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Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis.

Authors
  • Zheng, Zhaohai1
  • Peng, Fang2
  • Xu, Buyun2
  • Zhao, Jingjing1
  • Liu, Huahua3
  • Peng, Jiahao4
  • Li, Qingsong5
  • Jiang, Chongfu5
  • Zhou, Yan2
  • Liu, Shuqing6
  • Ye, Chunji2
  • Zhang, Peng2
  • Xing, Yangbo2
  • Guo, Hangyuan2
  • Tang, Weiliang7
  • 1 Department 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. , (China)
  • 2 Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing City, Zhejiang Province, 312000, PR China. , (China)
  • 3 Cardiovascular Research Center, School of Basic Medical Science, Xi'an Jiaotong University Health Science Center, 710049, Xi'an, China. , (China)
  • 4 Loma Linda University School of Public Health, 24951 Circle Dr, Loma Linda, CA 92354, USA.
  • 5 Department of Cardiology, Awati County People's Hospital, No.1 North Jiefang Road, Awati County, Xinjiang Uygur Autonomous Region, 843000, PR China. , (China)
  • 6 Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing City, Zhejiang Province, 312000, PR China; Shaoxing University School of Medicine, 312000, Shaoxing, Zhejiang, China. , (China)
  • 7 Department of Cardiology, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing City, Zhejiang Province, 312000, PR China. Electronic address: [email protected] , (China)
Type
Published Article
Journal
The Journal of infection
Publication Date
Aug 01, 2020
Volume
81
Issue
2
Identifiers
DOI: 10.1016/j.jinf.2020.04.021
PMID: 32335169
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

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. 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. 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]. 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. Copyright © 2020 Elsevier Ltd. All rights reserved.

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