bims-covirf Biomed News
on COVID19 risk factors
Issue of 2021–03–28
six papers selected by
Catherine Rycroft, BresMed
  1. Risk factors for poor outcomes in hospitalised COVID-19 patients: A systematic review and meta-analysis.
  2. Comorbidities' potential impacts on severe and non-severe patients with COVID-19: A systematic review and meta-analysis.
  3. Comparison of clinical manifestations, pre-existing comorbidities, complications and treatment modalities in severe and non-severe COVID-19 patients: A systemic review and meta-analysis.
  4. Risk profiles of severe illness in children with COVID-19: a meta-analysis of individual patients.
  5. Clinical Features and Risk Factors for In-Hospital Mortality From COVID-19 Infection at a Tertiary Care Medical Center, at the Onset of the US COVID-19 Pandemic.
  6. Association of Vitamin D Status with SARS-CoV-2 Infection or COVID-19 Severity: A Systematic Review and Meta-analysis.
  1. J Glob Health. 2021 Mar 01. 11 10001
    Risk factors for poor outcomes in hospitalised COVID-19 patients: A systematic review and meta-analysis.
    You Li, Thulani Ashcroft, Alexandria Chung, Izzie Dighero, Marshall Dozier, Margaret Horne, Emilie McSwiggan, Azwa Shamsuddin, Harish Nair.
       Background: Understanding the risk factors for poor outcomes among COVID-19 patients could help identify vulnerable populations who would need prioritisation in prevention and treatment for COVID-19. We aimed to critically appraise and synthesise published evidence on the risk factors for poor outcomes in hospitalised COVID-19 patients.
    Methods: We searched PubMed, medRxiv and the WHO COVID-19 literature database for studies that reported characteristics of COVID-19 patients who required hospitalisation. We included studies published between January and May 2020 that reported adjusted effect size of any demographic and/or clinical factors for any of the three poor outcomes: mortality, intensive care unit (ICU) admission, and invasive mechanical ventilation. We appraised the quality of the included studies using Joanna Briggs Institute appraisal tools and quantitatively synthesised the evidence through a series of random-effect meta-analyses. To aid data interpretation, we further developed an interpretation framework that indicated strength of the evidence, informed by both quantity and quality of the evidence.
    Results: We included a total of 40 studies in our review. Most of the included studies (29/40, 73%) were assessed as "good quality", with assessment scores of 80 or more. We found that male sex (pooled odds ratio (OR) = 1.32 (95% confidence interval (CI) = 1.18-1.48; 20 studies), older age (OR = 1.05, 95% CI = 1.04-1.07, per one year of age increase; 10 studies), obesity (OR = 1.59, 95% CI = 1.02-2.48; 4 studies), diabetes (OR = 1.25, 95% CI = 1.11-1.40; 11 studies) and chronic kidney diseases (6 studies; OR = 1.57, 95% CI = 1.27-1.93) were associated with increased risks for mortality with the greatest strength of evidence based on our interpretation framework. We did not find increased risk of mortality for several factors including chronic obstructive pulmonary diseases (5 studies), cancer (4 studies), or current smoker (5 studies); however, this does not indicate absence of risk due to limited data on each of these factors.
    Conclusion: Male sex, older age, obesity, diabetes and chronic kidney diseases are important risk factors of COVID-19 poor outcomes. Our review provides not only an appraisal and synthesis of evidence on the risk factors of COVID-19 poor outcomes, but also a data interpretation framework that could be adopted by relevant future research.
    DOI:  https://doi.org/10.7189/jogh.11.10001
  2. Medicine (Baltimore). 2021 Mar 26. 100(12): e24971
    Comorbidities' potential impacts on severe and non-severe patients with COVID-19: A systematic review and meta-analysis.
    Sixiang Cheng, Yuxin Zhao, Fenxiao Wang, Yan Chen, Atipatsa Chiwanda Kaminga, Huilan Xu.
