bims-covirf Biomed News
on COVID19 risk factors
Issue of 2020–08–09
eleven papers selected by
Catherine Rycroft, BresMed
  1. Comorbidities, clinical signs and symptoms, laboratory findings, imaging features, treatment strategies, and outcomes in adult and pediatric patients with COVID-19: A systematic review and meta-analysis.
  2. Characterization of clinical, laboratory and imaging factors related to mild vs. severe Covid-19 infection: a systematic review and meta-analysis.
  3. Development and Validation of Prognosis Model of Mortality Risk in Patients with COVID-19.
  4. Increased Risk of Hospitalization and Death in Patients with COVID-19 and Pre-existing Noncommunicable Diseases and Modifiable Risk Factors in Mexico.
  5. Underlying respiratory diseases, specifically COPD, and smoking are associated with severe COVID-19 outcomes: A systematic review and meta-analysis.
  6. Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis.
  7. Impact of COVID -19 in cancer patients on severity of disease and fatal outcomes: A systematic review and meta-analysis.
  8. The risk and prognosis of COVID-19 infection in cancer patients: A systematic review and meta-analysis.
  9. Body Mass Index and Outcome in Patients with COVID-19: A Dose-Response Meta-Analysis.
  10. Association of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers with risk of COVID-19, inflammation level, severity, and death in patients with COVID-19: A rapid systematic review and meta-analysis.
  11. The effect of smoking on COVID-19 severity: a systematic review and meta-analysis.
  1. Travel Med Infect Dis. 2020 Aug 04. pii: S1477-8939(20)30321-5. [Epub ahead of print] 101825
    Comorbidities, clinical signs and symptoms, laboratory findings, imaging features, treatment strategies, and outcomes in adult and pediatric patients with COVID-19: A systematic review and meta-analysis.
    Catherine R Jutzeler, Lucie Bourguignon, Caroline V Weis, Bobo Tong, Cyrus Wong, Bastian Rieck, Hans Pargger, Sarah Tschudin-Sutter, Adrin Egli, Karsten Borgwardt, Matthias Walter.
       INTRODUCTION: Since December 2019, a novel coronavirus (SARS-CoV-2) has triggered a world-wide pandemic with an enormous medical and societal-economic toll. Thus, our aim was to gather all available information regarding comorbidities, clinical signs and symptoms, outcomes, laboratory findings, imaging features, and treatments in patients with coronavirus disease 2019 (COVID-19).
    METHODS: EMBASE, PubMed/Medline, Scopus, and Web of Science were searched for studies published in any language between December 1st, 2019 and March 28th. Original studies were included if the exposure of interest was an infection with SARS-CoV-2 or confirmed COVID-19. The primary outcome was the risk ratio of comorbidities, clinical signs and symptoms, imaging features, treatments, outcomes, and complications associated with COVID-19 morbidity and mortality. We performed random-effects pairwise meta-analyses for proportions and relative risks, I2, Tau2, and Cochrane Q, sensitivity analyses, and assessed publication bias.
    RESULTS: 148 studies met the inclusion criteria for the systematic review and meta-analysis with 12'149 patients (5'739 female) and a median age of 47.0 [35.0-64.6] years. 617 patients died from COVID-19 and its complication. 297 patients were reported as asymptomatic. Older age (SMD: 1.25 [0.78- 1.72]; p < 0.001), being male (RR = 1.32 [1.13-1.54], p = 0.005) and pre-existing comorbidity (RR = 1.69 [1.48-1.94]; p < 0.001) were identified as risk factors of in-hospital mortality. The heterogeneity between studies varied substantially (I2; range: 1.5-98.2%). Publication bias was only found in eight studies (Egger's test: p < 0.05).
    CONCLUSIONS: Our meta-analyses revealed important risk factors that are associated with severity and mortality of COVID-19.
