Acute complications and mortality in hospitalized patients with coronavirus disease 2019: a systematic review and meta-analysis
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Published on: September 24, 2020
Nicola Potere1, Emanuele Valeriani2, Matteo Candeloro3
1Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University, Via Dei Vestini 31, 66100, Chieti, Italy.
Insights
COVID-19 complications and mortality were high in hospitalized patients, especially those critically ill. Evidence quality was low, indicating potential underreporting of serious outcomes.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- The characterization of acute complications and mortality rates in COVID-19 patients is incomplete.
- Hospitalized COVID-19 patients face significant risks that require further investigation.
Purpose of the Study:
- To systematically review and meta-analyze evidence on clinically relevant outcomes in hospitalized COVID-19 patients.
- To quantify the incidence of mortality, acute respiratory distress syndrome (ARDS), and other complications.
Main Methods:
- Searched MEDLINE, EMBASE, PubMed, and medRxiv for studies up to April 20, 2020.
- Included hospitalized symptomatic adult patients with laboratory-confirmed COVID-19.
- Conducted meta-analyses to estimate summary outcomes, including all-cause mortality and ARDS.
Main Results:
- Included 44 peer-reviewed studies with 14,866 patients; risk of bias was generally high.
- Overall all-cause mortality was 10%, rising to 34% in ICUs and 83% with invasive ventilation.
- Significant incidences of ARDS (14%), acute cardiac injury (15%), and venous thromboembolism (15%) were observed.
Conclusions:
- Mortality is very high in critically ill COVID-19 patients, though evidence quality is low due to heterogeneity and bias.
- Clinically relevant outcomes are substantial, but underreporting is likely given that only a third of studies reported them.
Background:
The incidence of acute complications and mortality associated with COVID-19 remains poorly characterized. The aims of this systematic review and meta-analysis were to summarize the evidence on clinically relevant outcomes in hospitalized patients with COVID-19.
Methods:
MEDLINE, EMBASE, PubMed, and medRxiv were searched up to April 20, 2020, for studies including hospitalized symptomatic adult patients with laboratory-confirmed COVID-19. The primary outcomes were all-cause mortality and acute respiratory distress syndrome (ARDS). The secondary outcomes included acute cardiac or kidney injury, shock, coagulopathy, and venous thromboembolism. The main analysis was based on data from peer-reviewed studies. Summary estimates and the corresponding 95% prediction intervals (PIs) were obtained through meta-analyses.
Results:
A total of 44 peer-reviewed studies with 14,866 COVID-19 patients were included. In general, risk of bias was high. All-cause mortality was 10% overall (95% PI, 2 to 39%; 1687/14203 patients; 43 studies), 34% in patients admitted to intensive care units (95% PI, 8 to 76%; 659/2368 patients; 10 studies), 83% in patients requiring invasive ventilation (95% PI, 1 to 100%; 180/220 patients; 6 studies), and 75% in patients who developed ARDS (95% PI, 35 to 94%; 339/455 patients; 11 studies). On average, ARDS occurred in 14% of patients (95% PI, 2 to 59%; 999/6322 patients; 23 studies), acute cardiac injury in 15% (95% PI, 5 to 38%; 452/2389 patients; 10 studies), venous thromboembolism in 15% (95% PI, 0 to 100%; patients; 3 studies), acute kidney injury in 6% (95% PI, 1 to 41%; 318/4682 patients; 15 studies), coagulopathy in 6% (95% PI, 1 to 39%; 223/3370 patients; 9 studies), and shock in 3% (95% PI, 0 to 61%; 203/4309 patients; 13 studies).
Conclusions:
Mortality was very high in critically ill patients based on very low-quality evidence due to striking heterogeneity and risk of bias. The incidence of clinically relevant outcomes was substantial, although reported by only one third of the studies suggesting considerable underreporting.
Trial Registration:
PROSPERO registration ID for this study is CRD42020177243 ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=177243 ).
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