bims-covirf Biomed News
on COVID19 risk factors
Issue of 2021‒03‒21
six papers selected by
Catherine Rycroft

  1. BMC Geriatr. 2021 03 17. 21(1): 186
      BACKGROUND: A large number of studies have explored the association between frailty and mortality among COVID-19 patients, with inconsistent results. The aim of this meta-analysis was to synthesize the evidence on this issue.METHODS: Three databases, PubMed, Embase, and Cochrane Library, from inception to 20th January 2021 were searched for relevant literature. The Newcastle-Ottawa Scale (NOS) was used to assess quality bias, and STATA was employed to pool the effect size by a random effects model. Additionally, potential publication bias and sensitivity analyses were performed.
    RESULTS: Fifteen studies were included, with a total of 23,944 COVID-19 patients, for quantitative analysis. Overall, the pooled prevalence of frailty was 51% (95% CI: 44-59%). Patients with frailty who were infected with COVID-19 had an increased risk of mortality compared to those without frailty, and the pooled hazard ratio (HR) and odds ratio (OR) were 1.99 (95% CI: 1.66-2.38) and 2.48 (95% CI: 1.78-3.46), respectively. In addition, subgroup analysis based on population showed that the pooled ORs for hospitalized patients in eight studies and nursing home residents in two studies were 2.62 (95% CI: 1.68-4.07) and 2.09 (95% CI: 1.40-3.11), respectively. Subgroup analysis using the frailty assessment tool indicated that this association still existed when using the clinical frailty scale (CFS) (assessed in 6 studies, pooled OR = 2.88, 95% CI: 1.52-5.45; assessed in 5 studies, pooled HR = 1.99, 95% CI: 1.66-2.38) and other frailty tools (assessed in 4 studies, pooled OR = 1.98, 95% CI: 1.81-2.16). In addition, these significant positive associations still existed in the subgroup analysis based on study design and geographic region.
    CONCLUSION: Our study indicates that frailty is an independent predictor of mortality among patients with COVID-19. Thus, frailty could be a prognostic factor for clinicians to stratify high-risk groups and remind doctors and nurses to perform early screening and corresponding interventions urgently needed to reduce mortality rates in patients infected by SARS-CoV-2.
    Keywords:  COVID-19; Frailty; Meta-analysis; Mortality; Older adults
  2. Arch Gerontol Geriatr. 2021 Mar 05. pii: S0167-4943(21)00051-0. [Epub ahead of print]95 104388
      INTRODUCTION: Older adults are indisputably struck hard by the coronavirus disease 2019 (COVID-19) pandemic. The main objective of this meta-analysis is to establish the association between delirium and mortality in older adults with COVID-19.METHODS: Systematic literature searches of PubMed, Embase, and Scopus databases were performed up until 28 November 2020. The exposure in this study was the diagnosis of delirium using clinically validated criteria. Delirium might be in-hospital, at admission, or both. The main outcome was mortality defined as clinically validated non-survivor/death. The effect estimates were reported as odds ratios (ORs) and adjusted odds ratios (aORs).
    RESULTS: A total of 3,868 patients from 9 studies were included in this systematic review and meta-analysis. The percentage of patients with delirium was 27% [20%, 34%]. Every 1 mg/L increase in CRP was significantly associated with 1% increased delirium risk (OR 1.01 [1.00. 1.02], p=0.033). Delirium was associated with mortality (OR 2.39 [1.64, 3.49], p<0.001; I2: 82.88%). Subgroup analysis on delirium assessed at admission indicate independent association (OR 2.12 [1.39, 3.25], p<0.001; I2: 82.67%). Pooled adjusted analysis indicated that delirium was independently associated with mortality (aOR 1.50 [1.16, 1.94], p=0.002; I2: 31.02%). Subgroup analysis on delirium assessed at admission indicate independent association (OR 1.40 [1.03, 1.90], p=0.030; I2: 35.19%). Meta-regression indicates that the association between delirium and mortality were not significantly influenced by study-level variations in age, sex [reference: male], hypertension, diabetes, and dementia.
