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The Clinical Characteristics and Risk Factors of Severe COVID-19
Jianhua Hu1, Yanggan Wang2,3
1Department of Internal Medicine, Zhongnan Hospital of Wuhan University, Wuhan, China.
Insights
Male, elderly, obese, and comorbid patients are at higher risk for severe COVID-19. Key indicators for severity include elevated C-reactive protein (CRP), decreased lymphocytes, and signs of organ dysfunction.
Area of Science:
- Infectious Diseases
- Epidemiology
- Clinical Medicine
Background:
- Coronavirus disease 2019 (COVID-19) poses a significant global health challenge.
- Understanding risk factors for severe COVID-19 is crucial for patient management and public health strategies.
Purpose of the Study:
- To identify clinical characteristics and risk factors associated with severe COVID-19 cases.
- To compare these factors between severe and non-severe COVID-19 patients.
Main Methods:
- A comprehensive meta-analysis was conducted.
- Relevant studies were systematically searched and collected from major scientific databases (PubMed, EMBASE, Web of Science, CNKI) up to July 26, 2020.
- Data from 30 selected papers were analyzed.
Main Results:
- Severe COVID-19 cases frequently included males (60%), individuals over 65 (25%), obese patients (34%), and those with comorbidities (55%).
- Common comorbidities were hypertension (34%), diabetes (20%), and cardiovascular disease (CVD; 12%).
- Elevated C-reactive protein (CRP; 87%), decreased lymphocytes (68%), and increased liver enzymes and cardiac biomarkers were prevalent in severe cases, indicating organ dysfunction.
Conclusions:
- Male sex, advanced age, obesity, and comorbidities (hypertension, diabetes, CVD) are associated with increased COVID-19 severity.
- Age modifies the association between comorbidities and severity.
- Biomarkers like elevated CRP, reduced lymphocytes, and indicators of cardiac, hepatic, and renal dysfunction are critical markers for COVID-19 severity.
Objective:
We aim to investigate the clinical characteristics and risk factors for the severe cases of coronavirus disease 2019 (COVID-19) in comparison with the non-severe patients.
Methods:
We searched PubMed, EMBASE, Web of Science, and CNKI to collect all relevant studies published before July 26, 2020, and a total of 30 papers were included in this meta-analysis.
Results:
In the severe COVID-19 patients, 60% (95% CI = 56-64%) were male, 25% (95% CI = 21-29%) were over 65 years old, 34% (95% CI = 24-44%) were obese, and 55% (95% CI = 41-70%) had comorbidities. The most prevalent comorbidities were hypertension (34%, 95% CI = 25-44%), diabetes (20%, 95% CI = 15-25%), and cardiovascular disease (CVD; 12%, 95% CI = 9-16%). The most common blood test abnormalities were elevated C-reactive protein (CRP; 87%, 82-92%), decreased lymphocyte count (68%, 58-77%), and increased lactate dehydrogenase (69%, 95% CI = 57-81%). In addition, abnormal laboratory findings revealing organ dysfunctions were frequently observed in the severe cases, including decrease in albumin (43%, 95% CI = 24-63%) and increase in aspartate aminotransferase (47%, 95% CI = 38-56%), alanine aminotransferase (28%, 95% CI = 16-39%), troponin I/troponin T (TnI/TnT; 29%, 95% CI = 13-45%), and serum Cr (SCr; 10%, 95% CI = 5-15%).
Conclusion:
The male, elderly and obese patients and those with any comorbidities, especially with hypertension, diabetes, and CVD, were more likely to develop into severe cases. But the association between hypertension, diabetes, CVD, and severity of COVID-19 was declined by the increase of age. A significant elevation in cardiac TnI/TnT, the hepatic enzymes, and SCr and the reduction in lymphocytes with elevated CRPs are important markers for the severity. Specific attention should be given to the elderly male and obese patients and those with indications of severe immune injury in combination with bacterial infection and indication of multi-organ dysfunction or damages.
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