High mortality in COVID‐19 patients with mild respiratory disease

Masetti, Chiara; Generali, Elena; Colapietro, Francesca; Voza, Antonio; Cecconi, Maurizio; Messina, Antonio; Omodei, Paolo; Angelini, Claudio; Ciccarelli, Michele; Badalamenti, Salvatore; Canonica, Giorgio Walter; Lleo, Ana; Aghemo, Alessio

doi:10.1111/eci.13314

Cited by 41 publications

(45 citation statements)

References 27 publications

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“…The majority of deaths occurred in patients over age 60 (60.8%). There was a clear increase in the risk of mortality among older patients which is consistent with current COVID-19 literature for adults [5-9, 12, 13, 15, 21,22]. Suleyman et al reported the odds of death in patients over 60 were 5.3 times that of patients less than 60 years (p < 0.001) [6].…”

Section: Discussionsupporting

confidence: 79%

Mortality Associated With Intubation and Mechanical Ventilation in Patients with COVID-19

Zimmerman

Stroever²,

Burton

et al. 2020

Preprint

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Objective: The need for critical care, hemodynamic support, renal replacement therapy, and mechanical ventilation have emerged as key features of the SARS-nCoV-2 (COVID-19) pandemic. The primary aim of this study was to determine the in-hospital mortality rate of mechanically ventilated patients. We also sought to determine the risk of in-hospital mortality by age, gender, race, ethnicity, and body mass index. Methods: We performed a retrospective cohort study to determine the mortality rate among inpatient adults with COVID-19 on mechanical ventilation in the Nuvance Health system between March 1, 2020 and July 17, 2020. Patients were included if they were 18 years or older, had a laboratory confirmed COVID-19 diagnosis, were admitted to hospitals within the Nuvance Health network (7 hospitals), and were on mechanical ventilation at any time during their inpatient stay. Results: Overall mortality in our cohort of 304 patients was 53.3 percent. Multivariable logistic regression including age, gender, race, ethnicity, and BMI demonstrated patients over 71 years old had greater risk of mortality compared to patients ages 61-70, and females had half the risk compared to males. There was no significant difference in risk of mortality given race, ethnicity, or BMI. Conclusions: In adult patients with confirmed COVID-19 infection requiring mechanical ventilation and intensive care, advanced age (>71 years old) and male gender are associated with increased risk of mortality. This information contributes to a collective body of evidence to support ongoing planning and decision-making among clinicians and for directed infection prevention programming.

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Section: Discussionsupporting

confidence: 79%

Mortality Associated With Intubation and Mechanical Ventilation in Patients with COVID-19

Zimmerman

Stroever²,

Burton

et al. 2020

Preprint

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“…Twenty-two studies [ 20 , 26 , 74 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 102 ] showed higher D-Dimer levels in 1149 subjects dead with COVID-19 as compared to 4407 subjects survived to COVID-19 (SMD: 3.88; 95%CI: 2.70, 5.07, p < 0.001, Figure 3 ). The heterogeneity among studies was significant (I 2 : 99.4%, p < 0.001) and was not reduced by the exclusion of one study at a time.…”

Section: Resultsmentioning

confidence: 99%

“…A lower PLT count (SMD: −0.60, 95%CI: −0.82, −0.38; p < 0.001, Figure 4 ) was found in 1339 non-survivors to COVID-19 as compared to 5637 survivors enrolled in 21 studies [ 20 , 22 , 26 , 74 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 91 , 92 , 93 , 94 , 95 , 97 , 98 , 100 , 101 , 102 ]. The heterogeneity among studies was significant (I 2 : 90.3%, p < 0.001) and was not reduced by the exclusion of one study at a time.…”

Section: Resultsmentioning

confidence: 99%

“…A total of nine studies [ 20 , 84 , 86 , 89 , 92 , 96 , 97 , 98 , 100 ] showed comparable fibrinogen values in 429 subjects dead with COVID-19 as compared to 2472 subjects survived (SMD: 0.08; 95%CI: −0.14, 0.31, p = 0.475, Figure 5 ). The heterogeneity among studies was significant (I 2 : 67.1%, p = 0.002) and was not reduced by the exclusion of one study at a time.…”

Section: Resultsmentioning

confidence: 99%

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Hemostatic Changes in Patients with COVID-19: A Meta-Analysis with Meta-Regressions

