bims-covirf Biomed News
on COVID19 risk factors
Issue of 2021–02–07
seven papers selected by
Catherine Rycroft, BresMed
  1. The Association between Presence of Comorbidities and COVID-19 Severity: A Systematic Review and Meta-Analysis.
  2. Clinical Characteristics and Predictors of Mortality in Minority Patients Hospitalized with COVID-19 Infection.
  3. Risk Factors for Severe COVID-19 in Children.
  4. A meta-meta-analysis: Evaluation of meta-analyses published in the effectiveness of cardiovascular comorbidities on the severity of COVID-19.
  5. Clinical characteristics and outcomes in women and men hospitalized for coronavirus disease 2019 in New Orleans.
  6. Prevalence of Underlying Medical Conditions Associated with Severe COVID-19 Illness in Adult Cancer Survivors in the United States.
  7. High body mass index is a significant risk factor for the progression and prognosis of imported COVID-19: a multicenter, retrospective cohort study.
  1. Cerebrovasc Dis. 2021 Feb 02. 1-9
    The Association between Presence of Comorbidities and COVID-19 Severity: A Systematic Review and Meta-Analysis.
    Maryam Honardoost, Laila Janani, Rokhsareh Aghili, Zahra Emami, Mohammad E Khamseh.
       AIM: Several studies reported the accompaniment of severe COVID-19 with comorbidities. However, there is not a systematic evaluation of all aspects of this association. Therefore, this meta-analysis aimed to assess the association between all underlying comorbidities in COVID-19 infection severity.
    METHODS: Electronic literature search was performed via scientific search engines. After the removal of duplicates and selection of articles of interest, 28 studies were included. A fixed-effects model was used; however, if heterogeneity was high (I2 > 50%) a random-effects model was applied to combine the data.
    RESULTS: A total of 6,270 individuals were assessed (1,615 severe and 4,655 non-severe patients). The median age was 63 (95% confidence interval [CI]: 49-74) and 47 (95% CI: 19-63) years in the severe and non-severe groups, respectively. Moreover, about 41% of patients had comorbidities. Severity was higher in patients with a history of cerebrovascular disease: OR 4.85 (95% CI: 3.11-7.57). The odds of being in a severe group increase by 4.81 (95% CI: 3.43-6.74) for a history of cardiovascular disease (CVD). This was 4.19 (95% CI: 2.84-6.19) for chronic lung disease and 3.18, 95% CI: 2.09-4.82 for cancer. The odds ratios of diabetes and hypertension were 2.61 (95% CI: 2.02-3.3) and 2.37 (95% CI: 1.80-3.13), respectively.
    CONCLUSIONS: The presence of comorbidities is associated with severity of COVID-19 infection. The strongest association was observed for cerebrovascular disease, followed by CVD, chronic lung disease, cancer, diabetes, and hypertension.
    Keywords:  COVID-19; Cardiovascular disorders; Cerebrovasular disease; Comorbid conditions; Disease severity
    DOI:  https://doi.org/10.1159/000513288
  2. J Racial Ethn Health Disparities. 2021 Feb 04.
    Clinical Characteristics and Predictors of Mortality in Minority Patients Hospitalized with COVID-19 Infection.
    Rizwan Muhammad, Richard Ogunti, Basharat Ahmed, Muhammad Munawar, Sahai Donaldson, Mahbubur Sumon, Angesom Kibreab, Alicia N Thomas, Alem Mehari.
       OBJECTIVES: To identify the early mortality predictors in minority patients hospitalized with coronavirus disease 2019 (COVID-19).
    DESIGN: Demographics, presenting characteristics, admission laboratory data, ICU admission, and mortality data were collected from 200 consecutively hospitalized patients with COVID-19.
