bims-covirf Biomed News
on COVID19 risk factors
Issue of 2021–02–28
eight papers selected by
Catherine Rycroft, BresMed
  1. Primary Care Relevant Risk Factors for Adverse Outcomes in Patients With COVID-19 Infection: A Systematic Review.
  2. Obesity and Mortality Among Patients Diagnosed With COVID-19: A Systematic Review and Meta-Analysis.
  3. Prevalence of comorbidity in Chinese patients with COVID-19: systematic review and meta-analysis of risk factors.
  4. Impact of cardiovascular diseases on severity of COVID-19 patients: A systematic review.
  5. Obesity in COVID-19 era, implications for mechanisms, comorbidities, and prognosis: a review and meta-analysis.
  6. Coronary heart disease and COVID-19: A meta-analysis.
  7. Association of smoking history with severe and critical outcome in COVID-19 patients: A systemic review and meta-analysis.
  8. Asthma in patients with coronavirus disease 2019: a systematic review and meta-analysis.
  1. J Am Board Fam Med. 2021 Feb;34(Suppl): S113-S126
    Primary Care Relevant Risk Factors for Adverse Outcomes in Patients With COVID-19 Infection: A Systematic Review.
    Michelle Bentivegna, Cassie Hulme, Mark H Ebell.
       BACKGROUND: The aim of this systematic review is to summarize the best available evidence regarding individual risk factors, simple risk scores, and multivariate models that use patient characteristics, vital signs, comorbidities, and laboratory tests relevant to outpatient and primary care settings.
    METHODS: Medline, WHO COVID-19, and MedRxIV databases were searched; studies meeting inclusion criteria were reviewed in parallel, and variables describing study characteristics, study quality, and risk factor data were abstracted. Study quality was assessed using the Quality in Prognostic Studies tool. Random effects meta-analysis of relative risks (categorical variables) and unstandardized mean differences (continuous variables) was performed; multivariate models and clinical prediction rules were summarized qualitatively.
    RESULTS: A total of 551 studies were identified and 22 studies were included. The median or mean age ranged from 38 to 68 years. All studies included only inpatients, and mortality rates ranged from 3.2% to 50.5%. Individual risk factors most strongly associated with mortality included increased age, c-reactive protein (CRP), d-dimer, heart rate, respiratory rate, lactate dehydrogenase, and procalcitonin as well as decreased oxygen saturation, the presence of dyspnea, and comorbid coronary heart and chronic kidney disease. Independent predictors of adverse outcomes reported most frequently by multivariate models include increasing age, increased CRP, decreased lymphocyte count, increased lactate dehydrogenase, elevated temperature, and the presence of any comorbidity. Simple risk scores and multivariate models have been proposed but are often complex, and most have not been validated.
    CONCLUSIONS: Our systematic review identifies several risk factors for adverse outcomes in COVID-19-infected inpatients that are often available in the outpatient and primary care settings: increasing age, increased CRP or procalcitonin, decreased lymphocyte count, decreased oxygen saturation, dyspnea on presentation, and the presence of comorbidities. Future research to develop clinical prediction models and rules should include these predictors as part of their core data set to develop and validate pragmatic outpatient risk scores.
    Keywords:  C-Reactive Protein; COVID-19; Clinical Prediction Rule; Comorbidity; Meta-Analysis; Prognosis; Risk Factors; Systematic Review
    DOI:  https://doi.org/10.3122/jabfm.2021.S1.200429
  2. Front Med (Lausanne). 2021 ;8 620044
    Obesity and Mortality Among Patients Diagnosed With COVID-19: A Systematic Review and Meta-Analysis.
    Tahmina Nasrin Poly, Md Mohaimenul Islam, Hsuan Chia Yang, Ming Chin Lin, Wen-Shan Jian, Min-Huei Hsu, Yu-Chuan Jack Li.
