bims-covirf Biomed News
on COVID19 risk factors
Issue of 2020‒11‒29
ten papers selected by
Catherine Rycroft
BresMed


  1. Medicine (Baltimore). 2020 Nov 25. 99(48): e23327
    Wang Z, Deng H, Ou C, Liang J, Wang Y, Jiang M, Li S.
      BACKGROUND: The pandemic of COVID-19 poses a challenge to global healthcare. The mortality rates of severe cases range from 8.1% to 38%, and it is particularly important to identify risk factors that aggravate the disease.METHODS: We performed a systematic review of the literature with meta-analysis, using 7 databases to identify studies reporting on clinical characteristics, comorbidities and complications in severe and non-severe patients with COVID-19. All the observational studies were included. We performed a random or fixed effects model meta-analysis to calculate the pooled proportion and 95% confidence interval (CI). Measure of heterogeneity was estimated by Cochran's Q statistic, I index and P value.
    RESULTS: A total of 4881 cases from 25 studies related to COVID-19 were included. The most prevalent comorbidity was hypertension (severe: 33.4%, 95% CI: 25.4%-41.4%; non-severe 21.6%, 95% CI: 9.9%-33.3%), followed by diabetes (severe: 14.4%, 95% CI: 11.5%-17.3%; non-severe: 8.5%, 95% CI: 6.1%-11.0%). The prevalence of acute respiratory distress syndrome, acute kidney injury and shock were all higher in severe cases, with 41.1% (95% CI: 14.1%-68.2%), 16.4% (95% CI: 3.4%-29.5%) and 19.9% (95% CI: 5.5%-34.4%), rather than 3.0% (95% CI: 0.6%-5.5%), 2.2% (95% CI: 0.1%-4.2%) and 4.1% (95% CI: -4.8%-13.1%) in non-severe patients, respectively. The death rate was higher in severe cases (30.3%, 95% CI: 13.8%-46.8%) than non-severe cases (1.5%, 95% CI: 0.1%-2.8%).
    CONCLUSION: Hypertension, diabetes and cardiovascular diseases may be risk factors for severe COVID-19.
    DOI:  https://doi.org/10.1097/MD.0000000000023327
  2. Aging (Albany NY). 2020 Nov 21. 12
    Zhou X, Cheng Z, Shu D, Lin W, Ming Z, Chen W, Hu Y.
      The outbreak of coronavirus disease 2019 (COVID-19) initially occurred in December 2019 and triggered a public health emergency. The increasing number of deaths due to this disease was of great concern. Therefore, our study aimed to explore risk factors associated with COVID-19 deaths. After having searched the PubMed, EMBASE, and CNKI for studies published as of August 10, 2020, we selected articles and extracted data. The meta-analysis was performed using Stata 16.0 software. Nineteen studies were used in our meta-analysis. The proportions of comorbidities such as diabetes, hypertension, malignancies, chronic obstructive pulmonary disease, cardio-cerebrovascular disease, and chronic liver disease were statistically significantly higher in mortal COVID-19 cases. Coagulation and inflammatory markers, such as platelet count, D-dimer, prothrombin time, C-reactive protein, procalcitonin, and interleukin 6, predicted the deterioration of the disease. In addition, extracorporeal membrane oxygenation and mechanical ventilation predicted the poor prognosis during its progression. The COVID-19 pandemic is still evolving, placing a huge burden on healthcare facilities. Certain coagulation indicators, inflammatory indicators, and comorbidities contribute to the prognosis of patients. Our study results may help clinicians optimize the treatment and ultimately reduce the mortality rate.
    Keywords:  COVID-19; SARS-CoV-2; coronavirus disease 2019 (COVID-19); death cases; survival cases
    DOI:  https://doi.org/10.18632/aging.202216
  3. PLoS One. 2020 ;15(11): e0242760
    Filardo TD, Khan MR, Krawczyk N, Galitzer H, Karmen-Tuohy S, Coffee M, Schaye VE, Eckhardt BJ, Cohen GM.