    Keywords:  COVID-19; SARS-CoV-2; clinical characteristics; comorbidities; imaging features; laboratory findings; meta-analysis; systematic review; treatment
    DOI:  https://doi.org/10.1016/j.tmaid.2020.101825
  2. Ann Med. 2020 Aug 05. 1-21
    Characterization of clinical, laboratory and imaging factors related to mild vs. severe Covid-19 infection: a systematic review and meta-analysis.
    Xiaomei Wu, Lei Liu, Jinghua Jiao, Lina Yang, Bo Zhu, Xin Li.
      Background: Early detection of disease progression associated with severe COVID-19, and access to proper medical care lowers fatality rates of severe cases. Currently, no studies had systematically examined the variables in detecting severe COVID-19.Method: Systematic searching of electronic databases identified observational studies which recruited participants with confirmed COVID-19 infection who were divided into different groups according to disease severity were identified.Results: To analysis 41 studies with 5064 patients were included.Patients who are elderly (SMD, 1.90; 95% CI, 1.01 to 2.8), male (OR, 1.71; 95% CI, 1.39 to 2.11) and have comorbidities or flu-like symptoms were significantly associated with the development to severe cases. Severe cases were associated with significant increased WBC (OR, 5.83; 95% CI, 2.76 to 12.32), CRP (OR, 3.62; 95% CI, 1.62 to 8.03), D-dimer (SMD, 1.69; 95% CI, 1.09 to 2.28), AST (OR, 4.64; 95% CI, 3.18 to 6.77) and LDH (OR, 7.94; 95% CI, 2.09 to 30.21). CT manifestation of bilateral lung involvement (OR, 4.55; 95% CI, 2.17 to 9.51) was associated with the severe cases.Conclusions and Relevance: Our findings offer guidance for a wide spectrum of clinicians to early identify severe COVID-19 patients, transport to specialized centers, and initiate appropriate treatment. Key Messages:This systematic review and meta-analysis examined 41 studies including 5,064 patients with confirmed COVID-19. Severe cases were associated with age, male gender, and with fever, cough and respiratory diseases, increased WBC, CRP, D-dimer, AST and LDH levels. Furthermore, CT manifestation of bilateral lung involvement was associated with the severe cases.These findings provide guidance to health professionals with early identification of severe COVID-19 patients, transportation to specialized care and initiate appropriate supportive treatment.
    Keywords:  COVID-19; clinical characteristics; disease severity; laboratory indicators; meta-analysis
    DOI:  https://doi.org/10.1080/07853890.2020.1802061
  3. Epidemiol Infect. 2020 Aug 04. 1-25
    Development and Validation of Prognosis Model of Mortality Risk in Patients with COVID-19.
    Xuedi Ma, Michael Ng, Shuang Xu, Zhouming Xu, Hui Qiu, Yuwei Liu, Jiayou Lyu, Jiwen You, Peng Zhao, Shihao Wang, Yunfei Tang, Hao Cui, Changxiao Yu, Feng Wang, Fei Shao, Peng Sun, Ziren Tang.
      
    DOI:  https://doi.org/10.1017/S0950268820001727
  4. Arch Med Res. 2020 Jul 22. pii: S0188-4409(20)30722-0. [Epub ahead of print]
    Increased Risk of Hospitalization and Death in Patients with COVID-19 and Pre-existing Noncommunicable Diseases and Modifiable Risk Factors in Mexico.
    Diego Rolando Hernández-Galdamez, Miguel Ángel González-Block, Daniela Karola Romo-Dueñas, René Lima-Morales, Irma Alejandra Hernández-Vicente, Marivel Lumbreras-Guzmán, Pablo Méndez-Hernández.
       BACKGROUND: The population in Mexico has high prevalence rates of noncommunicable diseases (NCDs). Hospitalization and death of COVID-19 patients in the countries most affected by the pandemic has been associated to chronic comorbidities.
    OBJECTIVE: To describe the prevalence of NCDs in patients with COVID-19 in Mexico and analyze the increased risk due to comorbidities and risk factors on hospitalization, utilization of intensive care units and death.
    METHODS: A cross-sectional study was performed from 212,802 confirmed COVID-19 cases reported by the Ministry of Health up to June 27, 2020. Odds ratios were performed using logistic regression model.
