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Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis
Zhaohai Zheng1, Fang Peng2, Buyun Xu2
1Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing City, Zhejiang Province, 312000, PR China; Department of Cardiology, The Run Run Shaw Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, 310003, Zhejiang, PR China.
Insights
Older age, male sex, and smoking increase COVID-19 severity risk. Underlying conditions like diabetes and hypertension, plus symptoms like shortness of breath, also indicate poor prognosis. Specific lab markers predict disease progression.
Area of Science:
- Medical research
- Epidemiology
- Public Health
Background:
- The COVID-19 pandemic, declared a Public Health Emergency of International Concern, necessitated identifying risk factors for severe disease.
- Understanding these factors is crucial for clinical management and reducing mortality.
Purpose of the Study:
- To identify risk factors associated with COVID-19 progression to critical illness and death.
- To provide data for improved clinical decision-making and patient outcomes.
Main Methods:
- A meta-analysis was conducted on data from 3027 patients with SARS-CoV-2 infection, retrieved from four databases.
- Statistical analysis identified risk factors differentiating critical/mortal from non-critical COVID-19 cases.
Main Results:
- Male sex, age over 65, and current smoking were significant risk factors for disease progression.
- Comorbidities including diabetes, hypertension, cardiovascular disease, and respiratory disease were more prevalent in critical/mortal patients.
- Clinical symptoms like shortness of breath and laboratory markers (elevated AST, Cr, hs-cTnI, PCT, LDH, D-dimer; low WBC) indicated higher risk.
Conclusions:
- Male gender, advanced age, smoking, and specific comorbidities significantly elevate the risk of severe COVID-19 outcomes.
- Clinical and laboratory findings serve as important indicators for predicting disease progression and guiding treatment strategies.
Background:
An epidemic of Coronavirus Disease 2019 (COVID-19) began in December 2019 and triggered a Public Health Emergency of International Concern (PHEIC). We aimed to find risk factors for the progression of COVID-19 to help reducing the risk of critical illness and death for clinical help.
Methods:
The data of COVID-19 patients until March 20, 2020 were retrieved from four databases. We statistically analyzed the risk factors of critical/mortal and non-critical COVID-19 patients with meta-analysis.
Results:
Thirteen studies were included in Meta-analysis, including a total number of 3027 patients with SARS-CoV-2 infection. Male, older than 65, and smoking were risk factors for disease progression in patients with COVID-19 (male: OR = 1.76, 95% CI (1.41, 2.18), P < 0.00001; age over 65 years old: OR =6.06, 95% CI(3.98, 9.22), P < 0.00001; current smoking: OR =2.51, 95% CI(1.39, 3.32), P = 0.0006). The proportion of underlying diseases such as hypertension, diabetes, cardiovascular disease, and respiratory disease were statistically significant higher in critical/mortal patients compared to the non-critical patients (diabetes: OR=3.68, 95% CI (2.68, 5.03), P < 0.00001; hypertension: OR = 2.72, 95% CI (1.60,4.64), P = 0.0002; cardiovascular disease: OR = 5.19, 95% CI(3.25, 8.29), P < 0.00001; respiratory disease: OR = 5.15, 95% CI(2.51, 10.57), P < 0.00001). Clinical manifestations such as fever, shortness of breath or dyspnea were associated with the progression of disease [fever: 0R = 0.56, 95% CI (0.38, 0.82), P = 0.003;shortness of breath or dyspnea: 0R=4.16, 95% CI (3.13, 5.53), P < 0.00001]. Laboratory examination such as aspartate amino transferase(AST) > 40U/L, creatinine(Cr) ≥ 133mol/L, hypersensitive cardiac troponin I(hs-cTnI) > 28pg/mL, procalcitonin(PCT) > 0.5ng/mL, lactatede hydrogenase(LDH) > 245U/L, and D-dimer > 0.5mg/L predicted the deterioration of disease while white blood cells(WBC)<4 × 109/L meant a better clinical status[AST > 40U/L:OR=4.00, 95% CI (2.46, 6.52), P < 0.00001; Cr ≥ 133μmol/L: OR = 5.30, 95% CI (2.19, 12.83), P = 0.0002; hs-cTnI > 28 pg/mL: OR = 43.24, 95% CI (9.92, 188.49), P < 0.00001; PCT > 0.5 ng/mL: OR = 43.24, 95% CI (9.92, 188.49), P < 0.00001;LDH > 245U/L: OR = 43.24, 95% CI (9.92, 188.49), P < 0.00001; D-dimer > 0.5mg/L: OR = 43.24, 95% CI (9.92, 188.49), P < 0.00001; WBC < 4 × 109/L: OR = 0.30, 95% CI (0.17, 0.51), P < 0.00001].
Conclusion:
Male, aged over 65, smoking patients might face a greater risk of developing into the critical or mortal condition and the comorbidities such as hypertension, diabetes, cardiovascular disease, and respiratory diseases could also greatly affect the prognosis of the COVID-19. Clinical manifestation such as fever, shortness of breath or dyspnea and laboratory examination such as WBC, AST, Cr, PCT, LDH, hs-cTnI and D-dimer could imply the progression of COVID-19.
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