bims-covirf 2021-01-10 papers

bims-covirf

Biomed News

on COVID19 risk factors

Issue of 2021–01–10
nine papers selected by
Catherine Rycroft, BresMed

The Clinical Characteristics and Risk Factors of Severe COVID-19.
Age, Comorbid Conditions, and Racial Disparities in COVID-19 Outcomes.
Inflammatory and hematologic markers as predictors of severe outcomes in COVID-19 infection: A systematic review and meta-analysis.
Risk factors associated with mortality of COVID-19 in 3125 counties of the United States.
The Relationship Between Social Determinants of Health and Racial Disparities in COVID-19 Mortality.
Risk Factors Associated With All-Cause 30-Day Mortality in Nursing Home Residents With COVID-19.
Clinical characteristics and predictors of mortality in young adults with severe COVID-19: a retrospective observational study.
Obesity is Associated with Poor Covid-19 Outcomes: A Systematic Review and Meta-Analysis.
Obesity Increases the Severity and Mortality of Influenza and COVID-19: A Systematic Review and Meta-Analysis.

Gerontology. 2021 Jan 06. 1-12

The Clinical Characteristics and Risk Factors of Severe COVID-19.

Jianhua Hu, Yanggan Wang.

   OBJECTIVE: We aim to investigate the clinical characteristics and risk factors for the severe cases of coronavirus disease 2019 (COVID-19) in comparison with the non-severe patients.
METHODS: We searched PubMed, EMBASE, Web of Science, and CNKI to collect all relevant studies published before July 26, 2020, and a total of 30 papers were included in this meta-analysis.
RESULTS: In the severe COVID-19 patients, 60% (95% CI = 56-64%) were male, 25% (95% CI = 21-29%) were over 65 years old, 34% (95% CI = 24-44%) were obese, and 55% (95% CI = 41-70%) had comorbidities. The most prevalent comorbidities were hypertension (34%, 95% CI = 25-44%), diabetes (20%, 95% CI = 15-25%), and cardiovascular disease (CVD; 12%, 95% CI = 9-16%). The most common blood test abnormalities were elevated C-reactive protein (CRP; 87%, 82-92%), decreased lymphocyte count (68%, 58-77%), and increased lactate dehydrogenase (69%, 95% CI = 57-81%). In addition, abnormal laboratory findings revealing organ dysfunctions were frequently observed in the severe cases, including decrease in albumin (43%, 95% CI = 24-63%) and increase in aspartate aminotransferase (47%, 95% CI = 38-56%), alanine aminotransferase (28%, 95% CI = 16-39%), troponin I/troponin T (TnI/TnT; 29%, 95% CI = 13-45%), and serum Cr (SCr; 10%, 95% CI = 5-15%).
CONCLUSION: The male, elderly and obese patients and those with any comorbidities, especially with hypertension, diabetes, and CVD, were more likely to develop into severe cases. But the association between hypertension, diabetes, CVD, and severity of COVID-19 was declined by the increase of age. A significant elevation in cardiac TnI/TnT, the hepatic enzymes, and SCr and the reduction in lymphocytes with elevated CRPs are important markers for the severity. Specific attention should be given to the elderly male and obese patients and those with indications of severe immune injury in combination with bacterial infection and indication of multi-organ dysfunction or damages.

Keywords:  2019-nCoV; Coronavirus; Coronavirus disease 2019; Pandemic; Severe acute respiratory syndrome-CoV-2

DOI:  https://doi.org/10.1159/000513400
J Racial Ethn Health Disparities. 2021 Jan 07.

Age, Comorbid Conditions, and Racial Disparities in COVID-19 Outcomes.

Zanthia Wiley, Julianne N Kubes, Jason Cobb, Jesse T Jacob, Nicole Franks, Laura Plantinga, Janice Lea.

