Risk factors for predicting mortality of COVID-19 patients: A systematic review and meta-analysis

Abstract

Background Early and accurate prognosis prediction of the patients was urgently warranted due to the widespread popularity of COVID-19. We performed a meta-analysis aimed at comprehensively summarizing the clinical characteristics and laboratory abnormalities correlated with increased risk of mortality in COVID-19 patients. Methods PubMed, Scopus, Web of Science, and Embase were systematically searched for studies considering the relationship between COVID-19 and mortality up to 4 June 2020. Data were extracted including clinical characteristics and laboratory examination. Results Thirty-one studies involving 9407 COVID-19 patients were included. Dyspnea (OR = 4.52, 95%CI [3.15, 6.48], P < 0.001), chest tightness (OR = 2.50, 95%CI [1.78, 3.52], P<0.001), hemoptysis (OR = 2.00, 95%CI [1.02, 3.93], P = 0.045), expectoration (OR = 1.52, 95%CI [1.17, 1.97], P = 0.002) and fatigue (OR = 1.27, 95%CI [1.09, 1.48], P = 0.003) were significantly related to increased risk of mortality in COVID-19 patients. Furthermore, increased pretreatment absolute leukocyte count (OR = 11.11, 95%CI [6.85,18.03], P<0.001) and decreased pretreatment absolute lymphocyte count (OR = 9.83, 95%CI [6.72, 14.38], P<0.001) were also associated with increased mortality of COVID-19. We also compared the mean value of them between survivors and non-survivors, and found that non-survivors showed significantly raise in pretreatment absolute leukocyte count (WMD: 3.27×109/L, 95%CI [2.34, 4.21], P<0.001) and reduction in pretreatment absolute lymphocyte count (WMD = -0.39×109/L, 95%CI [-0.46, -0.33], P<0.001) compared with survivors. The results of pretreatment lactate dehydrogenase (LDH), procalcitonin (PCT), D-Dimer and ferritin showed the similar trend with pretreatment absolute leukocyte count. Conclusions Among the common symptoms of COVID-19 infections, fatigue, expectoration, hemoptysis, dyspnea and chest tightness were independent predictors of death. As for laboratory examinations, significantly increased pretreatment absolute leukocytosis count, LDH, PCT, D-Dimer and ferritin, and decreased pretreatment absolute lymphocyte count were found in non-survivors, which also have an unbeneficial impact on mortality among COVID-19 patients. Motoring these indicators during the hospitalization plays a very important role in predicting the prognosis of patients.

Mortality in critically ill patients with coronavirus disease 2019‐associated pulmonary aspergillosis: A systematic review and meta‐analysis

“…In a retrospective study by Salmanton‐Garcia et al, the analysis if 186 cases of CAPA (including 62 cases from published literature, 45 from the FungiScope registry and 79 from both) revealed an overall mortality of 52.2% which is similar to with our pooled estimate 59 . In other meta‐analysis evaluating the factors predicting mortality in patients with COVID‐19, patient characteristics like increasing age, male gender; the presence of diabetes or hypertension clinical features like fatigue, expectoration, haemoptysis, dyspnoea, chest tightness and altered laboratory parameters like leukocytosis, lymphopenia, elevated LDH, procalcitonin, CRP and D‐dimer have been reported in non‐survivors 11,60 . Monitoring these indicators could help in predicting the prognosis of patients with COVID‐19.…”

“…The poor outcome is associated with older age, high disease severity scores, use of MV, renal replacement therapy (RRT), exposure to a steroid, underlying diabetes and longer length of hospital stay 7–9 . In patients with COVID‐19, smoking, renal disease, hypertension, malignancy, diabetes, obesity and elevated laboratory parameters like lactate dehydrogenase (LDH), procalcitonin and D‐Dimer ferritin have an unbeneficial impact on mortality 10‐15 . However, it is not clear which associated factors adversely affect the outcome in patients with CAPA.…”

Simple prognostic factors and change of inflammatory markers in patients with severe coronavirus disease 2019: a single‐center observational study

“…Factors indicating high risk in severe COVID‐19 were age; comorbidity including chronic obstructive pulmonary disease; history of smoking; and elevated levels of IL‐6, D‐dimer, lactate dehydrogenase, PCT, and high hypersensitive troponin I. 6 , 7 , 8 , 9 , 10 , 11 In our study, the day from the onset of first symptoms to admission (start of mechanical ventilation) was detected as an independent factor of poor outcome. This result suggests that rapid progressive deterioration of a patient’s condition from disease onset might be related to a weakened host immune system and can lead to death.…”

The risk factors and related hospitalizations for cases with positive and negative COVID-19 tests: A case-control study

“…Based on a systematic review and meta-analysis, the clinical manifestations such as fever [OR=0.56] and shortness of breath or dyspnea [OR=4.16] have attested to their association with the progression of the disease (23) . Another meta-analysis study reported that dyspnea [OR = 4.52], chest tightness [OR = 2.50], hemoptysis [OR = 2.00], expectoration [OR = 1.52] and fatigue [OR = 1.27] were significantly associated with increased risk of mortality in COVID-19 patients (24) , indicating their values as independent predictors of death. Based on the data presented herein, older age [OR=1.5] and obesity [OR=1.87] were found to be more frequent in COVID-19 patients when compared with non-COVID-19 cases.…”