    CONCLUSION: The presence of delirium is associated with increased risk of mortality in hospitalized older adults with COVID-19.
    Keywords:  Confusion; Delirium; Geriatric; SARS-CoV-2; Severe
  3. Curr Med Res Opin. 2021 Mar 17. 1
      BACKGROUND: To develop a sensitive and clinically applicable risk assessment tool identifying coronavirus disease 2019 (COVID-19) patients with a high risk of mortality at hospital admission. This model would assist frontline clinicians in optimizing medical treatment with limited resources.METHODS: 6,415 patients from seven hospitals in Wuhan city were assigned to the training and testing cohorts. A total of 6,351 patients from another three hospitals in Wuhan, 2,169 patients from outside of Wuhan, and 553 patients from Milan, Italy were assigned to three independent validation cohorts. A total of 64 candidate clinical variables at hospital admission were analyzed by random forest and least absolute shrinkage and selection operator (LASSO) analyses.
    RESULTS: Eight factors, namely, Oxygen saturation, blood Urea nitrogen, Respiratory rate, admission before the date the national Maximum number of daily new cases was reached, Age, Procalcitonin, C-reactive protein (CRP), and absolute Neutrophil counts, were identified as having significant associations with mortality in COVID-19 patients. A composite score based on these eight risk factors, termed the OURMAPCN-score, predicted the risk of mortality among the COVID-19 patients, with a C-statistic of 0.92 (95% confidence interval [CI] 0.90-0.93). The hazard ratio for all-cause mortality between patients with OURMAPCN-score >11 compared with those with scores ≤11 was 18.18 (95% CI 13.93-23.71; P < 0.0001). The predictive performance, specificity, and sensitivity of the score were validated in three independent cohorts.
    CONCLUSIONS: The OURMAPCN score is a risk assessment tool to determine the mortality rate in COVID-19 patients based on a limited number of baseline parameters. This tool can assist physicians in optimizing the clinical management of COVID-19 patients with limited hospital resources.
    Keywords:  COVID-19; In-hospital; Modeling; Mortality; Risk Score
  4. Int J Infect Dis. 2021 Mar 16. pii: S1201-9712(21)00255-1. [Epub ahead of print]
      OBJECTIVE: To describe clinical features and assess determinants of severity and in-hospital mortality of COVID-19 patients from unique setting in Ethiopia.METHODS: Consecutive patients admitted to COVID-19 quarantine and isolation center were included. We analyzed proportions of clinical spectrum of COVID-19, factors associated with risk of severe COVID-19 and in-hospital mortality.
    RESULTS: Of 2617 patients, three-quarter of the quarantined (N = 1935; 74%) appeared asymptomatic, and only 114 (4.4%) presented with severe COVID-19. Common characteristics among the 682 symptomatics were cough (N = 354; 50.6%), myalgia (N = 212; 31.1%), head ache (N = 196; 28.7%), fever (N = 161; 23.6%), dyspnea (N = 111; 16.3%), anosmia and/or dysgeusia (N = 90; 13.2%), sore throat (N = 87; 12.8%) and chest pain (N = 77; 11.3%). Factors associated with severe COVID-19 were older age [adjusted relative risk (aRR) 1.78, 95% CI 1.61 to 1.97; p < 0.0001], diabetes (aRR 2.00, 95% CI 1.20 to 3.32; p = 0.007), cardiovascular diseases (aRR 2.53, 95% CI 1.53 to 4.17; p < 0.0001), malignancy (aRR 4.57, 95% CI 1.62 to 12.87; p = 0.004), surgery/trauma (aRR 23.98, 95% CI 10.35 to 55.57; p < 0.0001), and infection with HIV-1 (aRR 4.24, 95% CI 1.55 to 11.61; p = 005). Factors associated with risk of in-hospital mortality included older age (aRR 2.37, 95% CI 1.90 to 2.95; p < 0.001), malignancy (aRR 6.73, 95% CI 1.50 to 30.16; p = 0.013) and surgery/trauma (aRR 59.52, 95% CI 12.90 to 274.68; p < 0.0001).