       BACKGROUND: An ongoing outbreak of pneumonia associated with the severe acute respiratory coronavirus (SARS-CoV-2) emerged in December 2019 in Wuhan, China. Epidemiologic evidence suggests that patients with comorbidities and novel coronavirus disease 2019 (COVID-19) infection may have poor survival outcomes. However, the risk of these coexisting medical conditions in severe and non-severe cases has not been systematically reported.
    PURPOSE: The present study aimed to estimate the association of chronic comorbidities in severe and non-severe cases.
    METHODS: A literature search was conducted using the databases PubMed, Embase, China National Knowledge Infrastructure (CNKI), and Wanfang Database, Chinese Scientific Journals Full-text Database (CQVIP) from the inception dates to April 1, 2020, to identify cohort studies assessing comorbidity and risk of adverse outcome. Either a fixed- or random-effects model was used to calculate the overall combined risk estimates.
    RESULTS: A total of 22 studies involving 3286 patients with laboratory-confirmed COVID-19 were included in the analysis. Overall, compared with the patients with non-severe cases, the pooled odds ratios (ORs) of hypertension, diabetes mellitus, and cardiovascular, cerebrovascular, and respiratory diseases in patients with severe cases were 2.79 (95% confidence intervals [95% CI]: 1.66-4.69), 1.64 (95% CI: 2.30-1.08), 1.79 (95% CI: 1.08-2.96), 3.92 (95% CI: 2.45-6.28), and 1.98 (95% CI: 1.26-3.12), respectively.
    CONCLUSIONS: This meta-analysis supports the finding that chronic comorbidities may contribute to severe outcome in patients with COVID-19. According to the findings of the present study, old age and 2 or more comorbidities are significantly impactful to COVID-19 outcomes in hospitalized patients in China.
    DOI:  https://doi.org/10.1097/MD.0000000000024971
  3. Sci Prog. 2021 Jan-Mar;104(1):104(1): 368504211000906
    Comparison of clinical manifestations, pre-existing comorbidities, complications and treatment modalities in severe and non-severe COVID-19 patients: A systemic review and meta-analysis.
    Mohan Giri, Anju Puri, Ting Wang, Shuliang Guo.
      The global pandemic of novel coronavirus disease 2019 (COVID-19) has become an emergency of major international concern. We aim to assess the prevalence of clinical manifestations, pre-existing comorbidities, complications and treatment modalities in COVID-19 patients and compare incidence of these clinical data of severe patients with non-severe patients. An electronic search was performed in four databases to identify studies reporting clinical data of severe and non-severe COVID-19 patients. We calculated the odds ratio (OR) using fixed or random effect model. The analysis included 41 studies with 16,495 patients. The most prevalent clinical manifestations were fever 78.1%, cough 64.6%, fatigue 40.8%, and dyspnea 38.6%. Dyspnea (OR: 4.20, 95% CI: 3.09-5.72), cough (OR: 1.45, 95% CI: 1.18-1.78), and fatigue (OR: 1.40, 95% CI: 1.14-1.72) were found to be statistically significant higher in severe COVID-19 patients. We found that the most prevalent comorbidities were hypertension 32.2%, diabetes 17.1%, and cardiovascular disease 15.3%. Compared with non-severe group, proportion of hypertension (OR: 1.98, 95% CI: 1.62-2.42), diabetes (OR: 2.04, 95% CI: 1.67-2.50), cardiovascular disease (OR: 2.78, 95% CI: 2.00-3.86), and cancer (OR: 1.75, 95% CI: 1.40-2.18) were statistically significant higher in severe group. 24.7% patients presented with ARDS. The pooled effect of ARDS in severe and non-severe cases was 42.69 (OR: 42.69, 95% CI: 21.62-84.31). There was significant higher incidence of antiviral drugs, antibiotics, and glucocorticoids use in severe patients. Compared with non-severe patients, symptoms such as fever, cough, dyspnea, existing comorbidities, and complications are prevalent in severe COVID-19 patients.
