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Published on: September 24, 2020
Factors associated with mortality in patients with COVID-19 admitted to intensive care: a systematic review and
E H Taylor1, E J Marson2, M Elhadi3
1Global Surgery Division, University of Cape Town, Cape Town, South Africa.
Insights
Identifying high-risk COVID-19 patients in intensive care is crucial. Factors like older age, comorbidities, and illness severity predict mortality, while sex and BMI do not.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Epidemiology
Background:
- COVID-19 poses significant risks to critically ill patients.
- Identifying prognostic factors for mortality in intensive care unit (ICU) patients is essential for effective management.
Purpose of the Study:
- To conduct a meta-analysis identifying factors associated with mortality in adult COVID-19 patients admitted to intensive care.
Main Methods:
- Searched databases for observational studies published between January 1, 2020, and December 6, 2020.
- Included 58 studies with 44,305 patients; excluded mixed or specific sub-group cohorts.
- Analyzed dichotomous variables (pooled OR, 95%CI) and continuous variables (pooled SMD, 95%CI).
Main Results:
- Increased age, smoking, hypertension, diabetes, cardiovascular, respiratory, renal diseases, and malignancy were associated with higher mortality.
- Higher SOFA and APACHE-II scores, lower PaO2:FiO2 ratio, and need for mechanical ventilation predicted mortality.
- Elevated white blood cell counts, neutrophils, D-dimers, ferritin, and lower platelet and lymphocyte counts correlated with mortality.
Conclusions:
- Older age, pre-existing comorbidities, and disease severity significantly increase mortality risk in ICU COVID-19 patients.
- Host response indicators, such as specific blood cell counts and inflammatory markers, are crucial prognostic factors.
- Male sex and increasing BMI were not found to be associated with mortality in this cohort.
Abstract:
Identification of high-risk patients admitted to intensive care with COVID-19 may inform management strategies. The objective of this meta-analysis was to determine factors associated with mortality among adults with COVID-19 admitted to intensive care by searching databases for studies published between 1 January 2020 and 6 December 2020. Observational studies of COVID-19 adults admitted to critical care were included. Studies of mixed cohorts and intensive care cohorts restricted to a specific patient sub-group were excluded. Dichotomous variables were reported with pooled OR and 95%CI, and continuous variables with pooled standardised mean difference (SMD) and 95%CI. Fifty-eight studies (44,305 patients) were included in the review. Increasing age (SMD 0.65, 95%CI 0.53-0.77); smoking (OR 1.40, 95%CI 1.03-1.90); hypertension (OR 1.54, 95%CI 1.29-1.85); diabetes (OR 1.41, 95%CI 1.22-1.63); cardiovascular disease (OR 1.91, 95%CI 1.52-2.38); respiratory disease (OR 1.75, 95%CI 1.33-2.31); renal disease (OR 2.39, 95%CI 1.68-3.40); and malignancy (OR 1.81, 95%CI 1.30-2.52) were associated with mortality. A higher sequential organ failure assessment score (SMD 0.86, 95%CI 0.63-1.10) and acute physiology and chronic health evaluation-2 score (SMD 0.89, 95%CI 0.65-1.13); a lower PaO2 :FI O2 (SMD -0.44, 95%CI -0.62 to -0.26) and the need for mechanical ventilation at admission (OR 2.53, 95%CI 1.90-3.37) were associated with mortality. Higher white cell counts (SMD 0.37, 95%CI 0.22-0.51); neutrophils (SMD 0.42, 95%CI 0.19-0.64); D-dimers (SMD 0.56, 95%CI 0.43-0.69); ferritin (SMD 0.32, 95%CI 0.19-0.45); lower platelet (SMD -0.22, 95%CI -0.35 to -0.10); and lymphocyte counts (SMD -0.37, 95%CI -0.54 to -0.19) were all associated with mortality. In conclusion, increasing age, pre-existing comorbidities, severity of illness based on validated scoring systems, and the host response to the disease were associated with mortality; while male sex and increasing BMI were not. These factors have prognostic relevance for patients admitted to intensive care with COVID-19.
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