    RESULTS: Up to 47.40% of patients with COVID-19 diagnosis were also reported with a comorbidity, with hypertension being the most frequent (20.12%). The report of at least one NCD significantly increased the risk of death with respect to patients without such diagnoses. Chronic kidney disease increased the risk of death the most (OR 2.31), followed by diabetes (OR 1.69), immunosuppression (OR 1.62), obesity (OR 1.42), hypertension (OR 1.24), chronic obstructive pulmonary disease (OR 1.20). The comorbidities that most increased the risk of ICU and of intubation were diabetes, immunosuppression and obesity.
    CONCLUSION: NCD comorbidities increase the severity of COVID-19 infection. Given high NCD prevalence rates among the Mexican population, the pandemic poses a special threat to the health system and to society. Special prevention measures need to be strengthened for persons with NCD diagnoses in the short-term. In the mid-term, disease control strategies need to be improved to protect these patients against COVID-19 severity.
    Keywords:  COVID-19; Comorbidities; Endotracheal intubation; Intensive care unit; Modifiable risk factors; Non-communicable diseases; SARS-CoV-2
    DOI:  https://doi.org/10.1016/j.arcmed.2020.07.003
  5. Respir Med. 2020 Jul 30. pii: S0954-6111(20)30236-5. [Epub ahead of print]171 106096
    Underlying respiratory diseases, specifically COPD, and smoking are associated with severe COVID-19 outcomes: A systematic review and meta-analysis.
    Diana C Sanchez-Ramirez, Denise Mackey.
       BACKGROUND: An outbreak of Corona Virus Disease 2019 (COVID-19) has spread rapidly reaching over 3 million of confirmed cases worldwide. The association of respiratory diseases and smoking, both highly prevalent globally, with COVID-19 severity has not been elucidated. Given the gap in the evidence and the growing prevalence of COVID-19, the objective of this study was to explore the association of underlying respiratory diseases and smoking with severe outcomes in patients with COVID-19 infection.
    METHODS: A systematic search was performed to identify studies reporting prevalence of respiratory diseases and/or smoking in relation with disease severity in patients with confirm COVID-19, published between January 1 to April 15, 2020 in English language. Pooled odds-ratio (OR) and 95% confidence intervals (95% CI) were calculated.
    FINDINGS: Twenty two studies met the inclusion criteria. All the studies presented data of 13,184 COVID-19 patients (55% males). Patients with severe outcomes were older and a larger percentage were males compared with the non-severe. Pooled analysis showed that prevalence of respiratory diseases (OR 4.21; 95% CI, 2.9-6.0) and smoking (current smoking OR 1.98; 95% CI, 1.16-3.39 and former smoking OR 3.46; 95% CI, 2.46-4.85) were significantly associated with severe COVID-19 outcomes.
    INTERPRETATION: Results suggested that underlying respiratory diseases, specifically COPD, and smoking were associated with severe COVID-19 outcomes. These findings may support the planning of preventive interventions and could contribute to improvements in the assessment and management of patient risk factors in clinical practice, leading to the mitigation of severe outcomes in patients with COVID-19 infection.
    DOI:  https://doi.org/10.1016/j.rmed.2020.106096
  6. Am J Emerg Med. 2020 May 27. pii: S0735-6757(20)30436-8. [Epub ahead of print]38(9): 1722-1726
    Lactate dehydrogenase levels predict coronavirus disease 2019 (COVID-19) severity and mortality: A pooled analysis.
    Brandon Michael Henry, Gaurav Aggarwal, Johnny Wong, Stefanie Benoit, Jens Vikse, Mario Plebani, Giuseppe Lippi.
      Coronavirus disease 2019 (COVID-19) infection has now reached a pandemic state, affecting more than a million patients worldwide. Predictors of disease outcomes in these patients need to be urgently assessed to decrease morbidity and societal burden. Lactate dehydrogenase (LDH) has been associated with worse outcomes in patients with viral infections. In this pooled analysis of 9 published studies (n = 1532 COVID-19 patients), we evaluated the association between elevated LDH levels measured at earliest time point in hospitalization and disease outcomes in patients with COVID-19. Elevated LDH levels were associated with a ~6-fold increase in odds of developing severe disease and a ~16-fold increase in odds of mortality in patients with COVID-19. Larger studies are needed to confirm these findings.