    Keywords:  COVID-19; clinical features; comorbidities; complications; treatment
    DOI:  https://doi.org/10.1177/00368504211000906
  4. Pediatr Res. 2021 Mar 22.
    Risk profiles of severe illness in children with COVID-19: a meta-analysis of individual patients.
    Bo Zhou, Yuan Yuan, Shunan Wang, Zhixin Zhang, Min Yang, Xiangling Deng, Wenquan Niu.
       BACKGROUND: We prepared a meta-analysis on case reports in children with COVID-19, aiming to identify potential risk factors for severe illness and to develop a prediction model for risk assessment.
    METHODS: Literature retrieval, case report selection, and data extraction were independently completed by two authors. STATA software (version 14.1) and R programming environment (v4.0.2) were used for data handling.
    RESULTS: This meta-analysis was conducted based on 52 case reports, including 203 children (96 boys) with COVID-19. By severity, 26 (12.94%), 160 (79.60%), and 15 (7.46%) children were diagnosed as asymptomatic, mild/moderate, and severe cases, respectively. After adjusting for age and sex, 11 factors were found to be significantly associated with the risk of severe illness relative to asymptomatic or mild/moderate illness, especially for dyspnea/tachypnea (odds ratio, 95% confidence interval, P: 6.61, 4.12-9.09, <0.001) and abnormal chest X-ray (3.33, 1.84-4.82, <0.001). A nomogram modeling age, comorbidity, cough, dyspnea or tachypnea, CRP, and LDH was developed, and prediction performance was good as reflected by the C-index.
    CONCLUSIONS: Our findings provide systematic evidence for the contribution of comorbidity, cough, dyspnea or tachypnea, CRP, and LDH, both individually and jointly, to develop severe symptoms in children with asymptomatic or mild/moderate COVID-19.
    IMPACT: We have identified potential risk factors for severe illness in children with COVID-19. We have developed a prediction model to facilitate risk assessment in children with COVID-19. We found the contribution of five risk factors to develop severe symptoms in children with asymptomatic or mild/moderate COVID-19.
    DOI:  https://doi.org/10.1038/s41390-021-01429-2
  5. J Intensive Care Med. 2021 Mar 24. 8850666211001799
    Clinical Features and Risk Factors for In-Hospital Mortality From COVID-19 Infection at a Tertiary Care Medical Center, at the Onset of the US COVID-19 Pandemic.
    Ashish Bhargava, Susanna M Szpunar, Mamta Sharma, Elisa Akagi Fukushima, Sami Hoshi, Miriam Levine, Nikhil Gandhi, Wei Zhao, Somero Michael, Farah Tanveer, Dima Youssef, Meredith Coyle, Johnson Leonard, Louis Saravolatz.
       BACKGROUND: Mortality from COVID-19 has been associated with older age, black race, and comorbidities including obesity, Understanding the clinical risk factors and laboratory biomarkers associated with severe and fatal COVID-19 will allow early interventions to help mitigate adverse outcomes. Our study identified risk factors for in-hospital mortality among patients with COVID-19 infection at a tertiary care center, in Detroit, Michigan.
    METHODS: We conducted a single-center, retrospective cohort study at a 776-bed tertiary care urban academic medical center. Adult inpatients with confirmed COVID-19 (nasopharyngeal swab testing positive by real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay) from March 8, 2020, to June 14, 2020, were included. Clinical information including the presence of comorbid conditions (according to the Charlson Weighted Index of Comorbidity (CWIC)), initial vital signs, admission laboratory markers and management data were collected. The primary outcome was in-hospital mortality.
