Multi-organ Dysfunction in Patients with COVID-19: A Systematic Review and Meta-analysis

Abstract

This study aimed to provide systematic evidence for the association between multiorgan dysfunction and COVID-19 development. Several online databases were searched for articles published until May 13, 2020. Two investigators independently selected trials, extracted data, and evaluated the quality of individual trials. Single-arm meta-analysis was performed to summarize the clinical features of confirmed COVID-19 patients. Fixed effects meta-analysis was performed for clinically relevant parameters that were closely related to the patients' various organ functions. A total of 73 studies, including 171,108 patients, were included in this analysis. The overall incidence of severe COVID-19 and mortality were 24% (95% confidence interval [CI], 20%-28%) and 2% (95% CI, 1%-3%), respectively. Patients with hypertension (odds ratio [OR] = 2.40; 95% CI, 2.08-2.78), cardiovascular disease (CVD) (OR = 3.54; 95% CI, 2.68-4.68), chronic obstructive pulmonary disease (COPD) (OR=3.70; 95% CI, 2.93-4.68), chronic liver disease (CLD) (OR=1.48; 95% CI, 1.09-2.01), chronic kidney disease (CKD) (OR = 1.84; 95% CI, 1.47-2.30), chronic cerebrovascular diseases (OR = 2.53; 95% CI, 1.84-3.49) and chronic gastrointestinal (GI) disease (OR = 2.13; 95% CI, 1.12-4.05) were more likely to develop severe COVID-19. Increased levels of lactate dehydrogenase (LDH), creatine kinase (CK), highsensitivity cardiac troponin I (hs-cTnI), myoglobin, creatinine, urea, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin were highly associated with severe COVID-19. The incidence of acute organ injuries, including acute cardiac injury (ACI); (OR = 11.87; 95% CI, 7.64-18.46), acute kidney injury (AKI); (OR=10.25; 95% CI, 7.60-13.84), acute respiratory distress syndrome (ARDS); (OR=27.66; 95% CI, 18.58-41.18), and acute cerebrovascular diseases (OR=9.22; 95% CI, 1.61-52.72) was more common in patients with severe COVID-19 than in patients with non-severe COVID-19. Patients with a history of organ dysfunction are more susceptible to severe conditions. COVID-19 can aggravate an acute multiorgan injury.

A meta-meta-analysis: Evaluation of meta-analyses published in the effectiveness of cardiovascular comorbidities on the severity of COVID-19

“…Wong ( Wong et al, 2020 ) 76 studies (11,028 patients) 0.11 (0.09,0.14) Jing YANG ( Yang et al, 2020a ) 7studies (1576 patients) 0.08 (0.03,0.13) Setor K. Kunutsor ( Kunutsor and Laukkanen, 2020 ) 17 studies (5815 patients) 0.14 (0.11,0.18) Ting Wu ( Wu et al, 2020a ) 73studies (171,108 patients) 0.08 (0.04,0.14) Zhaohai Zheng M.D ( Zheng et al, 2020b ) 13studies (3027 patients) 0.06 (0.05,0.07) Yinghao Cao ( Cao et al, 2020 ) 31studies (46,959 patients) 0.11 (0.07,0.14) Jing Yang ( Yang et al, 2020b ) 8 studies (46248 patients) 0.05 (0.04,0.07) Safiya Richardson ( Richardson et al, 2020 ) 32studies (310585) 0.11 (0.08,0.13) …”

“… 19 studies 0.18 (0.08,0.29) Jolanda sabatino ( Sabatino et al , 2020 ) 21 studies (77317 patients) 0.36 (0.2,0.53) Awadhesh K. singh ( Awadhesh et al 2020 ) 18 studies (558 patients) 0.11 (0.09,0.13) Elinor Ten ( Tan et al , 2020 ) 45studies (16,561 patients) 0.49 (0.44,0.54) Carlos K.H. Wong ( Wong et al , 2020 ) 76 studies (11,028 patients) 0.18 (0.15,0.2) Jing YANG ( Yang et al, 2020a ) 7studies (1576 patients) 0.21 (0.13,0.27) Setor K. Kunutsor ( Kunutsor and Laukkanen, 2020 ) 17 studies (5815 patients) 0.29 (0.25,0.33) Ting Wu ( Wu et al , 2020a ) 73studies (171,108 patients) 0.19 (0.15,0.23) Zhaohai Zheng M.D ( Zheng et al , 2020b ) 13 studies (3027 patients) 0.22 (0.2,0.23) Yinghao Cao ( Cao et al , 2020 ) 31studies (46,959 patients) 0.18 (0.13,0.23) Jing Yang ( Yang et al, 2020b ) 8 studies (46248 patients) 0.17 (0.14,0.22) Safiya Richardson ( Richardson et al , 2020 ) 32studies (310585) 0.56 (0.54,0.58) …”

Chronic Kidney Diseases and Acute Kidney Injury in Patients With COVID-19: Evidence From a Meta-Analysis

“…Although far from detailed, the importance of AKI has been more profiled by several reports in COVID-19 patients (6, 7). More recently, several meta-analyses have proved the important prognostic values of AKI in severe COVID-19 patients (74)(75)(76)(77). As a vital complication, the presence of AKI was associated with more adverse prognosis in the disease course.…”

Is Gut Microbiota Dysbiosis a Predictor of Increased Susceptibility to Poor Outcome of COVID-19 Patients? An Update

“…The most typical symptoms, which usually appear in a few days after viral exposure, are fever, cough, fatigue, muscle or body aches, and shortness of breath, further evolving to pneumonia. In more severe cases, patients present respiratory, hepatic, gastrointestinal, and neurological complications, which require hospitalization and eventually progress to multi-organ dysfunction and death [ 15 ]. COVID-19 severity and mortality rate are considerably higher in elderly patients, particularly those with pre-existing comorbidities, including hypertension, diabetes, renal disease, or pulmonary conditions, among other chronic diseases [ 16 , 17 , 18 ].…”

“…In line with the previous major coronavirus outbreaks in humans (namely SARS-CoV and Middle East Respiratory Syndrome Coronavirus (MERS-CoV)) [ 39 ], the more severe cases of SARS-CoV-2 infection have been associated with a hyperresponse of the immune system, featured by an exacerbated systemic inflammatory response and the massive release of cytokines, collectively described as a “cytokine storm” [ 40 ]. The resulting multi-organ failure fueled by a self-sustaining loop of ongoing age-related immunosenescence and inflammaging can additionally contribute to the poor outcomes in elderly patients with chronic comorbidities [ 15 , 41 , 42 ].…”