“…Extreme heterogeneity between studies was observed (I 2 = 92.4%, P < 0.001). SAA concentrations remained significantly higher (SMD 1.25, 95% CI 0.87 to 1.63, P = 0.001; I 2 = 92.7%, P < 0.001) in patients with high severity or non-survival status after excluding the large study by Yu et al (2020) , which accounted for nearly 58% of the overall sample size. Fig.…”
Section: Resultsmentioning
confidence: 95%
“…After a full-text revision of the remaining 26 articles, seven were excluded because they did not meet the inclusion criteria. Thus, nineteen studies, all conducted in China, were included in the meta-analysis ( Table 1 ) ( Chen et al, 2020a , Chen et al, 2020b , Cheng et al, 2020 , Dong et al, 2020 , Fu et al, 2020 , Li et al, 2020 , Li and Chen, 2020 , Liu et al, 2020a , Liu et al, 2020b , Liu et al, 2020c , Mo et al, 2020 , Wang et al, 2020 , Xu et al, 2020 , Yang et al, 2020 , Yu et al, 2020 , Zeng et al, 2020b , Zhang et al, 2020a , Zhang et al, 2020b , Zhao et al, 2020 ). A total of 5,617 COVID-19 patients were studied, 3,723 (49% males, mean age 53 years) with low disease severity or alive during follow-up and 1,894 (63% males, mean age 64 years) with high severity or not surviving during follow up.…”
Section: Resultsmentioning
confidence: 99%
“…A total of 5,617 COVID-19 patients were studied, 3,723 (49% males, mean age 53 years) with low disease severity or alive during follow-up and 1,894 (63% males, mean age 64 years) with high severity or not surviving during follow up. Fifteen studies were retrospective ( Chen et al, 2020b , Cheng et al, 2020 , Dong et al, 2020 , Fu et al, 2020 , Li et al, 2020 , Liu et al, 2020a , Liu et al, 2020b , Liu et al, 2020c , Wang et al, 2020 , Xu et al, 2020 , Yang et al, 2020 , Yu et al, 2020 , Zeng et al, 2020b , Zhang et al, 2020b , Zhao et al, 2020 ), one was prospective ( Li and Chen, 2020 ), whilst no information was available in the remaining three ( Chen et al, 2020a , Mo et al, 2020 , Zhang et al, 2020a ). Endpoints included disease severity, based on current clinical guidelines (16 studies) ( Dong et al, 2020 , Fu et al, 2020 , Li et al, 2020 , Li and Chen, 2020 , Liu et al, 2020a , Liu et al, 2020b , Liu et al, 2020c , Mo et al, 2020 , Wang et al, 2020 , Xu et al, 2020 , Yang et al, 2020 , Yu et al, 2020 , Zeng et al, 2020b , Zhang et al, 2020a , Zhang et al, 2020b , Zhao et al, 2020 ) or the occurrence of acute respiratory distress syndrome (ARDS, one study) ( Chen et al, 2020a ), and survival status (two studies) ( Chen et al, 2020b , Cheng et al, 2020 ).…”
Section: Resultsmentioning
confidence: 99%
“…2 . In 18 studies, patients with high severity or non-surviving status had higher SAA concentrations when compared to those with low severity or alive during follow up (mean difference range, 0.08 to 3.40) ( Chen et al, 2020a , Chen et al, 2020b , Dong et al, 2020 , Fu et al, 2020 , Li et al, 2020 , Li and Chen, 2020 , Liu et al, 2020a , Liu et al, 2020b , Liu et al, 2020c , Mo et al, 2020 , Wang et al, 2020 , Xu et al, 2020 , Yang et al, 2020 , Yu et al, 2020 , Zeng et al, 2020b , Zhang et al, 2020a , Zhang et al, 2020b , Zhao et al, 2020 ), although the difference was non statistically significant in two studies ( Zeng et al, 2020b , Zhang et al, 2020a ). By contrast, in the remaining study, SAA concentrations were slightly higher in patients with low severity or alive during follow up (mean difference -0.33) ( Cheng et al, 2020 ).…”
Section: Resultsmentioning
confidence: 99%
“…Another limitation is represented by the paucity of data in the selected studies on the dynamic changes in SAA concentrations in hospitalized COVID-19 patients, and their associations with disease severity and/or mortality. Notably, in the five studies that addressed this issue, serial SAA concentrations remained high, or increased during hospitalization, in COVID-19 patients that experienced adverse clinical outcomes ( Chen et al, 2020b , Cheng et al, 2020 , Fu et al, 2020 , Liu et al, 2020c , Yu et al, 2020 ). However, the different time-points for SAA measurement used in individual studies precluded their meta-analysis.…”
“…Extreme heterogeneity between studies was observed (I 2 = 92.4%, P < 0.001). SAA concentrations remained significantly higher (SMD 1.25, 95% CI 0.87 to 1.63, P = 0.001; I 2 = 92.7%, P < 0.001) in patients with high severity or non-survival status after excluding the large study by Yu et al (2020) , which accounted for nearly 58% of the overall sample size. Fig.…”
Section: Resultsmentioning
confidence: 95%
“…After a full-text revision of the remaining 26 articles, seven were excluded because they did not meet the inclusion criteria. Thus, nineteen studies, all conducted in China, were included in the meta-analysis ( Table 1 ) ( Chen et al, 2020a , Chen et al, 2020b , Cheng et al, 2020 , Dong et al, 2020 , Fu et al, 2020 , Li et al, 2020 , Li and Chen, 2020 , Liu et al, 2020a , Liu et al, 2020b , Liu et al, 2020c , Mo et al, 2020 , Wang et al, 2020 , Xu et al, 2020 , Yang et al, 2020 , Yu et al, 2020 , Zeng et al, 2020b , Zhang et al, 2020a , Zhang et al, 2020b , Zhao et al, 2020 ). A total of 5,617 COVID-19 patients were studied, 3,723 (49% males, mean age 53 years) with low disease severity or alive during follow-up and 1,894 (63% males, mean age 64 years) with high severity or not surviving during follow up.…”