    Keywords:  COVID-19; Coronavirus; Lactate dehydrogenase
    DOI:  https://doi.org/10.1016/j.ajem.2020.05.073
  7. Diabetes Metab Syndr. 2020 Jul 28. pii: S1871-4021(20)30285-X. [Epub ahead of print]14(5): 1431-1437
    Impact of COVID -19 in cancer patients on severity of disease and fatal outcomes: A systematic review and meta-analysis.
    Abhijeet Ashok Salunke, Kunal Nandy, Subodh Kumar Pathak, Jaymin Shah, Mayur Kamani, Viswanth Kottakota, Praveen Thivari, Apurva Pandey, Keval Patel, Priyank Rathod, Supreet Bhatt, Pariseema Dave, Shashank Pandya.
       BACKGROUND AND AIMSBACKGROUND: Currently there is limited knowledge on cancer and COVID-19; we conducted a systematic review and meta-analysis to evaluate the impact of cancer on serious events including ICU admission rate and mortality in COVID 19.
    METHODS: PubMed, Cochrane Central Register of Clinical Trials were searched on April 16, 2020, to extract published articles that reported the outcomes of cancer in COVID-19 patients. The search terms were "coronavirus" and "clinical characteristics" with no language or time restrictions. We identified 512 published results and 13 studies were included in the analysis.
    RESULTS: There were 3775 patients, of whom 63 (1·66%) had a cancer. The pooled estimates of ICU admission in COVID 19 patients with and without cancer were 40% versus 8·42%.The odds ratio of ICU admission rates between the cancer and non-cancer groups was 2.88 with a 95% CI of 1·18 to 7·01 (p = 0·026). The pooled estimates of death rate in COVID -19 patients with and without cancer were 20·83% versus 7·82%. The odds ratio of death rates between the cancer and non-cancer groups was 2.25 with a 95% CI ranging from 0·71 to 7·10 with p value of 0·166. The pooled prevalence of cancer patients was 2% (95 CI 1-4).
    CONCLUSIONS: Presence of cancer in COVID-19 leads to higher risk of developing serious events i.e. ICU admission, mechanical ventilation and mortality. The presence of cancer has a significant impact on mortality rate in COVID-19 patients.
    Keywords:  COVID-19; Cancer; Corona disease; ICU Stay; Mortality rate; Non cancer; Oncology
    DOI:  https://doi.org/10.1016/j.dsx.2020.07.037
  8. Hematol Oncol Stem Cell Ther. 2020 Jul 30. pii: S1658-3876(20)30122-9. [Epub ahead of print]
    The risk and prognosis of COVID-19 infection in cancer patients: A systematic review and meta-analysis.
    Ghada Elgohary.
      A number of studies have been published on outcomes of cancer patients infected with the SARS-CoV-2 virus causing the COVID-19 infection. However, most of these reports are single-center studies with a limited number of patients. To better assess the outcomes of this new infection in this subgroup of susceptible patients, we performed a systematic review and meta-analysis to evaluate the impact of COVID-19 infection on cancer patients. We searched PubMed, Web of Science, and Scopus for studies that reported the risk of infection and complications of COVID-19 in cancer patients. The literature search retrieved 22 studies (1018 cancer patients). The analysis showed that the frequency of cancer among COVID-19 confirmed patients was 2.1% (95% CI: 1.3%, 3%) in the overall cohort. These patients had a mortality of 21.1% (95% CI: 14.7%, 27.6%), severe/critical disease rate of 45.4% (95% CI: 37.4%, 53.3%), ICU admission rate of 14.5% (95% CI: 8.5%, 20.4%), and mechanical ventilation rate of 11.7% (95% CI: 5.5%, 18%). The double-arm analysis showed that cancer patients had higher risk of mortality (OR = 3.23, 95% CI: 1.71, 6.13), severe/critical disease (OR = 3.91, 95% CI: 2.70, 5.67), ICU admission (OR = 3.10, 95% CI: 1.85, 5.17), and mechanical ventilation (OR = 4.86, 95% CI: 1.27, 18.65), compared to non-cancer patients. Further, cancer patients had significantly lower platelet levels and a significantly higher D-dimer, C-reactive protein, and prothrombin time. In conclusion, these results indicate that cancer patients are at a higher risk of COVID-19 infection-related complications. Therefore, cancer patients need diligent preventive care measures and aggressive surveillance for earlier detection of COVID-19 infection.