   BACKGROUND: Black patients are disproportionately affected by COVID-19. The purpose of this study was to compare risks of hospitalization of Black and non-Black COVID-19 patients presenting to the emergency department and, of those hospitalized, to compare mortality and acute kidney injury.
METHODS: A retrospective cohort of 831 adult COVID-19 patients (68.5% Black) who presented to the emergency departments of four academic hospitals, March 1, 2020-May 31, 2020. The primary outcome was risk of hospitalization among Blacks vs. non-Blacks. Secondary outcomes were mortality and acute kidney injury, among hospitalized patients.
RESULTS: The crude odds of hospitalization were not different in Black vs. non-Black patients; however, with adjustment for age, Blacks had 55% higher odds of hospitalization. Mortality differed most in the model adjusted for age alone. Acute kidney injury was more common in the Black hospitalized patients, regardless of adjustment. Stratified analyses suggested that disparities in the risk of hospitalization and of in-hospital acute kidney injury were highest in the youngest patients.
CONCLUSIONS: Our report shows that Black and non-Black patients presenting to the emergency department with COVID-19 had similar risks of hospitalization and, of those who were hospitalized, similar mortality when adjusted for multiple factors. Blacks had higher risk of acute kidney injury. Our results suggest that examination of disparities without exploration of the individual effects of age and comorbidities may mask important patterns. While stratified analyses suggest that disparities in outcomes may differ substantially by age and comorbid conditions, further exploration among these important subgroups is needed to better target interventions to reduce disparities in COVID-19 clinical outcomes.

Keywords:  Acute kidney injury; Age; COVID-19; Comorbidities; Disparities; Race

DOI:  https://doi.org/10.1007/s40615-020-00934-0
Am J Emerg Med. 2020 Dec 30. pii: S0735-6757(20)31196-7. [Epub ahead of print]41 110-119

Inflammatory and hematologic markers as predictors of severe outcomes in COVID-19 infection: A systematic review and meta-analysis.

Timotius Ivan Hariyanto, Karunia Valeriani Japar, Felix Kwenandar, Vika Damay, Jeremia Immanuel Siregar, Nata Pratama Hardjo Lugito, Margaret Merlyn Tjiang, Andree Kurniawan.

   BACKGROUND: Laboratory testing is commonly performed in patients with COVID-19. Each of the laboratory parameters has potential value for risk stratification and prediction of COVID-19 outcomes. This systematic review and meta-analysis aimed to evaluate the difference between these parameters in severe and nonsevere disease and to provide the optimal cutoff value for predicting severe disease.
METHOD: We performed a systematic literature search through electronic databases. The variables of interest were serum procalcitonin, albumin, C-reactive protein (CRP), D-dimer, and lactate dehydrogenase (LDH) levels in each group of severity outcomes from COVID-19.
RESULTS: There were a total of 4848 patients from 23 studies. Our meta-analysis suggest that patients with severe COVID-19 infections have higher procalcitonin, (mean difference 0.07; 95% CI 0.05-0.10; p < 0.00001), CRP (mean difference 36.88; 95% CI 29.10-44.65; p < 0.00001), D-Dimer (mean difference 0.43; 95% CI 0.31-0.56; p < 0.00001), and LDH (mean difference 102.79; 95% CI 79.10-126.49; p < 0.00001) but lower levels of albumin (mean difference -4.58; 95% CI -5.76 to -3.39; p < 0.00001) than those with nonsevere COVID-19 infections. The cutoff values for the parameters were 0.065 ng/mL for procalcitonin, 38.85 g/L for albumin, 33.55 mg/L for CRP, 0.635 μ/L for D-dimer, and 263.5 U/L for LDH, each with high sensitivity and specificity.
CONCLUSION: This meta-analysis suggests elevated procalcitonin, CRP, D-dimer, and LDH and decreased albumin can be used for predicting severe outcomes in COVID-19.

Keywords:  Biomarker; COVID-19; Coronavirus; Laboratory; SARS-CoV-2

DOI:  https://doi.org/10.1016/j.ajem.2020.12.076
Infect Dis Poverty. 2021 Jan 04. 10(1): 3

Risk factors associated with mortality of COVID-19 in 3125 counties of the United States.

Ting Tian, Jingwen Zhang, Liyuan Hu, Yukang Jiang, Congyuan Duan, Zhongfei Li, Xueqin Wang, Heping Zhang.