Section: Resultsmentioning
confidence: 99%
“…A total of 5,617 COVID-19 patients were studied, 3,723 (49% males, mean age 53 years) with low disease severity or alive during follow-up and 1,894 (63% males, mean age 64 years) with high severity or not surviving during follow up. Fifteen studies were retrospective ( Chen et al, 2020b , Cheng et al, 2020 , Dong et al, 2020 , Fu et al, 2020 , Li et al, 2020 , Liu et al, 2020a , Liu et al, 2020b , Liu et al, 2020c , Wang et al, 2020 , Xu et al, 2020 , Yang et al, 2020 , Yu et al, 2020 , Zeng et al, 2020b , Zhang et al, 2020b , Zhao et al, 2020 ), one was prospective ( Li and Chen, 2020 ), whilst no information was available in the remaining three ( Chen et al, 2020a , Mo et al, 2020 , Zhang et al, 2020a ). Endpoints included disease severity, based on current clinical guidelines (16 studies) ( Dong et al, 2020 , Fu et al, 2020 , Li et al, 2020 , Li and Chen, 2020 , Liu et al, 2020a , Liu et al, 2020b , Liu et al, 2020c , Mo et al, 2020 , Wang et al, 2020 , Xu et al, 2020 , Yang et al, 2020 , Yu et al, 2020 , Zeng et al, 2020b , Zhang et al, 2020a , Zhang et al, 2020b , Zhao et al, 2020 ) or the occurrence of acute respiratory distress syndrome (ARDS, one study) ( Chen et al, 2020a ), and survival status (two studies) ( Chen et al, 2020b , Cheng et al, 2020 ).…”
Section: Resultsmentioning
confidence: 99%
“…2 . In 18 studies, patients with high severity or non-surviving status had higher SAA concentrations when compared to those with low severity or alive during follow up (mean difference range, 0.08 to 3.40) ( Chen et al, 2020a , Chen et al, 2020b , Dong et al, 2020 , Fu et al, 2020 , Li et al, 2020 , Li and Chen, 2020 , Liu et al, 2020a , Liu et al, 2020b , Liu et al, 2020c , Mo et al, 2020 , Wang et al, 2020 , Xu et al, 2020 , Yang et al, 2020 , Yu et al, 2020 , Zeng et al, 2020b , Zhang et al, 2020a , Zhang et al, 2020b , Zhao et al, 2020 ), although the difference was non statistically significant in two studies ( Zeng et al, 2020b , Zhang et al, 2020a ). By contrast, in the remaining study, SAA concentrations were slightly higher in patients with low severity or alive during follow up (mean difference -0.33) ( Cheng et al, 2020 ).…”
Section: Resultsmentioning
confidence: 99%
“…Another limitation is represented by the paucity of data in the selected studies on the dynamic changes in SAA concentrations in hospitalized COVID-19 patients, and their associations with disease severity and/or mortality. Notably, in the five studies that addressed this issue, serial SAA concentrations remained high, or increased during hospitalization, in COVID-19 patients that experienced adverse clinical outcomes ( Chen et al, 2020b , Cheng et al, 2020 , Fu et al, 2020 , Liu et al, 2020c , Yu et al, 2020 ). However, the different time-points for SAA measurement used in individual studies precluded their meta-analysis.…”
Current evidence on COVID-19 prognostic models is inconsistent and clinical applicability remains controversial. We performed a systematic review to summarize and critically appraise the available studies that have developed, assessed and/or validated prognostic models of COVID-19 predicting health outcomes. We searched six bibliographic databases to identify published articles that investigated univariable and multivariable prognostic models predicting adverse outcomes in adult COVID-19 patients, including intensive care unit (ICU) admission, intubation, high-flow nasal therapy (HFNT), extracorporeal membrane oxygenation (ECMO) and mortality. We identified and assessed 314 eligible articles from more than 40 countries, with 152 of these studies presenting mortality, 66 progression to severe or critical illness, 35 mortality and ICU admission combined, 17 ICU admission only, while the remaining 44 studies reported prediction models for mechanical ventilation (MV) or a combination of multiple outcomes. The sample size of included studies varied from 11 to 7,704,171 participants, with a mean age ranging from 18 to 93 years. There were 353 prognostic models investigated, with area under the curve (AUC) ranging from 0.44 to 0.99. A great proportion of studies (61.5%, 193 out of 314) performed internal or external validation or replication. In 312 (99.4%) studies, prognostic models were reported to be at high risk of bias due to uncertainties and challenges surrounding methodological rigor, sampling, handling of missing data, failure to deal with overfitting and heterogeneous definitions of COVID-19 and severity outcomes. While several clinical prognostic models for COVID-19 have been described in the literature, they are limited in generalizability and/or applicability due to deficiencies in addressing fundamental statistical and methodological concerns. Future large, multi-centric and well-designed prognostic prospective studies are needed to clarify remaining uncertainties.
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