    Keywords:  COVID-19; Cancer; Mechanical ventilation; Meta-analysis; Mortality
    DOI:  https://doi.org/10.1016/j.hemonc.2020.07.005
  9. Diabetes Metab. 2020 Jul 29. pii: S1262-3636(20)30097-5. [Epub ahead of print]
    Body Mass Index and Outcome in Patients with COVID-19: A Dose-Response Meta-Analysis.
    Raymond Pranata, Michael Anthonius Lim, Emir Yonas, Rachel Vania, Antonia Anna Lukito, Bambang Budi Siswanto, Markus Meyer.
       BACKGROUND: There is mounting evidence related to the association between obesity and severity of COVID-19. However, the direct relationship of the increase in the severe COVID-19 risk factors, with an increase in body mass index (BMI), has not yet been evaluated.
    AIM: This meta-analysis aims to evaluate the dose-response relationship between body mass index (BMI) and poor outcome in patients with COVID-19.
    METHODS: A systematic literature search was conducted using PubMed, Europe PMC, ProQuest, and the Cochrane Central Database. The primary outcome was composite poor outcome composed of mortality and severity. The secondary outcomes were mortality and severity.
    RESULTS: A total of 34,390 patients from 12 studies were included in this meta-analysis. The meta-analysis demonstrated that obesity was associated with composite poor outcome (OR 1.73 [1.40, 2.14], P<0.001; I2: 55.6%), mortality (OR 1.55 [1.16, 2.06], P=0.003; I2: 74.4%), and severity (OR 1.90 [1.45, 2.48], P<0.001; I2: 5.2%) in patients with COVID-19. A pooled analysis of highest BMI versus reference BMI indicate that a higher BMI in the patients was associated with composite poor outcome (aOR 3.02 [1.82, 5.00], P<0.001; I2: 59.8%), mortality (aOR 2.85 [1.17, 6.92], P=0.002; I2: 79.7%), and severity (aOR 3.08 [1.78, 5.33], P<0.001; I2: 11.7%). The dose-response meta-analysis showed an increased risk of composite poor outcome by aOR of 1.052 [1.028, 1.077], P<0.001 for every 5kg/m2 increase in BMI (Pnon-linearity<0.001). The curve became steeper with increasing BMI.
    CONCLUSION: Dose-response meta-analysis demonstrated that increased BMI was associated with increased poor outcome in patients with COVID-19.
    Keywords:  Body Mass Index; Coronavirus; Obesity; SARS-CoV-2; Weight
    DOI:  https://doi.org/10.1016/j.diabet.2020.07.005
  10. Clin Cardiol. 2020 Aug 05.
    Association of angiotensin converting enzyme inhibitors and angiotensin II receptor blockers with risk of COVID-19, inflammation level, severity, and death in patients with COVID-19: A rapid systematic review and meta-analysis.
    Xiao Liu, Chuyan Long, Qinmei Xiong, Chen Chen, Jianyong Ma, Yuhao Su, Kui Hong.