   BACKGROUND: The number of cumulative confirmed cases of COVID-19 in the United States has risen sharply since March 2020. A county health ranking and roadmaps program has been established to identify factors associated with disparity in mobility and mortality of COVID-19 in all counties in the United States. The risk factors associated with county-level mortality of COVID-19 with various levels of prevalence are not well understood.
METHODS: Using the data obtained from the County Health Rankings and Roadmaps program, this study applied a negative binomial design to the county-level mortality counts of COVID-19 as of August 27, 2020 in the United States. In this design, the infected counties were categorized into three levels of infections using clustering analysis based on time-varying cumulative confirmed cases from March 1 to August 27, 2020. COVID-19 patients were not analyzed individually but were aggregated at the county-level, where the county-level deaths of COVID-19 confirmed by the local health agencies. Clustering analysis and Kruskal-Wallis tests were used in our statistical analysis.
RESULTS: A total of 3125 infected counties were assigned into three classes corresponding to low, median, and high prevalence levels of infection. Several risk factors were significantly associated with the mortality counts of COVID-19, where higher level of air pollution (0.153, P < 0.001) increased the mortality in the low prevalence counties and elder individuals were more vulnerable in both the median (0.049, P < 0.001) and high (0.114, P < 0.001) prevalence counties. The segregation between non-Whites and Whites (low: 0.015, P < 0.001; median:0.025, P < 0.001; high: 0.019, P = 0.005) and higher Hispanic population (low and median: 0.020, P < 0.001; high: 0.014, P = 0.009) had higher likelihood of risk of the deaths in all infected counties.
CONCLUSIONS: The mortality of COVID-19 depended on sex, race/ethnicity, and outdoor environment. The increasing awareness of the impact of these significant factors may help decision makers, the public health officials, and the general public better control the risk of pandemic, particularly in the reduction in the mortality of COVID-19.

Keywords:  Adverse health factors; County-level confirmed and deaths; Physical environment; Race/ethnicity; Segregation index

DOI:  https://doi.org/10.1186/s40249-020-00786-0
J Racial Ethn Health Disparities. 2021 Jan 05.

The Relationship Between Social Determinants of Health and Racial Disparities in COVID-19 Mortality.

Ankur K Dalsania, Matthew J Fastiggi, Aaron Kahlam, Rajvi Shah, Krishan Patel, Stephanie Shiau, Slawa Rokicki, Michelle DallaPiazza.

   BACKGROUND: The COVID-19 pandemic has magnified existing health disparities for marginalized populations in the United States (U.S.), particularly among Black Americans. Social determinants of health are powerful drivers of health outcomes that could influence COVID-19 racial disparities.
METHODS: We collected data from publicly available databases on COVID-19 death rates through October 28, 2020, clinical covariates, and social determinants of health indicators at the U.S. county level. We utilized negative binomial regression to assess the association between social determinants of health and COVID-19 mortality focusing on racial disparities in mortality.
RESULTS: Counties with higher death rates had a higher proportion of Black residents and greater levels of adverse social determinants of health. A one percentage point increase in percent Black residents, percent uninsured adults, percent low birthweight, percent adults without high school diploma, incarceration rate, and percent households without internet in a county increased COVID-19 death rates by 0.9% (95% CI 0.5%-1.3%), 1.9% (95% CI 1.1%-2.7%), 7.6% (95% CI 4.4%-11.0%), 3.5% (95% CI 2.5%-4.5%), 5.4% (95% CI 1.3%-9.7%), and 3.4% (95% CI 2.5%-4.2%), respectively. Counties in the lowest quintile of a measure of economic privilege had an increased COVID-19 death rates of 67.5% (95% CI 35.9%-106.6%). Multivariate regression and subgroup analyses suggested that adverse social determinants of health may partially explain racial disparities in COVID-19 mortality.
CONCLUSIONS: This study demonstrates that social determinants of health contribute to COVID-19 mortality for Black Americans at the county level, highlighting the need for public health policies that address racial disparities in health outcomes.

Keywords:  COVID-19; Communicable diseases; Epidemiology; Health inequalities; Social determinants of health

DOI:  https://doi.org/10.1007/s40615-020-00952-y
JAMA Intern Med. 2021 Jan 04.

Risk Factors Associated With All-Cause 30-Day Mortality in Nursing Home Residents With COVID-19.