      Coronavirus disease 2019 (COVID-19) has already raised serious concern globally as the number of confirmed or suspected cases have increased rapidly. Epidemiological studies reported that obesity is associated with a higher rate of mortality in patients with COVID-19. Yet, to our knowledge, there is no comprehensive systematic review and meta-analysis to assess the effects of obesity and mortality among patients with COVID-19. We, therefore, aimed to evaluate the effect of obesity, associated comorbidities, and other factors on the risk of death due to COVID-19. We did a systematic search on PubMed, EMBASE, Google Scholar, Web of Science, and Scopus between January 1, 2020, and August 30, 2020. We followed Cochrane Guidelines to find relevant articles, and two reviewers extracted data from retrieved articles. Disagreement during those stages was resolved by discussion with the main investigator. The random-effects model was used to calculate effect sizes. We included 17 articles with a total of 543,399 patients. Obesity was significantly associated with an increased risk of mortality among patients with COVID-19 (RRadjust: 1.42 (95%CI: 1.24-1.63, p < 0.001). The pooled risk ratio for class I, class II, and class III obesity were 1.27 (95%CI: 1.05-1.54, p = 0.01), 1.56 (95%CI: 1.11-2.19, p < 0.01), and 1.92 (95%CI: 1.50-2.47, p < 0.001), respectively). In subgroup analysis, the pooled risk ratio for the patients with stroke, CPOD, CKD, and diabetes were 1.80 (95%CI: 0.89-3.64, p = 0.10), 1.57 (95%CI: 1.57-1.91, p < 0.001), 1.34 (95%CI: 1.18-1.52, p < 0.001), and 1.19 (1.07-1.32, p = 0.001), respectively. However, patients with obesity who were more than 65 years had a higher risk of mortality (RR: 2.54; 95%CI: 1.62-3.67, p < 0.001). Our study showed that obesity was associated with an increased risk of death from COVID-19, particularly in patients aged more than 65 years. Physicians should aware of these risk factors when dealing with patients with COVID-19 and take early treatment intervention to reduce the mortality of COVID-19 patients.
    Keywords:  COVID-19; SARS-CoV-2; body mass index (BMI); mortality; obesity
    DOI:  https://doi.org/10.3389/fmed.2021.620044
  3. BMC Infect Dis. 2021 Feb 22. 21(1): 200
    Prevalence of comorbidity in Chinese patients with COVID-19: systematic review and meta-analysis of risk factors.
    Tingxuan Yin, Yuanjun Li, Ying Ying, Zhijun Luo.
       BACKGROUND: Coronavirus disease 2019 (COVID-19) is an infectious disease characterized by cough, fever, and fatigue and 20% of cases will develop into severe conditions resulting from acute lung injury with the manifestation of the acute respiratory distress syndrome (ARDS) that accounts for more than 50% of mortality. Currently, it has been reported that some comorbidities are linked with an increased rate of severity and mortality among COVID-19 patients. To assess the role of comorbidity in COVID-19 progression, we performed a systematic review with a meta-analysis on the relationship of COVID-19 severity with 8 different underlying diseases.
    METHODS: PubMed, Web of Science, and CNKI were searched for articles investigating the prevalence of comorbidities in severe and non-severe COVID-19 patients. A total of 41 studies comprising 12,526 patients were included.
    RESULTS: Prevalence of some commodities was lower than that in general population such as hypertension (19% vs 23.2%), diabetes (9% vs 10.9%), chronic kidney disease (CKD) (2% vs 9.5%), chronic liver diseases (CLD) (3% vs 24.8%) and chronic obstructive pulmonary disease (COPD) (3% vs 8.6%), while some others including cancer (1% vs 0.6%), cardiovascular disease (6% vs 1.8%) and cerebrovascular disease (2% vs 0.9%) exhibited greater percentage in COVID-19. Cerebrovascular disease (OR = 3.70, 95%CI 2.51-5.45) was found to be the strongest risk factor in disease exacerbation, followed by CKD (OR = 3.60, 95%CI 2.18-5.94), COPD (OR = 3.14, 95% CI 2.35-4.19), cardiovascular disease (OR = 2.76, 95% CI 2.18-3.49), malignancy (OR = 2.63, 95% CI 1.75-3.95), diabetes (OR = 2.49, 95% CI 2.10-2.96) and hypertension (OR = 2.13, 95% CI 1.81-2.51). We found no correlation between CLD and increased disease severity (OR = 1.32, 95% CI 0.96-1.82).
    CONCLUSION: The impact of all eight underlying diseases on COVID-19 deterioration seemed to be higher in patients outside Hubei. Based on different comorbidities, COVID-19 patients tend to be at risk of developing poor outcomes to a varying degree. Thus, tailored infection prevention and monitoring and treatment strategies targeting these high-risk subgroups might improve prognosis during the COVID-19 pandemic.
    Keywords:  COVID-19; Comorbidity; Meta-analysis; Mortality; Risk factors
    DOI:  https://doi.org/10.1186/s12879-021-05915-0
  4. Ann Acad Med Singap. 2021 01;50(1): 52-60
    Impact of cardiovascular diseases on severity of COVID-19 patients: A systematic review.
    Pinki Mishra, Rizwana Parveen, Ram Bajpai, Mohammed Samim, Nidhi Bharal Agarwal.
       INTRODUCTION: Coronavirus disease 2019 (COVID-19) cases are increasing rapidly worldwide. Similar to Middle East respiratory syndrome where cardiovascular diseases were present in nearly 30% of cases, the increased presence of cardiovascular comorbidities remains true for COVID-19 as well. The mechanism of this association remains unclear at this time. Therefore, we reviewed the available literature and tried to find the probable association between cardiovascular disease with disease severity and mortality in COVID-19 patients.