    RESULTS: The mean (SD) age was 58.9 (15.1) years, 121(60.5%) were men, 143 (71.5%) were African Americans, and 33 (16.5%) were Latino. Common presenting symptoms were cough 130 (65.0%), shortness of breath 129 (64.5%), and fever 121 (60.5%). One or more comorbid illness occurred in 171 (85.5%) and common comorbidities were hypertension (130 (65.2%)), diabetes (100 (50.0%)) and chronic kidney disease (60 (30.0%)). Of the 200 patients, 71 (35.5%) were treated in the ICU, 47 (24.2%) received mechanical ventilation, 45 (22.5%) died, and 155(77.5%) patients discharged home alive. The non-survivors were significantly older and had elevated markers of inflammation, coagulation, and acute organ damage on presentation. Age ≥ 65 years (odds ratio (OR), 3.78; 95% CI, 1.74-8.22; P = .001), lactate dehydrogenase level > 400 IU/L (OR, 9.1; 95% CI, 2.97-28.1; p < 0.001), C-reactive protein > 20 mg/dl (OR, 5.56; 95%CI, 1.84-16.8; p < 0.001), ferritin > 2000 ng/ml (OR, 5.42; 95%CI, 1.63-17.9; p = 0.006), creatinine kinase > 1000 iu/l (OR, 3.57; 95% CI, 1.23 10.3; p = 0.019), procalcitonin > 2.5 ng/ml (OR, 4.21; 95% CI, 1.47-12.0; p = 0.007), D-dimer level > 3.0 μg/ml (OR,10.9; 95% CI, 3.33-36.2; p = < 0.001), creatinine > 2 mg/dl (OR, 4.5; 95% CI, 1.29-15.8; P = 0.018) at admission were associated independently with increases risk of in-hospital mortality.
    CONCLUSION: Patients of advanced age that present with elevated biomarkers of inflammation, coagulation, and end-organ damage were at higher risk of mortality.
    Keywords:  COVID-19; Inflammation; Minority; Mortality; Thrombosis
    DOI:  https://doi.org/10.1007/s40615-020-00961-x
  3. Pediatr Infect Dis J. 2021 Feb 01.
    Risk Factors for Severe COVID-19 in Children.
    Kelly Graff, Christiana Smith, Lori Silveira, Sarah Jung, Shane Curran-Hays, Jane Jarjour, Lauren Carpenter, Kasey Pickard, Michael Mattiucci, JoEllen Fresia, Elizabeth J McFarland, Samuel R Dominguez, Lisa Abuogi.
       BACKGROUND: There are limited pediatric data regarding severe COVID-19 disease. Our study aims to describe the epidemiology and identify risk factors for severe COVID-19 disease in children.
    METHODS: This is a retrospective cohort study among children with positive SARS-CoV-2 PCR from March to July 2020 at Children's Hospital Colorado. Risk factors for severe disease were analyzed as defined by hospital admission, respiratory support, or critical care. Univariable and multivariable analyses were conducted.
    RESULTS: Among 454 patients identified with SARS-CoV-2, 191 (42.1%) were females, median age 11 years. Fifty-five percent of all patients identified as Hispanic compared with 29% among all hospital visits in 2019 (P < 0.0001). In multivariable analyses, age 0-3 months or >20 years [adjusted odds ratio (aOR), 7.85; P < 0.0001 and aOR, 5.1; P = 0.03, respectively], preterm birth history (aOR, 3.7; P = 0.03), comorbidities [including immunocompromise (aOR, 3.5; P = 0.004), gastrointestinal condition (aOR, 2.7; P = 0.009), diabetes (aOR, 6.6; P = 0.04), asthma (aOR, 2.2; P = 0.04)], and specific symptoms at presentation were predictors for admission. Age 0-3 months or >20 years, asthma, gastrointestinal condition, and similar symptoms at presentation were also predictors for respiratory support. Elevated C-reactive protein was associated with the need for critical care with median of 17.7 mg/dL (IQR, 5.3-22.9) versus 1.95 mg/dL (IQR, 0.7-5.5) among patients requiring critical versus no critical care (OR, 1.2; P = 0.02).
    CONCLUSIONS: Extremes of age, comorbid conditions, and elevated CRP are predictors of severe disease in children. Findings from this study can inform pediatric providers and public health officials to tailor clinical management, pandemic planning, and resource allocation.
    DOI:  https://doi.org/10.1097/INF.0000000000003043
  4. Obes Med. 2021 Mar;22 100323
    A meta-meta-analysis: Evaluation of meta-analyses published in the effectiveness of cardiovascular comorbidities on the severity of COVID-19.
    Mehri Bemani Naeini, Mahdieh Sahebi, Fateme Nikbakht, Zahra Jamshidi, Mahnaz Ahmadimanesh, Maryam Hashemi, Javad Ramezani, Hamid Heidarian Miri, Rezvan Yazdian-Robati.