      BACKGROUND: Despite evidence of socio-demographic disparities in outcomes of COVID-19, little is known about characteristics and clinical outcomes of patients admitted to public hospitals during the COVID-19 outbreak.OBJECTIVE: To assess demographics, comorbid conditions, and clinical factors associated with critical illness and mortality among patients diagnosed with COVID-19 at a public hospital in New York City (NYC) during the first month of the COVID-19 outbreak.
    DESIGN: Retrospective chart review of patients diagnosed with COVID-19 admitted to NYC Health + Hospitals / Bellevue Hospital from March 9th to April 8th, 2020.
    RESULTS: A total of 337 patients were diagnosed with COVID-19 during the study period. Primary analyses were conducted among those requiring supplemental oxygen (n = 270); half of these patients (135) were admitted to the intensive care unit (ICU). A majority were male (67.4%) and the median age was 58 years. Approximately one-third (32.6%) of hypoxic patients managed outside the ICU required non-rebreather or non-invasive ventilation. Requirement of renal replacement therapy occurred in 42.3% of ICU patients without baseline end-stage renal disease. Overall, 30-day mortality among hypoxic patients was 28.9% (53.3% in the ICU, 4.4% outside the ICU). In adjusted analyses, risk factors associated with mortality included dementia (adjusted risk ratio (aRR) 2.11 95%CI 1.50-2.96), age 65 or older (aRR 1.97, 95%CI 1.31-2.95), obesity (aRR 1.37, 95%CI 1.07-1.74), and male sex (aRR 1.32, 95%CI 1.04-1.70).
    CONCLUSION: COVID-19 demonstrated severe morbidity and mortality in critically ill patients. Modifications in care delivery outside the ICU allowed the hospital to effectively care for a surge of critically ill and severely hypoxic patients.
    DOI:  https://doi.org/10.1371/journal.pone.0242760
  4. Int J Infect Dis. 2020 Nov 20. pii: S1201-9712(20)32475-9. [Epub ahead of print]
    Tsankov BK, Allaire JM, Irvine MA, Lopez AA, Sauvé LJ, Vallance BA, Jacobson K.
      OBJECTIVE: There is limited information on the severity of COVID-19 infection in children with comorbidities. We investigated the effects of pediatric comorbidities on COVID-19 severity by means of a systematic review and meta-analysis of published literature.METHODS: PubMed, Embase, and Medline databases were searched for publications on pediatric COVID-19 infections published January 1st to October 5th, 2020. Articles describing at least one child with and without comorbidities, COVID-19 infection, and reported outcomes, were included.
    RESULTS: 42 studies containing 275,661 children without comorbidities and 9,353 children with comorbidities were included. Severe COVID-19 was present in 5.1% of children with comorbidities, and in 0.2% without comorbidities. Random-effects analysis revealed a higher risk of severe COVID-19 among children with comorbidities than for healthy children; relative risk ratio 1.79 (95% CI 1.27 - 2.51;I2 = 94%). Children with underlying conditions also had a higher risk of COVID-19-associated mortality; relative risk ratio 2.81 (95% CI 1.31 - 6.02; I2 = 82%). Children with obesity had a relative risk ratio of 2.87 (95% CI 1.16 - 7.07 I2 = 36%).
    CONCLUSIONS: Children with comorbidities have a higher risk of severe COVID-19 and associated mortality than children without underlying disease. Additional studies are required to further evaluate this relationship.
    Keywords:  COVID-19; Comorbidity; Coronavirus; Meta-Analysis; Pediatrics
    DOI:  https://doi.org/10.1016/j.ijid.2020.11.163
  5. Pediatr Clin North Am. 2021 02;pii: S0031-3955(20)30107-3. [Epub ahead of print]68(1): 321-338
    Tsabouri S, Makis A, Kosmeri C, Siomou E.
      The coronavirus disease 2019 (COVID-19) pandemic has affected hundreds of thousands of people. The authors performed a comprehensive literature review to identify the underlying mechanisms and risk factors for severe COVID-19 in children. Children have accounted for 1.7% to 2% of the diagnosed cases of COVID-19. They often have milder disease than adults, and child deaths have been rare. The documented risk factors for severe disease in children are young age and underlying comorbidities. It is unclear whether male gender and certain laboratory and imaging findings are also risk factors. Reports on other potential factors have not been published.
