The importance of patients’ case-mix for the correct interpretation of the hospital fatality rate in COVID-19 disease

Monforte, Antonella d’Arminio; Tavelli, Alessandro; Bai, Francesca; Tomasoni, Daniele; Falcinella, Camilla; Castoldi, Roberto; Barbanotti, Diletta; Mulè, Giovanni; Allegrini, Marina; Tesoro, Daniele; Tagliaferri, G; Mondatore, Debora; Augello, Matteo; Cona, Andrea; Ancona, Giuseppe; Gazzola, Lidia; Iannotti, Nathalie; Tincati, Camilla; Viganò, Ottavia; Bona, Anna De; Bini, Teresa; Cozzi‐Lepri, Alessandro; Marchetti, Giulia

doi:10.1016/j.ijid.2020.09.037

Cited by 13 publications

(7 citation statements)

References 25 publications

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“…In all, 68 studies [ 4 , 17 – 83 ] were published in English and 1 study [ 84 ] published in Chinese. Out of which 54 studies [ 4 , 18 – 24 , 29 – 31 , 34 – 39 , 45 – 53 , 55 , 56 , 59 – 84 ] were from China, 3 studies [ 17 , 32 , 54 ] were from the USA, 3 studies [ 25 , 40 , 44 ] were from Korea, 2 studies [ 26 , 27 ] were from Italy and the remaining 7 studies [ 28 , 33 , 41 – 43 , 57 , 58 ] were from Austria, Iran, Israel, Saudi Arabia, Spain, Turkey, and UK. The sample size per study ranged from 27 to 1590 (total 17 879; 9686 males).…”

Section: Resultsmentioning

confidence: 99%

“…The sample size per study ranged from 27 to 1590 (total 17 879; 9686 males). Considering methodological quality in items of NOS scale, 23 studies [ 4 , 17 , 19 , 21 , 24 , 27 – 29 , 33 , 34 , 37 , 46 , 49 , 55 , 58 , 61 , 65 , 67 – 69 , 73 , 75 , 76 ] were rated as high quality (>7 stars) and 46 studies [ 18 , 20 , 22 , 23 , 25 , 26 , 30 – 32 , 35 , 36 , 38 – 45 , 47 , 48 , 50 – 54 , 56 , 57 , 59 , 60 , 62 – 64 , 66 , 70 – 72 , 74 , 77 – 84 ] were rated as moderate quality (5−7 stars). The detailed characteristics and quality of the included studies are summarised in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Twenty-four studies [ 18 – 21 , 23 , 24 , 27 , 28 , 31 , 32 , 34 , 36 , 40 , 42 , 52 , 61 – 63 , 72 , 74 , 76 , 77 , 81 , 82 ], including 6822 patients, reported cerebrovascular disease data between non-survivors and survivors. The meta-analysis demonstrated that cerebrovascular disease was associated with death in COVID-19 patients (OR = 3.45, 95% CI: 2.46 to 4.84, P < 0.001; I 2 = 35.2%) ( Fig.…”

Section: Resultsmentioning

confidence: 99%

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Nervous system diseases are associated with the severity and mortality of patients with COVID-19: a systematic review and meta-analysis

et al. 2021

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Coronavirus Disease 2019 (COVID-19) has become a global pandemic. Previous studies showed that comorbidities in patients with COVID-19 are risk factors for adverse outcomes. This study aimed to clarify the association between nervous system diseases and severity or mortality in patients with COVID-19. We performed a systematic literature search of four electronic databases and included studies reporting the prevalence of nervous system diseases in COVID-19 patients with severe and non-severe disease or among survivors and non-survivors. The included studies were pooled into a meta-analysis to calculate the odds ratio (OR) with 95% confidence intervals (95%CI). We included 69 studies involving 17879 patients. Nervous system diseases were associated with COVID-19 severity (OR = 3.19, 95%CI: 2.37 to 4.30, P < 0.001) and mortality (OR = 3.75, 95%CI: 2.68 to 5.25, P < 0.001). Specifically, compared with the patients without cerebrovascular disease, patients with cerebrovascular disease infected with COVID-19 had a higher risk of severity (OR = 3.10, 95%CI: 2.21 to 4.36, P < 0.001) and mortality (OR = 3.45, 95% CI: 2.46 to 4.84, P < 0.001). Stroke was associated with severe COVID-19 disease (OR = 1.95, 95%CI: 1.11 to 3.42, P = 0.020). No significant differences were found for the prevalence of epilepsy (OR = 1.00, 95%CI: 0.42 to 2.35, P = 0.994) and dementia (OR = 2.39, 95%CI: 0.55 to 10.48, P = 0.247) between non-severe and severe COVID-19 patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Nervous system diseases are associated with the severity and mortality of patients with COVID-19: a systematic review and meta-analysis

et al. 2021

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“…Also, data collection was not complete for some biomarkers at all centers and we performed a complete case analysis excluding those with missing data. Another limitation is the fact that the score cannot be calculated before day 4 although the average time from admission to ICU appears to be even shorter at 3.5 days [ 16 ]. Nevertheless, the data from our cohort showed that up to 88% of patients were still free from mechanical ventilation and death by day 4 after starting tocilizumab.…”