Minno

Calcaterra

Lupoli

et al. 2020

JCM

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Background: Complications of coronavirus disease 2019 (COVID-19) include coagulopathy. We performed a meta-analysis on the association of COVID-19 severity with changes in hemostatic parameters. Methods: Data on prothrombin time (PT), activated partial thromboplastin time (aPTT), D-Dimer, platelets (PLT), or fibrinogen in severe versus mild COVID-19 patients, and/or in non-survivors to COVID-19 versus survivors were systematically searched. The standardized mean difference (SMD) was calculated. Results: Sixty studies comparing 5487 subjects with severe and 9670 subjects with mild COVID-19 documented higher PT (SMD: 0.41; 95%CI: 0.21, 0.60), D-Dimer (SMD: 0.67; 95%CI: 0.52, 0.82), and fibrinogen values (SMD: 1.84; 95%CI: 1.21, 2.47), with lower PLT count (SMD: −0.74; 95%CI: −1.01, −0.47) among severe patients. Twenty-five studies on 1511 COVID-19 non-survivors and 6287 survivors showed higher PT (SMD: 0.67; 95%CI: 0.39, 0.96) and D-Dimer values (SMD: 3.88; 95%CI: 2.70, 5.07), with lower PLT count (SMD: −0.60, 95%CI: −0.82, −0.38) among non-survivors. Regression models showed that C-reactive protein values were directly correlated with the difference in PT and fibrinogen. Conclusions: Significant hemostatic changes are associated with COVID-19 severity. Considering the risk of fatal complications with residual chronic disability and poor long-term outcomes, further studies should investigate the prognostic role of hemostatic parameters in COVID-19 patients.

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“…Research was pooled from 14 geographies with China the most commonly reported (n = 43) [19,, followed by USA (n = 15) [68][69][70][71][72][73][74][75][76][77][78][79][80][81][82], Italy (n = 4) [83][84][85][86], and UK (N = 3) [87][88][89]. The remaining papers were from Mexico [90,91], South Korea [92,93], Turkey [94], Brazil [95], Denmark [96], France [97], Israel [98], Iran [99], and Poland [100].…”

Section: Plos Onementioning

confidence: 99%

Population risk factors for severe disease and mortality in COVID-19: A global systematic review and meta-analysis

Booth¹,

Reed²,

Ponzo³

et al. 2021

PLoS ONE

443

312

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Aim COVID-19 clinical presentation is heterogeneous, ranging from asymptomatic to severe cases. While there are a number of early publications relating to risk factors for COVID-19 infection, low sample size and heterogeneity in study design impacted consolidation of early findings. There is a pressing need to identify the factors which predispose patients to severe cases of COVID-19. For rapid and widespread risk stratification, these factors should be easily obtainable, inexpensive, and avoid invasive clinical procedures. The aim of our study is to fill this knowledge gap by systematically mapping all the available evidence on the association of various clinical, demographic, and lifestyle variables with the risk of specific adverse outcomes in patients with COVID-19. Methods The systematic review was conducted using standardized methodology, searching two electronic databases (PubMed and SCOPUS) for relevant literature published between 1st January 2020 and 9th July 2020. Included studies reported characteristics of patients with COVID-19 while reporting outcomes relating to disease severity. In the case of sufficient comparable data, meta-analyses were conducted to estimate risk of each variable. Results Seventy-six studies were identified, with a total of 17,860,001 patients across 14 countries. The studies were highly heterogeneous in terms of the sample under study, outcomes, and risk measures reported. A large number of risk factors were presented for COVID-19. Commonly reported variables for adverse outcome from COVID-19 comprised patient characteristics, including age >75 (OR: 2.65, 95% CI: 1.81–3.90), male sex (OR: 2.05, 95% CI: 1.39–3.04) and severe obesity (OR: 2.57, 95% CI: 1.31–5.05). Active cancer (OR: 1.46, 95% CI: 1.04–2.04) was associated with increased risk of severe outcome. A number of common symptoms and vital measures (respiratory rate and SpO2) also suggested elevated risk profiles. Conclusions Based on the findings of this study, a range of easily assessed parameters are valuable to predict elevated risk of severe illness and mortality as a result of COVID-19, including patient characteristics and detailed comorbidities, alongside the novel inclusion of real-time symptoms and vital measurements.

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High mortality in COVID‐19 patients with mild respiratory disease

Cited by 41 publications

References 27 publications

Mortality Associated With Intubation and Mechanical Ventilation in Patients with COVID-19

Mortality Associated With Intubation and Mechanical Ventilation in Patients with COVID-19

Hemostatic Changes in Patients with COVID-19: A Meta-Analysis with Meta-Regressions

Population risk factors for severe disease and mortality in COVID-19: A global systematic review and meta-analysis

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