laboratory data, and radiology data were obtained, as well as outcomes and length of stay. Results: We identified 177 patients (54.8% male). Seventy-eight percent of the cases were admitted into wards whereas 22% of the cases were admitted into the intensive care unit (ICU). Twenty-five percent of the cases needed invasive mechanical ventilation during their hospital stay and median length of hospital stay until death or discharge was eight days (interquartile range (IQR) 5.0 - 16.0). Among 177 patients, overall in-hospital mortality rate was 19.8% (n=35; male:female=18:17; p=0.6553). In-hospital mortality rates were statistically significantly higher in patients with higher age (64 vs. 74; p=0.0091), respiratory rate (RR) (28 vs. 36; p=0.0002), C-reactive protein (CRP) (54.7 vs. 104.0; p<0.0001), d-dimer (1.2 vs. 3.2; p<0.0001), ferritin (170 vs. 450.4; p<0.0001), fibrinogen (512 vs. 598; p=0.0349), international normalized ratio (INR) (1.1 vs. 1.3; p=0.0001), prothrombin time (PT) (14.8 vs. 17.4; p=0.0001), procalcitonin (0.1 vs. 0.3; p<0.0001), creatinine (0.9 vs. 1.1; p=0.0084), longer length of stay (LOS) (8.0 vs. 13.0; p=0.0251) with lower oxygen saturation (sO 2 ) (93.0% vs 87.5%; p<0.0001), diastolic blood pressure (DBP) (78 vs. 70; p=0.0039), lymphocyte (1.2 vs. 0.8; p=0.0136), and with positive polymerase chain reaction (PCR) results (28.6% vs. 12.8%; p=0.0118). Conclusion: Patients with older age, higher RR, lower sO 2 and DBP, higher creatinine, d-dimer, INR, CRP, procalcitonin, ferritin, and fibrinogen on initial admission were found to be less likely to survive COVID-19.

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“…While earlier studies showed that men were at higher risk of mortality after contracting COVID-19 than women, [3][4][5][6] older women and minority women are also at increased risk of mortality. [7][8][9][10] In addition to mortality, COVID-19 patients are at elevated risk of cardiovascular complications. 11,12 Furthermore, preexisting cardiovascular disease and chronic disease, such as diabetes and COPD, 13,14 have been linked to worse prognosis in COVID-19.…”

Section: Introductionmentioning

confidence: 99%

COVID-19 Associated Mortality and Cardiovascular Disease Outcomes Among U.S. Women Veterans

Tsai,

Nguyen,

Ebrahimi

et al. 2020

SSRN Journal

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Background The burden of COVID-19 has been noted to be disproportionately greater in minority women, a population that is nevertheless still understudied in COVID-19 research. Methods We conducted a case-control cohort study to examine COVID-19-associated mortality and cardiovascular disease outcomes after testing (henceforth index) among a racially diverse adult women veteran population. We drew data from a Veterans Affairs (VA) national COVID-19 shared data repository, collected between February and August 2020. Kaplan-Meier curves and the Cox proportional hazards model were employed to examine the distribution of time to death and the effects of baseline predictors on mortality risk. Generalized linear models were used to examine 60-day cardiovascular disease outcomes. Covariates studied included age, body mass index (BMI), and active smoking status at index, and pre-existing conditions of diabetes, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and a history of treatment with antiplatelet or anti-thrombotic drug at any time in the 2 years prior to the index date. Results Women veterans who tested positive for SARS-CoV-2 had 4 times higher mortality risk than women veterans who tested negative (Hazard Ratio 3.8, 95% Con dence Interval CI 2.92 to 4.89) but had lower risk of cardiovascular events (Odds Ratio OR 0.78, 95% CI 0.66 to 0.92) and developing new heart disease conditions within 60 days (OR 0.67, 95% CI 0.58 to 0.77). Older age, obesity (BMI > 30), and prior CVD and COPD conditions were positively associated with increased mortality in 60 days. Despite a higher infection rate among minority women veterans, there was no signi cant race difference in mortality, cardiovascular events, or onset of heart disease. Conclusions and Relevance SARS-CoV-2 infection increased short-term mortality risk among women veterans similarly across race groups. However, there was no evidence of increased cardiovascular disease incidence in 60 days. A longer follow-up of women veterans who tested positive is warranted. Key Points Question: What is the impact of COVID-19 on mortality and cardiovascular disease outcomes in women and particularly in women of different racial and ethnic background? Findings: In a case-control observational study using data from racially diverse women veterans collected between February 24 and November 25, 2020, this study found that SARS-CoV-2 infection increased 60-Page 3/16 day mortality risk among women veterans similarly across race groups. Within this 60 day study period, those who tested positive were at lower risk of cardiovascular events and developing new heart disease conditions. Meaning The study lls a current gap in the COVID-19 studies and literature that underrepresent women, in particular, racial and ethnic minority women. While the ndings from the current study are speci c to women veterans, the ethnic and racial diversity of our study cohort suggests that our ndings may apply to women in the general population, thus providing a better understanding of...

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COVID-19 Clinical Characteristics, and Sex-Specific Risk of Mortality: Systematic Review and Meta-Analysis

Cited by 118 publications

References 66 publications

Role of IgG against N-protein of SARS-CoV2 in COVID19 clinical outcomes

Role of IgG against N-protein of SARS-CoV2 in COVID19 clinical outcomes

Variables Affecting Mortality Among COVID-19 Patients With Lung Involvement Admitted to the Emergency Department

COVID-19 Associated Mortality and Cardiovascular Disease Outcomes Among U.S. Women Veterans

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