    Keywords:  COVID-19; Children; Coronavirus; Risk factor; Severity
    DOI:  https://doi.org/10.1016/j.pcl.2020.07.014
  6. BMJ Open. 2020 Nov 23. 10(11): e042712
    Alaa A, Qian Z, Rashbass J, Benger J, van der Schaar M.
      OBJECTIVES: We investigated whether the timing of hospital admission is associated with the risk of mortality for patients with COVID-19 in England, and the factors associated with a longer interval between symptom onset and hospital admission.DESIGN: Retrospective observational cohort study of data collected by the COVID-19 Hospitalisation in England Surveillance System (CHESS). Data were analysed using multivariate regression analysis.
    SETTING: Acute hospital trusts in England that submit data to CHESS routinely.
    PARTICIPANTS: Of 14 150 patients included in CHESS until 13 May 2020, 401 lacked a confirmed diagnosis of COVID-19 and 7666 lacked a recorded date of symptom onset. This left 6083 individuals, of whom 15 were excluded because the time between symptom onset and hospital admission exceeded 3 months. The study cohort therefore comprised 6068 unique individuals.
    MAIN OUTCOME MEASURES: All-cause mortality during the study period.
    RESULTS: Timing of hospital admission was an independent predictor of mortality following adjustment for age, sex, comorbidities, ethnicity and obesity. Each additional day between symptom onset and hospital admission was associated with a 1% increase in mortality risk (HR 1.01; p<0.005). Healthcare workers were most likely to have an increased interval between symptom onset and hospital admission, as were people from Black, Asian and minority ethnic (BAME) backgrounds, and patients with obesity.
    CONCLUSION: The timing of hospital admission is associated with mortality in patients with COVID-19. Healthcare workers and individuals from a BAME background are at greater risk of later admission, which may contribute to reports of poorer outcomes in these groups. Strategies to identify and admit patients with high-risk and those showing signs of deterioration in a timely way may reduce the consequent mortality from COVID-19, and should be explored.
    Keywords:  health policy; infectious diseases; public health
    DOI:  https://doi.org/10.1136/bmjopen-2020-042712
  7. Public Health. 2020 Oct 17. pii: S0033-3506(20)30435-2. [Epub ahead of print]189 129-134
    Hawkins RB, Charles EJ, Mehaffey JH.
      OBJECTIVES: The United States has the highest number of coronavirus disease 2019 (COVID-19) in the world, with high variability in cases and mortality between communities. We aimed to quantify the associations between socio-economic status and COVID-19-related cases and mortality in the U.S.STUDY DESIGN: The study design includes nationwide COVID-19 data at the county level that were paired with the Distressed Communities Index (DCI) and its component metrics of socio-economic status.
    METHODS: Severely distressed communities were classified by DCI>75 for univariate analyses. Adjusted rate ratios were calculated for cases and fatalities per 100,000 persons using hierarchical linear mixed models.
    RESULTS: This cohort included 1,089,999 cases and 62,298 deaths in 3127 counties for a case fatality rate of 5.7%. Severely distressed counties had significantly fewer deaths from COVID-19 but higher number of deaths per 100,000 persons. In risk-adjusted analysis, the two socio-economic determinants of health with the strongest association with both higher cases per 100,000 persons and higher fatalities per 100,000 persons were the percentage of adults without a high school degree (cases: RR 1.10; fatalities: RR 1.08) and proportion of black residents (cases and fatalities: Relative risk(RR) 1.03). The percentage of the population aged older than 65 years was also highly predictive for fatalities per 100,000 persons (RR 1.07).
    CONCLUSION: Lower education levels and greater percentages of black residents are strongly associated with higher rates of both COVID-19 cases and fatalities. Socio-economic factors should be considered when implementing public health interventions to ameliorate the disparities in the impact of COVID-19 on distressed communities.
    Keywords:  COVID-19; Coronavirus; Race; SARS-CoV-2; Socio-economic status
    DOI:  https://doi.org/10.1016/j.puhe.2020.09.016
  8. Ann Intern Med. 2020 Nov 24.
    Ray JG, Schull MJ, Vermeulen MJ, Park AL.
