Parkinson's disease may worsen outcomes from coronavirus disease 2019 (COVID-19) pneumonia in hospitalized patients: A systematic review, meta-analysis, and meta-regression

Abstract

Background Parkinson’s Disease (PD) is among one of the common comorbidities in older patients. People with PD may be more vulnerable to severe pneumonia, due to the impairment of pulmonary function. Currently, the association between PD and COVID-19 is not yet established. This study aims to analyze the relationship between PD and in-hospital outcomes of COVID-19. Materials and Methods We systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until December 25 th , 2020. All articles published on COVID-19 and Parkinson’s Disease were retrieved. The quality of the study was assessed using the Newcastle Ottawa Scale (NOS) tool for observational studies and Joanna Briggs Institute (JBI) Critical Appraisal Tools for cross-sectional studies. Statistical analysis was done using Review Manager 5.4 software. Results A total of 12 studies with 103,874 COVID-19 patients were included in this meta-analysis. This meta-analysis showed that Parkinson’s Disease was associated with poor in-hospital outcomes [[OR 2.64 (95% CI 1.75 – 3.99), p < 0.00001, I 2 = 81%] and its subgroup which comprised of severe COVID-19 [OR 2.61 (95% CI 1.98 – 3.43), p < 0.00001, I 2 = 0%] and mortality from COVID-19 [RR 2.63 (95% CI 1.50 – 4.60), p = 0.0007, I 2 = 91%]. Meta-regression showed that the association was influenced by age (p = 0.05), but not by gender (p = 0.46) and dementia (p = 0.23). Conclusions Extra care and close monitoring should be provided to Parkinson’s Disease patients to minimize the risk of infections, preventing the development of severe and mortality outcomes.

A nomogram predicting severe COVID-19 based on a large study cohort from China

“…A study showed that ACE2 has an important salutary function: ACE2 limits several detrimental effects, including vasoconstriction and enhanced inflammation and thrombosis, but it is markedly downregulated by the entry of SARS-CoV-2 into cells, which may be especially detrimental in elderly individuals with age-related baseline ACE2 deficiency [ 24 ]. In addition, compared with younger COVID-19 patient groups, the elderly (≥65 years) patient population had the highest risk of severe or critical illness, intensive care use, and respiratory failure and the longest hospital stay, which may be partly due to their higher incidence of comorbidities (such as dementia and Parkinson's disease) and age-related degeneration of the immune system (known as immunosenescence) and hence impaired immunity to SARS-CoV-2 [ [25] , [26] , [27] ].…”

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