    METHODS: We searched Medline (via PubMed) and Cochrane Central Register of Controlled Trials for articles published until Sept 5, 2020. Nineteen articles were included involving 6,872 COVID-19 patients.
    RESULTS: The random-effect meta-analysis showed that cardiovascular disease was significantly associated with severity and mortality for COVID-19: odds ratio (OR) 2.89, 95% confidence interval (CI) 1.98-4.21 for severity and OR 3.00, 95% CI 1.67-5.39 for mortality, respectively. Risk of COVID-19 severity was higher in patients having diabetes, hypertension, chronic obstructive pulmonary disease, malignancy, cerebrovascular disease and chronic kidney disease. Similarly, patients with diabetes, hypertension, chronic liver disease, cerebrovascular disease and chronic kidney disease were at higher risk of mortality.
    CONCLUSION: Our findings showed that cardiovascular disease has a negative effect on health status of COVID-19 patients. However, large prevalence studies demonstrating the consequences of comorbid cardiovascular disease are urgently needed to understand the extent of these concerning comorbidities.
    DOI:  https://doi.org/10.47102/annals-acadmedsg.2020367
  5. Int J Obes (Lond). 2021 Feb 26.
    Obesity in COVID-19 era, implications for mechanisms, comorbidities, and prognosis: a review and meta-analysis.
    Seyed Morsal Mosallami Aghili, Mahbube Ebrahimpur, Babak Arjmand, Zhaleh Shadman, Mahnaz Pejman Sani, Mostafa Qorbani, Bagher Larijani, Moloud Payab.
       BACKGROUND: Recent studies have shown that obesity is associated with the severity of coronavirus disease (COVID-19). We reviewed clinical studies to clarify the obesity relationship with COVID-19 severity, comorbidities, and discussing possible mechanisms.
    MATERIALS AND METHODS: The electronic databases, including Web of Science, PubMed, Scopus, and Google Scholar, were searched and all studies conducted on COVID-19 and obesity were reviewed. All studies were independently screened by reviewers based on their titles and abstracts.
    RESULTS: Forty relevant articles were selected, and their full texts were reviewed. Obesity affects the respiratory and immune systems through various mechanisms. Cytokine and adipokine secretion from adipose tissue leads to a pro-inflammatory state in obese patients, predisposing them to thrombosis, incoordination of innate and adaptive immune responses, inadequate antibody response, and cytokine storm. Obese patients had a longer virus shedding. Obesity is associated with other comorbidities such as hypertension, cardiovascular diseases, diabetes mellitus, and vitamin D deficiency. Hospitalization, intensive care unit admission, mechanical ventilation, and even mortality in obese patients were higher than normal-weight patients. Obesity could alter the direction of severe COVID-19 symptoms to younger individuals. Reduced physical activity, unhealthy eating habits and, more stress and fear experienced during the COVID-19 pandemic may result in more weight gain and obesity.
    CONCLUSIONS: Obesity should be considered as an independent risk factor for the severity of COVID-19. Paying more attention to preventing weight gain in obese patients with COVID-19 infection in early levels of disease is crucial during this pandemic.
    DOI:  https://doi.org/10.1038/s41366-021-00776-8
  6. Med Clin (Barc). 2021 Jan 28. pii: S0025-7753(21)00031-2. [Epub ahead of print]
    Coronary heart disease and COVID-19: A meta-analysis.
    Chendi Liang, Weijun Zhang, Shuzhen Li, Gang Qin.
       OBJECTIVE: Since the World Health Organization (WHO) announced coronavirus disease 2019 (COVID-19) had become a global pandemic on March 11, 2020, the number of infections has been increasing. The purpose of this meta-analysis was to investigate the prognosis of COVID-19 in patients with coronary heart disease.
    METHOD: Pubmed, Embase, and Cochrane Library databases were searched to collect the literature concerning coronary heart disease and COVID-19. The retrieval time was from inception to Nov 20, 2020, using Stata version 14.0 for meta-analysis.
    RESULTS: A total of 22,148 patients from 40 studies were included. The meta-analysis revealed that coronary heart disease was associated with poor prognosis of COVID-19 (OR=3.42, 95%CI [2.83, 4.13], P<0.001). After subgroup analysis, coronary heart disease was found to be related to mortality (OR=3.75, 95%CI [2.91, 4.82], P<0.001), severe/critical COVID-19 (OR=3.23, 95%CI [2.19, 4.77], P<0.001), ICU admission (OR=2.25, 95%CI [1.34, 3.79], P=0.002), disease progression (OR=3.01, 95%CI [1.46, 6.22], P=0.003); Meta-regression showed that the association between coronary heart disease and poor prognosis of COVID-19 was affected by hypertension (P=0.004), and subgroup analysis showed that compared with the proportion of hypertension >30% (OR=2.85, 95%CI [2.33, 3.49]), the proportion of hypertension <30% (OR=4.78, 95%CI [3.50, 6.51]) had a higher risk of poor prognosis.