      On January 2020, WHO confirmed the epidemic outbreak of SARS-CoV-2 as a Health Emergency of International Concern. The aim of this meta-meta-analysis is quantifying meta-analytic findings on the association of cardiovascular disease (CVD) comorbidities and COVID-19 severity. Findings suggest that chances of getting severe COVID-19 disease in patients with CVD is greater than those without CVD. Also, prevalence of CVD in patents with COVID-19 is 0.08 (95% CI = 0.07-0.08). The OR as 3.44 indicates that the odds of getting severe COVID-19 is more than 3 times higher in those with CVD. Also, prevalence of hypertension in patient with COVID-19 is 0.27 (95%CI = 0.27-0.28) and the OR as 2.68 indicates that the odds of getting severe COVID-19 in cases with high blood pressure is more than 2.5 times higher than those without hypertension. It is rational to suppose that persons with coronary artery disease are prone to severe viral infection thereby, guideline-directed diagnosis and medical therapy is vital in CVD patients.
    Keywords:  ACE2, angiotensin converting enzyme 2; ACS, Acute coronary syndrome; ARDS, Acute respiratory distress syndrome; CHD, Coronary heart disease; COVID-19; COVID-19, Coronavirus disease-2019; CVD, Cardiovascular disease; Cardiovascular; Clinical characteristics; Heart damage; Hypertension; ICU, Intensive care unit; Meta-meta-analysis; NHC, National Health Commission of China; Prevalent comorbidity; SARS-CoV-2; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; Underlying disease
    DOI:  https://doi.org/10.1016/j.obmed.2021.100323
  5. Biol Sex Differ. 2021 Feb 05. 12(1): 20
    Clinical characteristics and outcomes in women and men hospitalized for coronavirus disease 2019 in New Orleans.
    Yilin Yoshida, Scott A Gillet, Margo I Brown, Yuanhao Zu, Sarah M Wilson, Sabreen J Ahmed, Saritha Tirumalasetty, Dragana Lovre, Marie Krousel-Wood, Joshua L Denson, Franck Mauvais-Jarvis.
       OBJECTIVES: Determine if sex differences exist in clinical characteristics and outcomes of adults hospitalized for coronavirus disease 2019 (COVID-19) in a US healthcare system.
    DESIGN: Case series study.
    SETTING AND PARTICIPANTS: Sequentially hospitalized adults admitted for COVID-19 at two tertiary care academic hospitals in New Orleans, LA, between 27 February and 15 July 2020.
    MEASURES AND OUTCOMES: Measures included demographics, comorbidities, presenting symptoms, and laboratory results. Outcomes included intensive care unit admission (ICU), invasive mechanical ventilation (IMV), and in-hospital death.
    RESULTS: We included 776 patients (median age 60.5 years; 61.4% women, 75% non-Hispanic Black). Rates of ICU, IMV, and death were similar in both sexes. In women versus men, obesity (63.8 vs 41.6%, P < 0.0001), hypertension (77.6 vs 70.1%, P = 0.02), diabetes (38.2 vs 31.8%, P = 0.06), chronic obstructive pulmonary disease (COPD, 22.1 vs 15.1%, P = 0.015), and asthma (14.3 vs 6.9%, P = 0.001) were more prevalent. More women exhibited dyspnea (61.2 vs 53.7%, P = 0.04), fatigue (35.7 vs 28.5%, P = 0.03), and digestive symptoms (39.3 vs 32.8%, P = 0.06) than men. Obesity was associated with IMV at a lower BMI (> 35) in women, but the magnitude of the effect of morbid obesity (BMI ≥ 40) was similar in both sexes. COPD was associated with ICU (adjusted OR (aOR), 2.6; 95%CI, 1.5-4.3) and IMV (aOR, 1.8; 95%CI, 1.2-3.1) in women only. Diabetes (aOR, 2.6; 95%CI, 1.2-2.9), chronic kidney disease (aOR, 2.2; 95%CI, 1.3-5.2), elevated neutrophil-to-lymphocyte ratio (aOR, 2.5; 95%CI, 1.4-4.3), and elevated ferritin (aOR, 3.6; 95%CI, 1.7-7.3) were independent predictors of death in women only. In contrast, elevated D-dimer was an independent predictor of ICU (aOR, 7.3; 95%CI, 2.7-19.5), IMV (aOR, 6.5; 95%CI, 2.1-20.4), and death (aOR, 4.5; 95%CI, 1.2-16.4) in men only.