      BACKGROUND: The ABO and rhesus (Rh) blood groups may influence risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.OBJECTIVE: To determine whether ABO and Rh blood groups are associated with risk for SARS-CoV-2 infection and severe coronavirus disease 2019 (COVID-19) illness.
    DESIGN: Population-based cohort study.
    SETTING: Ontario, Canada.
    PATIENTS: All adults and children who had ABO blood group assessed between January 2007 and December 2019 and who subsequently had SARS-CoV-2 testing between 15 January and 30 June 2020.
    MEASUREMENTS: The main study outcome was SARS-CoV-2 infection, determined by viral RNA polymerase chain reaction testing. A second outcome was severe COVID-19 illness or death. Adjusted relative risks (aRRs) and absolute risk differences (ARDs) were adjusted for demographic characteristics and comorbidities.
    RESULTS: A total of 225 556 persons were included, with a mean age of 54 years. The aRR of SARS-CoV-2 infection for O blood group versus A, AB, and B blood groups together was 0.88 (95% CI, 0.84 to 0.92; ARD, -3.9 per 1000 [CI, -5.4 to -2.5]). Rhesus-negative (Rh-) blood type was protective against SARS-CoV-2 infection (aRR, 0.79 [CI, 0.73 to 0.85]; ARD, -6.8 per 1000 [CI, -8.9 to -4.7]), especially for those who were O-negative (O-) (aRR, 0.74 [CI, 0.66 to 0.83]; ARD, -8.2 per 1000 [CI, -10.8 to -5.3]). There was also a lower risk for severe COVID-19 illness or death associated with type O blood group versus all others (aRR, 0.87 [CI, 0.78 to 0.97]; ARD, -0.8 per 1000 [CI, -1.4 to -0.2]) and with Rh- versus Rh-positive (aRR, 0.82 [CI, 0.68 to 0.96]; ARD, -1.1 per 1000 [CI, -2.0 to -0.2]).
    LIMITATION: Persons who rapidly died of severe COVID-19 illness may not have had SARS-CoV-2 testing.
    CONCLUSION: The O and Rh- blood groups may be associated with a slightly lower risk for SARS-CoV-2 infection and severe COVID-19 illness.
    PRIMARY FUNDING SOURCE: Ontario Academic Health Sciences Centre AFP Innovation Fund and the Ontario Ministry of Health and Long-Term Care.
    DOI:  https://doi.org/10.7326/M20-4511
  9. Cad Saude Publica. 2020 ;pii: S0102-311X2020001205003. [Epub ahead of print]36(12): e00129620
    Nunes BP, Souza ASS, Nogueira J, Andrade FB, Thumé E, Teixeira DSDC, Lima-Costa MF, Facchini LA, Batista SR.
      This study aimed to measure the occurrence of multimorbidity and to estimate the number of individuals in the Brazilian population 50 years or older at risk for severe COVID-19. This was a cross-sectional nationwide study based on data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015-2016, with 9,412 individuals 50 years or older. Multimorbidity was defined as ≥ 2 chronic conditions based on a list of 15 diseases considered risk conditions for severe COVID-19. The analyses included calculation of prevalence and estimation of the absolute number of persons in the population at risk. Self-rated health status, frailty, and basic activities of daily living were used as markers of health status. Sex, age, region of the country, and schooling were used as covariables. Some 80% of the sample had at least one of the target conditions, which represents some 34 million individuals. Multimorbidity was reported by 52% of the study population, with higher proportions in the Central, Southeast, and South of Brazil. Cardiovascular diseases and obesity were the most frequent chronic conditions. An estimated 2.4 million Brazilians are at serious health risk. The results revealed inequalities according to schooling. The number of persons 50 years or older who presented risk conditions for severe COVID-19 is high both in absolute and relative terms. The estimate is important for planning strategies to monitor persons with chronic conditions and for preventive strategies to deal with the novel coronavirus.
    DOI:  https://doi.org/10.1590/0102-311X00129620