Risk factors and predictors associated with the severity of COVID-19 in China: a systematic review, meta-analysis, and meta-regression

Journal of Thoracic Disease

article

Tao Zhang¹  Wei-Sen Huang²  Weijie Guan³  Ziying Hong³  Jiabo Gao³  Guoying Gao³  Guofeng Wu⁴  Yin-Yin Qin³ 

[1] Nanshan School, Guangzhou Medical University;School of Pharmaceutical Sciences, Guangzhou Medical University;State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University;Department of Medicine, Liwan Central Hospital of Guangzhou;Pulmonary and Critical Care Medicine, Shunde Affiliated Hospital of Guangzhou Medical University (Lecong Hospital of Shunde District)

关键词: COVID-19;    clinical characteristics;    clinical features;    meta-analysis;    meta-regression;   

DOI  :  10.21037/jtd-20-1743

学科分类：呼吸医学

来源: Pioneer Bioscience Publishing Company

【 摘 要 】

Since December 2019, the pneumonia cases infected with 2019 novel coronavirus have appeared, posing a critical threat to global health. In this study, we performed a meta-analysis to discover the different clinical characteristics between severe and non-severe patients with COVID-19 to find the potential risk factors and predictors of this disease’s severity, as well as to serve as a guidance for subsequent epidemic prevention and control work. PubMed, Cochrane Library, Medline, Embase and other databases were searched to collect studies on the difference of clinical characteristics of severe and non-severe patients. Meta-analysis was performed using RevMan 5.3 software, and the funnel plots could be made to evaluate the publication bias. P>0.05 means no statistical significance. Furthermore, a meta-regression analysis was performed by using Stata 15.0 to find the potential factors of the high degree of heterogeneity (I 2 >50%). Sixteen studies have been included, with 1,172 severe patients and 2,803 non-severe patients. Compared with non-severe patients, severe patients were more likely to have the symptoms of dyspnea, hemoptysis, and the complications of ARDS, shock, secondary infection, acute kidney injury, and acute cardiac injury. Interestingly, the former smokers were more prevalent in severe cases as compared to non-severe cases, but there was no difference between the two groups of ‘current smokers’. Except for chronic liver disease and chronic kidney disease, the underlying comorbidities of hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease (COPD), malignancy, cerebrovascular disease, and HIV can make the disease worse. In terms of laboratory indicators, the decreased lymphocyte and platelet count, and the increased levels of white blood cell (WBC), D-dimer, creatine kinase, lactate dehydrogenase, procalcitonin, alanine aminotransferase, aspartate aminotransferase, and C-reactive protein were more prevalent in severe patients. Meta-regression analysis showed that patient age, gender, and proportion of severe cases did not significantly impact on the outcomes of any clinical indexes that showed high degree of heterogeneity in the meta-analysis. In conclusion, the severity of COVID-19 could be evaluated by, radiologic finding, some symptoms like dyspnea and hemoptysis, some laboratory indicators, and smoking history, especially the ex-smokers. Compared with non-severe patients, severe patients were more likely to have complications and comorbidities including hypertension, cardiovascular disease etc., which were the risk factors for the disease to be severer, but the chronic liver disease and chronic kidney disease were not associated the severity of COVID-19 in China.

【 授权许可】

Unknown