    CONCLUSIONS: This study highlights sex disparities in clinical determinants of severe outcomes in COVID-19 patients that may inform management and prevention strategies to ensure gender equity.
    DOI:  https://doi.org/10.1186/s13293-021-00359-2
  6. J Natl Cancer Inst. 2021 Feb 03. pii: djab012. [Epub ahead of print]
    Prevalence of Underlying Medical Conditions Associated with Severe COVID-19 Illness in Adult Cancer Survivors in the United States.
    Changchuan Jiang, K Robin Yabroff, Lei Deng, Stuthi Perimbeti, Xuesong Han.
      Cancer, and other underlying medical conditions, including chronic obstructive pulmonary disease, heart diseases, diabetes, chronic kidney disease, and obesity, are associated with increased risk of severe COVID-19 illness. We identified 6,411 cancer survivors and 77,748 adults without a cancer history from the 2016-2018 National Health Interview Survey and examined the prevalence and sociodemographic factors associated with these conditions in the US. Most survivors reported having ≥1 of the conditions (56.4% [95% CI = 54.8% to 57.9%] vs 41.6% [95% CI = 40.9% to 42.2%] in adults without a cancer history) and nearly one-quarter (22.9%, 95% CI = 21.6% to 24.3%) reported ≥2, representing 8.7 million and 3.5 million cancer survivors, respectively. These conditions were more prevalent in survivors of kidney, liver and uterine cancers as well as Black survivors, those with low socioeconomic status, and public insurance. Findings highlight the need to protect survivors against COVID-19 transmission in health-care facilities and prioritize cancer patients, survivors, caregivers, and their health-care providers in vaccine allocation.
    DOI:  https://doi.org/10.1093/jnci/djab012
  7. BMC Infect Dis. 2021 Feb 05. 21(1): 147
    High body mass index is a significant risk factor for the progression and prognosis of imported COVID-19: a multicenter, retrospective cohort study.
    Huan Cai, Lisha Yang, Yingfeng Lu, Shanyan Zhang, Chanyuan Ye, Xiaoli Zhang, Guodong Yu, Jueqing Gu, Jiangshan Lian, Shaorui Hao, Jianhua Hu, Yimin Zhang, Ciliang Jin, Jifang Sheng, Yida Yang, Hongyu Jia.
       BACKGROUND: Coronavirus disease 2019(COVID-19) has spread worldwide. The present study aimed to characterize the clinical features and outcomes of imported COVID-19 patients with high body mass index (BMI) and the independent association of BMI with disease severity.
    METHODS: In this retrospective cohort study, 455 imported COVID-19 patients were admitted and discharged in Zhejiang province by February 28, 2020. Epidemiological, demographic, clinical, laboratory, radiological, treatment, and outcome data were collected, analyzed and compared between patients with BMI ≥ 24and < 24.
    RESULTS: A total of 268 patients had BMI < 24, and 187 patients had BMI ≥ 24. Those with high BMI were mostly men, had a smoking history, fever, cough, and sputum than those with BMI < 24. A large number of patients with BMI ≥ 24 were diagnosed as severe/critical types. Some biochemical indicators were significantly elevated in patients with BMI ≥ 24. Also, acute liver injury was the most common complication in these patients. The median days from illness onset to severe acute respiratory syndrome coronavirus 2 detection, duration of hospitalization, and days from illness onset to discharge were significantly longer in patients with BMI ≥ 24 than those with BMI < 24. High BMI, exposure to Wuhan, any coexisting medical condition, high temperature, C-reactive protein (CRP), and increased lactate dehydrogenase (LDH) were independent risk factors for severe/critical COVID-19. After adjusting for age, sex and above factors, BMI was still independently associated with progression to severe/critical illness (P = 0.0040). Hemoglobin, alanine aminotransferase (ALT), CRP, and serum creatinine (Scr) were independent risk factors associated with high BMI.
    CONCLUSIONS: Contrasted with the imported COVID-19 patients with BMI < 24, high proportion of COVID-19 patients with BMI ≥ 24 in our study, especially those with elevated CRP and LDH, developed to severe type, with longer hospitalization duration and anti-virus course. Thus, high BMI is a risk factor for the progression and prognosis of imported COVID-19.
    Keywords:  COVID-19; High BMI; Prognosis; Progression; Risk factor
    DOI:  https://doi.org/10.1186/s12879-021-05818-0
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