Section: Discussionmentioning

confidence: 99%

“…It is a retrospective, observational cohort study done in three tertiary care hospitals in the Emilia-Romagna region, Italy, on patients with COVID-19 severe pneumonia. All consecutively enrolled adult patients (≥18 years) with severe COVID-19 pneumonia, defined by the presence of at least one of the following: a respiratory rate (RR) ≥ 30 breaths per minute (bpm), peripheral blood oxygen saturation (SaO 2 ) ≤ 93%, a PaO 2 /FiO 2 ratio < 300 mmHg in room air and lung infiltrates >50% within 24–48 hours were included in the study [ 16 , 17 ].…”

Section: Methodsmentioning

confidence: 99%

Development and validation of a prediction model for tocilizumab failure in hospitalized patients with SARS-CoV-2 infection

et al. 2021

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Background The aim of this secondary analysis of the TESEO cohort is to identify, early in the course of treatment with tocilizumab, factors associated with the risk of progressing to mechanical ventilation and death and develop a risk score to estimate the risk of this outcome according to patients’ profile. Methods Patients with COVID-19 severe pneumonia receiving standard of care + tocilizumab who were alive and free from mechanical ventilation at day 6 after treatment initiation were included in this retrospective, multicenter cohort study. Multivariable logistic regression models were built to identify predictors of mechanical ventilation or death by day-28 from treatment initiation and β-coefficients were used to develop a risk score. Secondary outcome was mortality. Patients with the same inclusion criteria as the derivation cohort from 3 independent hospitals were used as validation cohort. Results 266 patients treated with tocilizumab were included. By day 28 of hospital follow-up post treatment initiation, 40 (15%) underwent mechanical ventilation or died [26 (10%)]. At multivariable analysis, sex, day-4 PaO2/FiO2 ratio, platelets and CRP were independently associated with the risk of developing the study outcomes and were used to generate the proposed risk score. The accuracy of the score in AUC was 0.80 and 0.70 in internal validation and test for the composite endpoint and 0.92 and 0.69 for death, respectively. Conclusions Our score could assist clinicians in identifying, early after tocilizumab administration, patients who are likely to progress to mechanical ventilation or death, so that they could be selected for eventual rescue therapies.

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Identification of Parameters Representative of Immune Dysfunction in Patients with Severe and Fatal COVID-19 Infection: a Systematic Review and Meta-analysis

Qin

Yang

et al. 2022

Clinic Rev Allerg Immunol

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Abnormal immunological indicators associated with disease severity and mortality in patients with COVID-19 have been reported in several observational studies. However, there are marked heterogeneities in patient characteristics and research methodologies in these studies. We aimed to provide an updated synthesis of the association between immune-related indicators and COVID-19 prognosis. We conducted an electronic search of PubMed, Scopus, Ovid, Willey, Web of Science, Cochrane library, and CNKI for studies reporting immunological and/or immune-related parameters, including hematological, inflammatory, coagulation, and biochemical variables, tested on hospital admission of COVID-19 patients with different severities and outcomes. A total of 145 studies were included in the current meta-analysis, with 26 immunological, 11 hematological, 5 inflammatory, 4 coagulation, and 10 biochemical variables reported. Of them, levels of cytokines, including IL-1β, IL-1Ra, IL-2R, IL-4, IL-6, IL-8, IL-10, IL-18, TNF-α, IFN-γ, IgA, IgG, and CD4 + T/CD8 + T cell ratio, WBC, neutrophil, platelet, ESR, CRP, ferritin, SAA, D-dimer, FIB, and LDH were significantly increased in severely ill patients or non-survivors. Moreover, non-severely ill patients or survivors presented significantly higher counts of lymphocytes, monocytes, lymphocyte/monocyte ratio, eosinophils, CD3 + T,CD4 + T and CD8 + T cells, B cells, and NK cells. The currently updated meta-analysis primarily identified a hypercytokinemia profile with the severity and mortality of COVID-19 containing IL-1β, IL-1Ra, IL-2R, IL-4, IL-6, IL-8, IL-10, IL-18, TNF-α, and IFN-γ. Impaired innate and adaptive immune responses, reflected by decreased eosinophils, lymphocytes, monocytes, B cells, NK cells, T cells, and their subtype CD4 + and CD8 + T cells, and augmented inflammation, coagulation dysfunction, and nonpulmonary organ injury, were marked features of patients with poor prognosis. Therefore, parameters of immune response dysfunction combined with inflammatory, coagulated, or nonpulmonary organ injury indicators may be more sensitive to predict severe patients and those non-survivors. Supplementary Information The online version contains supplementary material available at 10.1007/s12016-021-08908-8.

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The importance of patients’ case-mix for the correct interpretation of the hospital fatality rate in COVID-19 disease

Cited by 13 publications

References 25 publications

Nervous system diseases are associated with the severity and mortality of patients with COVID-19: a systematic review and meta-analysis

Nervous system diseases are associated with the severity and mortality of patients with COVID-19: a systematic review and meta-analysis

Development and validation of a prediction model for tocilizumab failure in hospitalized patients with SARS-CoV-2 infection

Identification of Parameters Representative of Immune Dysfunction in Patients with Severe and Fatal COVID-19 Infection: a Systematic Review and Meta-analysis

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