Predictors of in-hospital COVID-19 mortality: A comprehensive systematic review and meta-analysis exploring differences by age, sex and health conditions

Abstract

Objective Risk factors for in-hospital mortality in confirmed COVID-19 patients have been summarized in numerous meta-analyses, but it is still unclear whether they vary according to the age, sex and health conditions of the studied populations. This study explored these variables as potential mortality predictors. Methods A systematic review was conducted by searching the MEDLINE, Scopus, and Web of Science databases of studies available through July 27, 2020. The pooled risk was estimated with the odds ratio (p-OR) or effect size (p-ES) obtained through random-effects meta-analyses. Subgroup analyses and meta-regression were applied to explore differences by age, sex and health conditions. The MOOSE guidelines were strictly followed. Results The meta-analysis included 60 studies, with a total of 51,225 patients (12,458 [24.3%] deaths) from hospitals in 13 countries. A higher in-hospital mortality risk was found for dyspnoea (p-OR = 2.5), smoking (p-OR = 1.6) and several comorbidities (p-OR range: 1.8 to 4.7) and laboratory parameters (p-ES range: 0.3 to -2.6). Age was the main source of heterogeneity, followed by sex and health condition. The following predictors were more markedly associated with mortality in studies with patients with a mean age ≤60 years: dyspnoea (p-OR = 4.3), smoking (p-OR = 2.8), kidney disease (p-OR = 3.8), hypertension (p-OR = 3.7), malignancy (p-OR = 3.7), diabetes (p-OR = 3.2), pulmonary disease (p-OR = 3.1), decreased platelet count (p-ES = -1.7), decreased haemoglobin concentration (p-ES = -0.6), increased creatinine (p-ES = 2.4), increased interleukin-6 (p-ES = 2.4) and increased cardiac troponin I (p-ES = 0.7). On the other hand, in addition to comorbidities, the most important mortality predictors in studies with older patients were albumin (p-ES = -3.1), total bilirubin (p-ES = 0.7), AST (p-ES = 1.8), ALT (p-ES = 0.4), urea nitrogen (p-ES), C-reactive protein (p-ES = 2.7), LDH (p-ES = 2.4) and ferritin (p-ES = 1.7). Obesity was associated with increased mortality only in studies with fewer chronic or critical patients (p-OR = 1.8). Conclusion The prognostic effect of clinical conditions on COVID-19 mortality vary substantially according to the mean age of patients. PROSPERO registration number CRD42020176595.

Mortality and other outcomes of patients with coronavirus disease pneumonia admitted to the emergency department: A prospective observational Brazilian study

“…The LASSO multivariate analysis found age, number of comorbidities, extension of ground glass opacities on chest CT and troponin with a direct relationship with all-cause mortality, whereas dysgeusia, use of angiotensin converting enzyme inhibitor or angiotensin-ii receptor blocker and number of lymphocytes with an inverse relationship with all-cause mortality In different studies older age, hypertension, diabetes melitus, dyspnea, number of comorbidities, and laboratory parameters were associated to increased risk of mortality in patients with COVID-19 [ 28 , 29 ]. The symptoms at presentation in our study were not significantly different compared with those of other large studies [ 16 , 30 ], even considering that our patients had, on average, more severe disease.…”

First wave of COVID-19 hospital admissions in Denmark: a Nationwide population-based cohort study

“…Differences in laboratory markers of newly admitted SARS-CoV-2 positive cases and their association to severe outcomes have been reported from previous studies [3,[7][8][9][10][11][12][13][14][15][16][17], but remain unexplored in Denmark and other Scandinavian populations. We present a complete nationwide observational study with comprehensive clinical and laboratory parameters during the first five months of the COVID-19 epidemic in Denmark.…”

Clinical frailty scale and mortality in COVID-19: A systematic review and dose-response meta-analysis

“…Although age is associated with mortality ( Bonanad et al., 2020 ; Mesas et al., 2020 ), age alone is not sufficient for risk stratification in COVID-19 patients, and is subject to ethical controversies ( Lewis, Breckons, Lee, Dotchin & Walker, 2020 ; Montero-Odasso et al., 2020 ). Clinical frailty scale (CFS) emerges as a potentially useful and practical tool to enable efficient workflow even when faced with limited human resources and increasing demand for medical services ( Cesari & Proietti, 2020 ).…”