Factors Associated with Disease Severity and Mortality among Patients with Coronavirus Disease 2019: A Systematic Review and Meta-Analysis

  1. Vignesh Chidambaram
  2. Nyan Lynn Tun
  3. Waqas Z Haque
  4. Marie Gilbert Majella
  5. Ranjith Kumar Sivakumar
  6. Amudha Kumar
  7. Angela Ting-Wei Hsu
  8. Izza A Ishak
  9. Aqsha A Nur
  10. Samuel K Ayeh
  11. Emmanuella L Salia
  12. Ahsan Zil-E-Ali
  13. Muhammad A Saeed
  14. Ayu PB Sarena
  15. Bhavna Seth
  16. Muzzammil Ahmadzada
  17. Eman F Haque
  18. Pranita Neupane
  19. Kuang-Heng Wang
  20. Tzu-Miao Pu
  21. Syed MH Ali
  22. Muhammad A Arshad
  23. Lin Wang
  24. Sheriza Baksh
  25. Petros C Karakousis
  26. Panagis Galiatsatos
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Abstract

Background

Understanding the factors associated with disease severity and mortality in Coronavirus disease (COVID-19) is imperative to effectively triage patients. We performed a systematic review to determine the demographic, clinical, laboratory and radiological factors associated with severity and mortality in COVID-19.

Methods

We searched PubMed, Embase and WHO database for English language articles from inception until May 8, 2020. We included Observational studies with direct comparison of clinical characteristics between a) patients who died and those who survived or b) patients with severe disease and those without severe disease. Data extraction and quality assessment were performed by two authors independently.

Results

Among 15680 articles from the literature search, 109 articles were included in the analysis. The risk of mortality was higher in patients with increasing age, male gender (RR 1.45, 95%CI 1.23–1.71), dyspnea (RR 2.55, 95%CI 1.88–2.46), diabetes (RR 1.59, 95%CI 1.41–1.78), hypertension (RR 1.90, 95%CI 1.69–2.15). Congestive heart failure (OR 4.76, 95%CI 1.34–16.97), hilar lymphadenopathy (OR 8.34, 95%CI 2.57–27.08), bilateral lung involvement (OR 4.86, 95%CI 3.19–7.39) and reticular pattern (OR 5.54, 95%CI 1.24–24.67) were associated with severe disease. Clinically relevant cut-offs for leukocytosis(>10.0 ×10 9 /L), lymphopenia(< 1.1 ×10 9 /L), elevated C-reactive protein(>100mg/L), LDH(>250U/L) and D-dimer(>1mg/L) had higher odds of severe disease and greater risk of mortality.

Conclusion

Knowledge of the factors associated of disease severity and mortality identified in our study may assist in clinical decision-making and critical-care resource allocation for patients with COVID-19.

Primary Funding Source

None.

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