bims-covirf 2021-05-02 papers

Issue of 2021–05–02
five papers selected by
Catherine Rycroft, BresMed

J Glob Infect Dis. 2021 Jan-Mar;13(1):13(1): 13-19

Clinical Determinants of Severe COVID-19 Disease - A Systematic Review and Meta-Analysis.

Ankit Kumar Sahu, Roshan Mathew, Praveen Aggarwal, Jamshed Nayer, Sanjeev Bhoi, Swayamjeet Satapathy, Meera Ekka.

Background: A systematic review and meta-analysis of available studies was performed to investigate the clinical characteristics that can predict COVID-19 disease severity.
Materials and Methods: Databases including PubMed, Embase, and Web of Science were searched from December 31, 2019, to May 24, 2020. Random-effects meta-analysis was used for summarizing the Pooled odds ratio (pOR) of individual clinical characteristics to describe their association with severe COVID-19 disease.
Results: A total of 3895 articles were identified, and finally, 22 studies comprising 4380 patients were included. Severe disease was more common in males than females (pOR: 1.36, 95% confidence interval [CI]: 1.08-1.70). Clinical features that were associated with significantly higher odds of severe disease were abdominal pain (pOR: 6.58, 95% CI: 1.56-27.67), breathlessness (pOR: 3.94, 95% CI: 2.55-6.07), and hemoptysis (pOR: 3.35, 95% CI: 1.05-10.74). pOR was highest for chronic obstructive pulmonary disease (pOR: 2.92, 95% CI: 1.70-5.02), followed by obesity (pOR: 2.84, 95% CI: 1.19-6.77), malignancy (pOR: 2.38, 95% CI: 1.25-4.52), diabetes (pOR: 2.29, 95% CI: 1.56-3.39), hypertension (pOR: 1.72, 95% CI: 1.23-2.42), cardiovascular disease (pOR: 1.61, 95% CI: 1.31-1.98) and chronic kidney disease (pOR: 1.46, 95% CI: 1.06-2.02), for predicting severe COVID-19.
Conclusion: Our analysis describes the association of specific symptoms and comorbidities with severe COVID-19 disease. Knowledge of these clinical determinants will assist the clinicians in the risk-stratification of these patients for better triage and clinical management.

Keywords: COVID-19; Clinical determinants; clinical predictors; meta-analysis; severe disease

DOI: https://doi.org/10.4103/jgid.jgid_136_20

Diabetologia. 2021 Apr 28.

Risk phenotypes of diabetes and association with COVID-19 severity and death: a living systematic review and meta-analysis.

Sabrina Schlesinger, Manuela Neuenschwander, Alexander Lang, Kalliopi Pafili, Oliver Kuss, Christian Herder, Michael Roden.

AIMS/HYPOTHESIS: Diabetes has been identified as a risk factor for poor prognosis of coronavirus disease-2019 (COVID-19). The aim of this study is to identify high-risk phenotypes of diabetes associated with COVID-19 severity and death.
METHODS: This is the first edition of a living systematic review and meta-analysis on observational studies investigating phenotypes in individuals with diabetes and COVID-19-related death and severity. Four different databases were searched up to 10 October 2020. We used a random effects meta-analysis to calculate summary relative risks (SRR) with 95% CI. The certainty of evidence was evaluated by the GRADE tool.
RESULTS: A total of 22 articles, including 17,687 individuals, met our inclusion criteria. For COVID-19-related death among individuals with diabetes and COVID-19, there was high to moderate certainty of evidence for associations (SRR [95% CI]) between male sex (1.28 [1.02, 1.61], n = 10 studies), older age (>65 years: 3.49 [1.82, 6.69], n = 6 studies), pre-existing comorbidities (cardiovascular disease: 1.56 [1.09, 2.24], n = 8 studies; chronic kidney disease: 1.93 [1.28, 2.90], n = 6 studies; chronic obstructive pulmonary disease: 1.40 [1.21, 1.62], n = 5 studies), diabetes treatment (insulin use: 1.75 [1.01, 3.03], n = 5 studies; metformin use: 0.50 [0.28, 0.90], n = 4 studies) and blood glucose at admission (≥11 mmol/l: 8.60 [2.25, 32.83], n = 2 studies). Similar, but generally weaker and less precise associations were observed between risk phenotypes of diabetes and severity of COVID-19.
CONCLUSIONS/INTERPRETATION: Individuals with a more severe course of diabetes have a poorer prognosis of COVID-19 compared with individuals with a milder course of disease. To further strengthen the evidence, more studies on this topic that account for potential confounders are warranted.
REGISTRATION: PROSPERO registration ID CRD42020193692.

Keywords: COVID-19; Diabetes; Meta-analysis; SARS-CoV-2; Systematic review

DOI: https://doi.org/10.1007/s00125-021-05458-8

Ann Palliat Med. 2021 Apr 09. pii: apm-20-2557. [Epub ahead of print]

Risk factors for mortality of coronavirus disease 2019 (COVID-19) patients during the early outbreak of COVID-19: a systematic review and meta-analysis.

