Predictors of adverse prognosis in COVID‐19: A systematic review and meta‐analysis

Background Identification of reliable outcome predictors in coronavirus disease 2019 (COVID‐19) is of paramount importance for improving patient's management. Methods A systematic review of literature was conducted until 24 April 2020. From 6843 articles, 49 studies were selected for a pooled a...

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Bibliographic Details
Published in:European journal of clinical investigation Vol. 50; no. 10; pp. e13362 - n/a
Main Authors: Figliozzi, Stefano, Masci, Pier Giorgio, Ahmadi, Navid, Tondi, Lara, Koutli, Evangelia, Aimo, Alberto, Stamatelopoulos, Kimon, Dimopoulos, Meletios‐Athanasios, Caforio, Alida L. P., Georgiopoulos, Georgios
Format: Journal Article
Language:English
Published: England Blackwell Publishing Ltd 01.10.2020
Subjects:
Acute Disease
Acute Kidney Injury - epidemiology
Adrenal Cortex Hormones - therapeutic use
Adult
Age
Age Factors
Aged
Aged, 80 and over
Betacoronavirus
Biomarkers
C-Reactive Protein - metabolism
Cardiovascular Diseases - epidemiology
Cerebrovascular Disorders - epidemiology
Confidence intervals
Coronavirus Infections - epidemiology
Coronavirus Infections - metabolism
Coronavirus Infections - mortality
Coronavirus Infections - therapy
Coronaviruses
COVID-19
Death
Diabetes Mellitus - epidemiology
Dimers
Female
Ferritins - metabolism
Fibrin Fibrinogen Degradation Products - metabolism
Heart
Heart Diseases
Hospital Mortality
Hospitalization
Humans
Hypertension - epidemiology
Inflammation
Injuries
Intensive Care Units
Interleukin-6 - metabolism
Kidneys
Literature reviews
Liver Diseases - epidemiology
Lymphopenia
Lymphopenia - epidemiology
Male
Mechanical ventilation
Meta-analysis
Middle Aged
Mortality
Neoplasms - epidemiology
Obesity - epidemiology
outcomes
Pandemics
Patients
Pneumonia, Viral - epidemiology
Pneumonia, Viral - metabolism
Pneumonia, Viral - mortality
Pneumonia, Viral - therapy
predictors
Procalcitonin
Procalcitonin - metabolism
Prognosis
Pulmonary Disease, Chronic Obstructive - epidemiology
Respiration, Artificial
SARS-CoV-2
Severity of Illness Index
Sex
Sex Factors
Smoking - epidemiology
Statistical analysis
Steroid hormones
Steroids
Systematic review
Thrombocytopenia
Thrombocytopenia - epidemiology
Ventilation
Viral diseases
Young Adult
COVID-19
predictors
meta-analysis
outcomes
ISSN:0014-2972, 1365-2362, 1365-2362
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Summary:Background Identification of reliable outcome predictors in coronavirus disease 2019 (COVID‐19) is of paramount importance for improving patient's management. Methods A systematic review of literature was conducted until 24 April 2020. From 6843 articles, 49 studies were selected for a pooled assessment; cumulative statistics for age and sex were retrieved in 587 790 and 602 234 cases. Two endpoints were defined: (a) a composite outcome including death, severe presentation, hospitalization in the intensive care unit (ICU) and/or mechanical ventilation; and (b) in‐hospital mortality. We extracted numeric data on patients’ characteristics and cases with adverse outcomes and employed inverse variance random‐effects models to derive pooled estimates. Results We identified 18 and 12 factors associated with the composite endpoint and death, respectively. Among those, a history of CVD (odds ratio (OR) = 3.15, 95% confidence intervals (CIs) 2.26‐4.41), acute cardiac (OR = 10.58, 5.00‐22.40) or kidney (OR = 5.13, 1.78‐14.83) injury, increased procalcitonin (OR = 4.8, 2.034‐11.31) or D‐dimer (OR = 3.7, 1.74‐7.89), and thrombocytopenia (OR = 6.23, 1.031‐37.67) conveyed the highest odds for the adverse composite endpoint. Advanced age, male sex, cardiovascular comorbidities, acute cardiac or kidney injury, lymphocytopenia and D‐dimer conferred an increased risk of in‐hospital death. With respect to the treatment of the acute phase, therapy with steroids was associated with the adverse composite endpoint (OR = 3.61, 95% CI 1.934‐6.73), but not with mortality. Conclusions Advanced age, comorbidities, abnormal inflammatory and organ injury circulating biomarkers captured patients with an adverse clinical outcome. Clinical history and laboratory profile may then help identify patients with a higher risk of in‐hospital mortality.
Bibliography:Meletios‐Athanasios Dimopoulos, Alida LP Caforio, and Georgios Georgiopoulos contributed equally as senior authors.
Prospero registration number: CRD42020181873
Stefano Figliozzi and Pier Giorgio Masci contributed equally as first authors.
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ISSN:0014-2972
1365-2362
1365-2362
DOI:10.1111/eci.13362