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Published on: November 10, 2023
Factors associated with disease severity and mortality among patients with COVID-19: A systematic review and
Vignesh Chidambaram1, Nyan Lynn Tun1, Waqas Z Haque1
1Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Insights
Older age, male gender, diabetes, and hypertension increase COVID-19 mortality risk. Factors like dyspnea, bilateral lung involvement, and elevated inflammatory markers indicate severe disease and higher mortality in Coronavirus disease (COVID-19) patients.
Area of Science:
- Infectious Diseases
- Epidemiology
- Critical Care Medicine
Background:
- Understanding factors influencing Coronavirus disease (COVID-19) severity and mortality is crucial for patient triage.
- A systematic review was conducted to identify demographic, clinical, laboratory, and radiological predictors.
Purpose of the Study:
- To systematically review and identify factors associated with disease severity and mortality in COVID-19 patients.
- To inform clinical decision-making and resource allocation for COVID-19 care.
Main Methods:
- Systematic literature search of PubMed, Embase, and WHO databases up to May 8, 2020.
- Inclusion of observational studies comparing clinical characteristics of non-survivors vs. survivors and severe vs. non-severe cases.
- Independent data extraction and quality assessment by two authors.
Main Results:
- Increasing age, male gender, dyspnea, diabetes, and hypertension were associated with higher mortality risk.
- Severe disease was linked to congestive heart failure, hilar lymphadenopathy, bilateral lung involvement, and reticular patterns on imaging.
- Leukocytosis, lymphopenia, elevated C-reactive protein, LDH, and D-dimer levels correlated with increased odds of severe disease and mortality.
Conclusions:
- Identified factors can aid in clinical decision-making for COVID-19 patient management.
- Knowledge of these predictors supports critical-care resource allocation during the pandemic.
Background:
Understanding the factors associated with disease severity and mortality in Coronavirus disease (COVID-19) is imperative to effectively triage patients. We performed a systematic review to determine the demographic, clinical, laboratory and radiological factors associated with severity and mortality in COVID-19.
Methods:
We searched PubMed, Embase and WHO database for English language articles from inception until May 8, 2020. We included Observational studies with direct comparison of clinical characteristics between a) patients who died and those who survived or b) patients with severe disease and those without severe disease. Data extraction and quality assessment were performed by two authors independently.
Results:
Among 15680 articles from the literature search, 109 articles were included in the analysis. The risk of mortality was higher in patients with increasing age, male gender (RR 1.45, 95%CI 1.23-1.71), dyspnea (RR 2.55, 95%CI 1.88-2.46), diabetes (RR 1.59, 95%CI 1.41-1.78), hypertension (RR 1.90, 95%CI 1.69-2.15). Congestive heart failure (OR 4.76, 95%CI 1.34-16.97), hilar lymphadenopathy (OR 8.34, 95%CI 2.57-27.08), bilateral lung involvement (OR 4.86, 95%CI 3.19-7.39) and reticular pattern (OR 5.54, 95%CI 1.24-24.67) were associated with severe disease. Clinically relevant cut-offs for leukocytosis(>10.0 x109/L), lymphopenia(< 1.1 x109/L), elevated C-reactive protein(>100mg/L), LDH(>250U/L) and D-dimer(>1mg/L) had higher odds of severe disease and greater risk of mortality.
Conclusion:
Knowledge of the factors associated of disease severity and mortality identified in our study may assist in clinical decision-making and critical-care resource allocation for patients with COVID-19.
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