      An association among the use of angiotensin converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) with the clinical outcomes of coronavirus disease 2019 (COVID-19) is unclear. PubMed, EMBASE, MedRxiv, and BioRxiv were searched for relevant studies that assessed the association between application of ACEI/ARB and risk of COVID-19, inflammation level, severity COVID-19 infection, and death in patients with COVID-19. Eleven studies were included with 33 483 patients. ACEI/ARB therapy might be associated with the reduced inflammatory factor (interleukin-6) and elevated immune cells counts (CD3, CD8). Meta-analysis showed no significant increase in the risk of COVID-19 infection (odds ratio [OR]: 0.95, 95%CI: 0.89-1.05) in patients receiving ACEI/ARB therapy, and ACEI/ARB therapy was associated with a decreased risk of severe COVID-19 (OR: 0.75, 95%CI: 0.59-0.96) and mortality (OR: 0.52, 95%CI: 0.35-0.79). Subgroup analyses showed among the general population, ACEI/ARB therapy was associated with reduced severe COVID-19 infection (OR: 0.79, 95%CI: 0.60-1.05) and all-cause mortality (OR: 0.31, 95%CI: 0.13-0.75), and COVID-19 infection (OR: 0.85, 95% CI: 0.66-1.08) were not increased. Among patients with hypertension, the use of an ACEI/ARB was associated with a lower severity of COVID-19 (OR: 0.73, 95%CI: 0.51-1.03) and lower mortality (OR: 0.57, 95%CI: 0.37-0.87), without evidence of an increased risk of COVID-19 infection (OR: 1.00). On the basis of the available evidence, ACEI/ARB therapy should be continued in patients who are at risk for, or have COVID-19, either in general population or hypertension patients. Our results need to be interpreted with caution considering the potential for residual confounders, and more well-designed studies that control the clinical confounders are necessary to confirm our findings.
    Keywords:  ACEI/ARB; COVID-19; SARS-COV-2; hypertension; infectious disease; lung; pneumonia
    DOI:  https://doi.org/10.1002/clc.23421
  11. J Med Virol. 2020 Aug 04.
    The effect of smoking on COVID-19 severity: a systematic review and meta-analysis.
    Rohin K Reddy, Walton N Charles, Alexandros Sklavounos, Atul Dutt, Paul T Seed, Ankur Khajuria.
       BACKGROUND: Various comorbidities represent risk factors for severe COVID-19. The impact of smoking on COVID-19 severity has been previously reported in several meta-analyses limited by small sample sizes and poor methodology. We aimed to rigorously and definitively quantify the effects of smoking on COVID-19 severity.
    METHODS: MEDLINE, Embase, CENTRAL and Web of Science were searched between December 1, 2019 and June 2, 2020. Studies reporting smoking status of hospitalised patients with different severities of disease and/or at least one clinical endpoint of interest (disease progression, ICU admission, need for mechanical ventilation and mortality) were included. Data were pooled using a random effects model. This study was registered on PROSPERO: CRD42020180920.
    FINDINGS: We analysed 47 eligible studies reporting on 32,849 hospitalised COVID-19 patients, with 8417 (25·6%) reporting a smoking history, comprising 1501 current smokers, 5676 former smokers and 1240 unspecified smokers. Current smokers had an increased risk of severe COVID-19 (RR 1·80, 95% CI 1·14-2·85; p=0·012), and severe or critical COVID-19 (1·98, 1·16-3·38; p=0·012). Patients with a smoking history had a significantly increased risk of severe COVID-19 (1·31, 1·12-1·54; p=0·001), severe or critical COVID-19 (1·35, 1·19-1·53; p<0·0001), in-hospital mortality (1·26, 1·20-1·32; p<0·0001), disease progression (2·18, 1·06-4·49; p=0·035), and need for mechanical ventilation (1·20, 1·01-1·42; p=0·043).
    CONCLUSIONS: Patients with any smoking history are vulnerable to severe COVID-19 and worse in-hospital outcomes. In the absence of current targeted therapies, preventative and supportive strategies to reduce morbidity and mortality in current and former smokers are crucial. This article is protected by copyright. All rights reserved.
    Keywords:  Coronavirus < Virus classification; Pandemics < Epidemiology; Respiratory tract < Pathogenesis; Zoonoses < Epidemiology
    DOI:  https://doi.org/10.1002/jmv.26389
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