    CONCLUSIONS: Significant proportion of SARS-CoV-2 infection were asymptomatic and key comorbid conditions increased risk of COVID-19 severity and in-hospital mortality. These findings could help in the design of appropriate management of patients.
    Keywords:  Africa; COVID-19; Ethiopia; SARS-CoV-2; clinical features; comorbidities; mortality
  5. Cureus. 2021 Feb 05. 13(2): e13165
      Background Obesity can be associated with one or more co-morbidities that worsen the effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Studies demonstrated that severe forms of coronavirus disease (COVID-19) have occurred in elderly patients and patients with co-morbidities such as diabetes, hypertension, and cardiovascular diseases. Objective This study investigated the impact of obesity on COVID-19 severity, irrespective of other individual factors. Methods This retrospective observational study included all adult patients with confirmed COVID-19 infection, who were admitted to Sheikh Khalifa Ibn Zaid International University Hospital between March 20 and May 10, 2020. First, we compared patients with and those without obesity in terms of demographic characteristics, co-morbidities, clinical symptoms, and outcomes. Further, using logistic regression models, we analyzed the association between obesity and intensive care unit (ICU) admission. Also, we examined whether the association between obesity and ICU admission was also consistent among overweight patients. Results The study population included 107 patients with confirmed COVID-19 infection. Obese patients have been admitted in ICU more than patients without obesity (P-value = 0.035). While adjusting for other risk factors for ICU admission, we found that obesity was an independent risk factor for ICU admission (OR = 5.04, 95% CI (1.14-22.37)). When we examined the association of both obesity and overweight with ICU admission, we found that only obesity was significantly associated with ICU admission (OR = 9.11, 95% CI (1.49-55.84)). Conclusion Our study found that obesity was strongly associated with severity of COVID-19. The risk of ICU admission is greater in the presence of obesity. Physicians should be awarded to the need of specific and early management of obese patients with COVID-19 disease.
    Keywords:  covid-19; obesity; sars-cov-2; severity
  6. Wien Klin Wochenschr. 2021 Mar 15.
      BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a very wide range of disease severity: from completely asymptomatic to fatal, and the reasons for that are not well understood; however, there are some data that show vitamin D may have a protective effect.METHODS: To retrieve the vitamin D levels data, the authors analyzed the vitamin D European population data compiled by 2019 European Calcified Tissue Society (ECTS) statement on vitamin D status published in the European Journal of Endocrinology. For the data set to be used for analysis, only recently published data that included general adult population of both genders aged 40-65 years or wider and must have included the prevalence of vitamin D deficiency.
    RESULTS: There were data sets from 10 countries that fitted the criteria and were analyzed. Severe vitamin D deficiency was defined as 25(OH)D less than 25 nmol/L (10 ng/dL). Pearson correlation analysis between death rate per million of population from coronavirus disease 2019 (COVID-19) and prevalence of severe vitamin D deficiency showed a strong correlation with r = 0.79, p = 0.007. Over time, correlation strengthened, and r coefficient asymptotically increased. After adjusting for countries' age structure and per capita health expenditures, multiple linear regression analysis showed that higher prevalence of severe vitamin D deficiency is associated with increased mortality. Each 1% increase in prevalence increased deaths by 55 per million (95% confidence interval, CI 8-102), p = 0.03.
    CONCLUSION: The authors recommend universal screening for vitamin D deficiency, and further investigation of Vitamin D supplementation in randomized control studies, which may lead to possible treatment or prevention of COVID-19.
    Keywords:  Coronavirus; Death rate; Prevention; Protective effect; SARS-CoV-2