    RESULTS: Among 565 hospitalized patients, 172 patients died for a case fatality rate of 30.4%. The mean (SD) age of the cohort was 64.4 (16.2) years, and 294 (52.0%) were male. The patients who died were significantly older (mean [SD] age, 70.4 [14.1] years vs 61.7 [16.1] years; P < 0.0001), more likely to have congestive heart failure (35 [20.3%] vs 47 [12.0%]; P = 0.009), dementia (47 [27.3%] vs 48 [12.2%]; P < 0.0001), hemiplegia (18 [10.5%] vs 18 [4.8%]; P = 0.01) and a diagnosis of malignancy (16 [9.3%] vs 18 [4.6%]; P = 0.03).From multivariable analysis, factors associated with an increased odds of death were age greater than 60 years (OR = 2.2, P = 0.003), CWIC score (OR = 1.1, P = 0.023), qSOFA (OR = 1.7, P < 0.0001), WBC counts (OR = 1.1, P = 0.002), lymphocytopenia (OR = 2.0, P = 0.003), thrombocytopenia (OR = 1.9, P = 0.019), albumin (OR = 0.6, P = 0.014), and AST levels (OR = 2.0, P = 0.004) on admission.
    CONCLUSIONS: This study identified risk factor for in-hospital mortality among patients admitted with COVID-19 in a tertiary care hospital at the onset of U.S. Covid-19 pandemic. After adjusting for age, CWIC score, and laboratory data, qSOFA remained an independent predictor of mortality. Knowing these risk factors may help identify patients who would benefit from close observations and early interventions.
    Keywords:  clinical research; hospital mortality; infections
    DOI:  https://doi.org/10.1177/08850666211001799
  6. Adv Nutr. 2021 Mar 05. pii: nmab012. [Epub ahead of print]
    Association of Vitamin D Status with SARS-CoV-2 Infection or COVID-19 Severity: A Systematic Review and Meta-analysis.
    Asma Kazemi, Vida Mohammadi, Sahar Keshtkar Aghababaee, Mahdieh Golzarand, Cain C T Clark, Siavash Babajafari.
      This systematic review was conducted to summarize and clarify the evidence on the association between 25-hydroxyvitamin-D [25(OH)D] concentrations and coronavirus disease 2019 (COVID-19) risk and outcomes. PubMed, Scopus, and Web of Science databases and Google Scholar were searched up to 26 November 2020. All retrospective and prospective cohort, cross-sectional, case-control, and randomized controlled trial studies that investigated the relation between 25(OH)D and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 severity were included. Thirty-nine studies were included in the current systematic review. In studies that were adjusted (OR: 1.77; 95% CI: 1.24, 2.53; I2: 44.2%) and nonadjusted for confounders (OR: 1.75; 95% CI: 1.44, 2.13; I2: 33.0%) there was a higher risk of SARS-CoV-2 infection in the vitamin D deficiency (VDD) group. Fifteen studies evaluated associations between VDD and composite severity. In the studies that were adjusted (OR: 2.57; 95% CI: 1.65, 4.01; I2 = 0.0%) and nonadjusted for confounders (OR: 10.61; 95% CI: 2.07, 54.23; I2 = 90.8%) there was a higher severity in the VDD group. Analysis of studies with crude OR (OR: 2.62; 95% CI: 1.13, 6.05; I2: 47.9%), and adjusted studies that used the Cox survival method (HR: 2.35; 95% CI: 1.22, 4.52; I2: 84%) indicated a significant association of VDD with mortality, while in adjusted studies that used logistic regression, no relation was observed (OR: 1.05; 95% CI: 0.63, 1.75; I2: 76.6%). The results of studies that examined relations between VDD and intensive care unit (ICU) admission, pulmonary complications, hospitalization, and inflammation were inconsistent. In conclusion, although studies were heterogeneous in methodological and statistical approach, most of them indicated a significant relation between 25(OH)D and SARS-CoV-2 infection, COVID-19 composite severity, and mortality. With regard to infection, caution should be taken in interpreting the results, due to inherent study limitations. For ICU admission, inflammation, hospitalization, and pulmonary involvement, the evidence is currently inconsistent and insufficient.
    Keywords:  COVID-19; SARS-CoV-2; infection; severity; vitamin D
    DOI:  https://doi.org/10.1093/advances/nmab012
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