Orestis A Panagiotou, Cyrus M Kosar, Elizabeth M White, Leonidas E Bantis, Xiaofei Yang, Christopher M Santostefano, Richard A Feifer, Carolyn Blackman, James L Rudolph, Stefan Gravenstein, Vincent Mor.

Importance: The coronavirus disease 2019 (COVID-19) pandemic has severely affected nursing homes. Vulnerable nursing home residents are at high risk for adverse outcomes, but improved understanding is needed to identify risk factors for mortality among nursing home residents.
Objective: To identify risk factors for 30-day all-cause mortality among US nursing home residents with COVID-19.
Design, Setting, and Participants: This cohort study was conducted at 351 US nursing homes among 5256 nursing home residents with COVID-19-related symptoms who had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection confirmed by polymerase chain reaction testing between March 16 and September 15, 2020.
Exposures: Resident-level characteristics, including age, sex, race/ethnicity, symptoms, chronic conditions, and physical and cognitive function.
Main Outcomes and Measures: Death due to any cause within 30 days of the first positive SARS-CoV-2 test result.
Results: The study included 5256 nursing home residents (3185 women [61%]; median age, 79 years [interquartile range, 69-88 years]; and 3741 White residents [71%], 909 Black residents [17%], and 586 individuals of other races/ethnicities [11%]) with COVID-19. Compared with residents aged 75 to 79 years, the odds of death were 1.46 (95% CI, 1.14-1.86) times higher for residents aged 80 to 84 years, 1.59 (95% CI, 1.25-2.03) times higher for residents aged 85 to 89 years, and 2.14 (95% CI, 1.70-2.69) times higher for residents aged 90 years or older. Women had lower risk for 30-day mortality than men (odds ratio [OR], 0.69 [95% CI, 0.60-0.80]). Two comorbidities were associated with mortality: diabetes (OR, 1.21 [95% CI, 1.05-1.40]) and chronic kidney disease (OR, 1.33 [95%, 1.11-1.61]). Fever (OR, 1.66 [95% CI, 1.41-1.96]), shortness of breath (OR, 2.52 [95% CI, 2.00-3.16]), tachycardia (OR, 1.31 [95% CI, 1.04-1.64]), and hypoxia (OR, 2.05 [95% CI, 1.68-2.50]) were also associated with increased risk of 30-day mortality. Compared with cognitively intact residents, the odds of death among residents with moderate cognitive impairment were 2.09 (95% CI, 1.68-2.59) times higher, and the odds of death among residents with severe cognitive impairment were 2.79 (95% CI, 2.14-3.66) times higher. Compared with residents with no or limited impairment in physical function, the odds of death among residents with moderate impairment were 1.49 (95% CI, 1.18-1.88) times higher, and the odds of death among residents with severe impairment were 1.64 (95% CI, 1.30-2.08) times higher.
Conclusions and Relevance: In this cohort study of US nursing home residents with COVID-19, increased age, male sex, and impaired cognitive and physical function were independently associated with mortality. Understanding these risk factors can aid in the development of clinical prediction models of mortality in this population.

DOI: https://doi.org/10.1001/jamainternmed.2020.7968
Ann Clin Microbiol Antimicrob. 2021 Jan 06. 20(1): 3

Clinical characteristics and predictors of mortality in young adults with severe COVID-19: a retrospective observational study.

Yanjiao Lu, Zhenli Huang, Meijia Wang, Kun Tang, Shanshan Wang, Pengfei Gao, Jungang Xie, Tao Wang, Jianping Zhao.

   BACKGROUND AND OBJECTIVE: Little is yet known whether pathogenesis of COVID-19 is different between young and elder patients. Our study aimed to investigate the clinical characteristics and provide predictors of mortality for young adults with severe COVID-19.
METHODS: A total of 77 young adults with confirmed severe COVID-19 were recruited retrospectively at Tongji Hospital. Clinical characteristics, laboratory findings, treatment and outcomes were obtained from electronic medical records. The prognostic effects of variables were analyzed using logistic regression model.
RESULTS: In this retrospective cohort, non-survivors showed higher incidence of dyspnea and co-existing laboratory abnormalities, compared with young survivals in severe COVID-19. Multivariate logistic regression analysis showed that lymphopenia, elevated level of d-dimer, hypersensitive cardiac troponin I (hs-CTnI) and high sensitivity C-reactive protein (hs-CRP) were independent predictors of mortality in young adults with severe COVID-19. Further analysis showed that severely young adults with two or more factors abnormalities above would be more prone to death. The similar predictive effect of above four factors had been observed in all-age patients with severe COVID-19.
CONCLUSION: Lymphopenia, elevated level of d-dimer, hs-CTnI and hs-CRP predicted clinical outcomes of young adults with severe COVID-19.