    CONCLUSION: Coronary heart disease is a risk factor for poor prognosis in patients with COVID-19.
    Keywords:  COVID-19; Cardiopatía coronaria; Coronary heart disease; Meta-analysis; Metaanálisis
    DOI:  https://doi.org/10.1016/j.medcli.2020.12.017
  7. Eur J Integr Med. 2021 Feb 18. 101313
    Association of smoking history with severe and critical outcome in COVID-19 patients: A systemic review and meta-analysis.
    Huimei Zhang, Shaodi Ma, Tiantian Han, Guangbo Qu, Ce Cheng, John Patrick Uy, Mohammad Baseem Shaikh, Qin Zhou, Evelyn J Song, Chenyu Sun.
      Introduction: The highly infectious coronavirus disease 2019 (COVID-19) has now rapidly spread around the world. This meta-analysis was strictly focused on the influence of smoking history on the severe and critical outcomes on people with COVID-19 pneumonia. Methods: A systematic literature search was conducted in eight online databases before 1 February 2021. All studies meeting our selection criteria were included and evaluated. Stata 14.0 software was used to analyze the data. Results: A total of 109 articles involving 517,020 patients were included in this meta-analysis. A statistically significant association was discovered between smoking history and COVID-19 severity, the pooled OR was 1.55 (95%CI: 1.41-1.71). Smoking was significantly associated with the risk of admission to intensive care unit (ICU) (OR=1.73, 95%CI: 1.36-2.19), increased mortality (OR=1.58, 95%CI: 1.38-1.81), and critical diseases composite endpoints (OR=1.61, 95%CI: 1.35-1.93), whereas there was no relationship with mechanical ventilation. The pooled prevalence of smoking using the random effects model (REM) was 15% (95%CI: 14%-16%). Meta-regression analysis showed that age (P=0.004), hypertension (P=0.007), diabetes (P=0.029), chronic obstructive pulmonary disease (COPD) (P=0.001) were covariates that affect the association. Conclusions: Smoking was associated with severe or critical outcomes and increased the risk of admission to ICU and mortality in COVID-19 patients, but not associated with mechanical ventilation. This association was more significant for former smokers than in current smokers. Current smokers also had a higher risk of developing severe COVID-19 compared with non-smokers. More detailed data, which are representative for more counties, are needed to confirm these preliminary findings.
    Keywords:  COVID-19; mortality; severity; smoking; systematic review
    DOI:  https://doi.org/10.1016/j.eujim.2021.101313
  8. Ann Allergy Asthma Immunol. 2021 Feb 17. pii: S1081-1206(21)00130-7. [Epub ahead of print]
    Asthma in patients with coronavirus disease 2019: a systematic review and meta-analysis.
    Li Shi, Jie Xu, Wenwei Xiao, Ying Wang, Yuefei Jin, Shuaiyin Chen, Guangcai Duan, Haiyan Yang, Yadong Wang.
       BACKGROUND: It is unclear if there is the influence of asthma on contracting COVID-19, or having worse outcomes from COVID-19 disease.
    OBJECTIVE: To explore the prevalence of asthma in COVID-19 patients and the relationship between asthma and COVID-19 patients with poor outcomes.
    METHODS: The pooled prevalence of asthma in COVID-19 patients and corresponding 95% confidence interval (CI) were estimated. The pooled effect size (ES) was used to evaluate the association between asthma and COVID-19 patients with poor outcomes.
    RESULTS: The pooled prevalence of asthma in COVID-19 patients worldwide was 8.3% (95% CI 7.6-9.0%) based on 116 articles (119 studies) with 403,392 cases. The pooled ES based on unadjusted effect estimates showed that asthma was not associated with the reduced risk of poor outcomes in COVID-19 patients (ES 0.91, 95% CI 0.78-1.06). Similarly, the pooled ES based on unadjusted effect estimates revealed that asthma was not associated with the reduced risk of mortality in COVID19 patients (ES 0.88, 95% CI 0.73-1.05). However, the pooled ES based on adjusted effect estimates indicated that asthma was significantly associated with the reduced risk of mortality in COVID-19 patients (ES 0.80, 95% CI 0.74-0.86).
    CONCLUSION: The pooled prevalence of asthma in COVID-19 patients was similar to that in the general population, and asthma might be an independent protective factor for the death of COVID-19 patients, which suggests that we should pay high attention to COVID-19 patients with asthma and take locally tailored interventions and treatment. Further well-designed studies with large sample sizes are required to verify our findings.
    Keywords:  Asthma; COVID-19; Meta-analysis; Mortality; Poor outcomes; Prevalence; Respiratory disease
    DOI:  https://doi.org/10.1016/j.anai.2021.02.013
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