Keywords:  COVID-19; Predictors; SARS-CoV-2; Severe; Young adults

DOI:  https://doi.org/10.1186/s12941-020-00412-9
Horm Metab Res. 2021 Jan 04.

Obesity is Associated with Poor Covid-19 Outcomes: A Systematic Review and Meta-Analysis.

Caroline Wei Shan Hoong, Ikram Hussain, Veeraraghavan Meyyur Aravamudan, Ei Ei Phyu, Jaime Hui Xian Lin, Huilin Koh.

Our aim was to assess the association between obesity and the risk of unfavourable outcomes (composite of severe disease and mortality) in inpatients with COVID-19. We conducted a systematic search of databases between December 2019 and 28th June 2020. Studies were included if they reported or allowed estimation of an odds ratio (OR) for unfavourable outcome in obese compared to non-obese patients hospitalised for COVID-19. Twenty cohort studies of 28 355 hospitalised patients with COVID-19 infection were included. Meta-analysis estimated a pooled OR of 2.02 (1.41-2.89, p<0.001) for an unfavourable outcome in obese versus non-obese patients when adjusted for age, sex and co-morbidities. When unadjusted for confounders, the OR for unfavourable outcomes was 1.25 (CI 1.07-1.45, p=0.005). An increased adjusted OR was also seen for death (OR 1.51; CI 1.13-2.21, p=0.006) and severe illness (OR 2.26; CI 1.47-3.48, p<0.001). Compared to a normal BMI, the risk of an unfavourable outcome was increased even in overweight patients, with severe obesity having an escalated risk.Obesity is independently associated with an unfavourable outcome of COVID-19 illness, with obese patients having twice the risk of a composite outcome of severe disease or mortality, and a 50% increased risk of death.

DOI: https://doi.org/10.1055/a-1326-2125
Front Endocrinol (Lausanne). 2020 ;11 595109

Obesity Increases the Severity and Mortality of Influenza and COVID-19: A Systematic Review and Meta-Analysis.

Xue Zhao, Xiaokun Gang, Guangyu He, Zhuo Li, You Lv, Qing Han, Guixia Wang.

  Since December 2019, COVID-19 has aroused global attention. Studies show the link between obesity and severe outcome of influenza and COVID-19. Thus, we aimed to compare the impacts of obesity on the severity and mortality of influenza and COVID-19 by performing a meta-analysis. A systematic search was performed in MEDLINE, EMASE, ClinicalTrials.gov, and Web of Science from January 2009 to July 2020. The protocol was registered onto PROSPERO (CRD42020201461). After selection, 46 studies were included in this meta-analysis. The pooled odds ratios (ORs) with 95% confidence intervals (CIs) were analyzed. We found obesity was a risk factor for the severity and mortality of influenza (ORsevere outcome = 1.56, CI: 1.28-1.90; ORmortality = 1.99, CI: 1.15-3.46). For COVID-19, obesity was a significant risk factor only for severe outcome (OR = 2.07, CI: 1.53-2.81) but not for mortality (OR = 1.57, CI: 0.85-2.90). Compared with obesity, morbid obesity was linked with a higher risk for the severity and mortality of both influenza (OR = 1.40, CI: 1.10-1.79) and COVID-19 (OR = 3.76, CI: 2.67-5.28). Thus, obesity should be recommended as a risk factor for the prognosis assessment of COVID-19. Special monitoring and earlier treatment should be implemented in patients with obesity and COVID-19.

Keywords:  COVID-19; influenza; mortality; obesity; severe outcome

DOI:  https://doi.org/10.3389/fendo.2020.595109