Yanyan Wu, Hongyu Li, Zhongheng Zhang, Wenhua Liang, Tiansong Zhang, Zhenhua Tong, Xiaozhong Guo, Xingshun Qi.

BACKGROUND: Identification of risk factors for poor prognosis of patients with coronavirus disease 2019 (COVID-19) is necessary to enable the risk stratification and modify the patient's management. Thus, we performed a systematic review and meta-analysis to evaluate the in-hospital mortality and risk factors of death in COVID-19 patients.
METHODS: All studies were searched via the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases. The in-hospital mortality of COVID-19 patients was pooled. Odds ratios (ORs) or mean difference (MD) with 95% confidence intervals (CIs) were calculated for evaluation of risk factors.
RESULTS: A total of 80 studies were included with a pooled in-hospital mortality of 14% (95% CI: 12.2- 15.9%). Older age (MD =13.32, 95% CI: 10.87-15.77; P<0.00001), male (OR =1.66, 95% CI: 1.37-2.01; P<0.00001), hypertension (OR =2.67, 95% CI: 2.08-3.43; P<0.00001), diabetes (OR =2.14, 95% CI: 1.76-2.6; P<0.00001), chronic respiratory disease (OR =3.55, 95% CI: 2.65-4.76; P<0.00001), chronic heart disease/cardiovascular disease (OR =3.15, 95% CI: 2.43-4.09; P<0.00001), elevated levels of high-sensitive cardiac troponin I (MD =66.65, 95% CI: 16.94-116.36; P=0.009), D-dimer (MD =4.33, 95% CI: 2.97-5.68; P<0.00001), C-reactive protein (MD =48.03, 95% CI: 27.79-68.27; P<0.00001), and a decreased level of albumin at admission (MD =-3.98, 95% CI: -5.75 to -2.22; P<0.0001) are associated with higher risk of death. Patients who developed acute respiratory distress syndrome (OR =62.85, 95% CI: 29.45-134.15; P<0.00001), acute cardiac injury (OR =25.16, 95% CI: 6.56-96.44; P<0.00001), acute kidney injury (OR =22.86, 95% CI: 4.60-113.66; P=0.0001), and septic shock (OR =24.09, 95% CI: 4.26-136.35; P=0.0003) might have a higher in-hospital mortality.
CONCLUSIONS: Advanced age, male, comorbidities, increased levels of acute inflammation or organ damage indicators, and complications are associated with the risk of mortality in COVID-19 patients, and should be integrated into the risk stratification system.

Keywords: Coronavirus disease 2019 (COVID-19); meta-analysis; mortality; risk factors; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

DOI: https://doi.org/10.21037/apm-20-2557

Int J Environ Res Public Health. 2021 Apr 12. pii: 4021. [Epub ahead of print]18(8):

Identification of Vulnerable Populations and Areas at Higher Risk of COVID-19-Related Mortality during the Early Stage of the Epidemic in the United States.

Esteban Correa-Agudelo, Tesfaye B Mersha, Adam J Branscum, Neil J MacKinnon, Diego F Cuadros.

We characterized vulnerable populations located in areas at higher risk of COVID-19-related mortality and low critical healthcare capacity during the early stage of the epidemic in the United States. We analyze data obtained from a Johns Hopkins University COVID-19 database to assess the county-level spatial variation of COVID-19-related mortality risk during the early stage of the epidemic in relation to health determinants and health infrastructure. Overall, we identified highly populated and polluted areas, regional air hub areas, race minorities (non-white population), and Hispanic or Latino population with an increased risk of COVID-19-related death during the first phase of the epidemic. The 10 highest COVID-19 mortality risk areas in highly populated counties had on average a lower proportion of white population (48.0%) and higher proportions of black population (18.7%) and other races (33.3%) compared to the national averages of 83.0%, 9.1%, and 7.9%, respectively. The Hispanic and Latino population proportion was higher in these 10 counties (29.3%, compared to the national average of 9.3%). Counties with major air hubs had a 31% increase in mortality risk compared to counties with no airport connectivity. Sixty-eight percent of the counties with high COVID-19-related mortality risk also had lower critical care capacity than the national average. The disparity in health and environmental risk factors might have exacerbated the COVID-19-related mortality risk in vulnerable groups during the early stage of the epidemic.

Keywords: COVID-19; air pollution; comorbidity; ethnicity; health disparities; healthcare capacity; multilevel models; neighborhood

DOI: https://doi.org/10.3390/ijerph18084021

Minerva Med. 2021 Apr 29.

Role of comorbidities on the mortality in patients with SARS-CoV-2 infection: an Italian cohort study.

Pasquale Vergara, Luca Rossi, Andrea Biagi, Giulio Falasconi, Luigi Pannone, Alessia Zanni, Concetta Sticozzi, Greta Comastri, Stefano Gandolfi, Cosmo Godino, Alessandro Malagoli, Giovanni Q Villani.

BACKGROUND: Cardiovascular comorbidities are a common cause of death in COVID-19 and the aim of this study is to evaluate the effect of comorbidities on mortality in COVID-19 patients.
METHODS: In this retrospective observational study we enrolled 1049 patients hospitalized with confirmed SARS-CoV-2 infection in a single Italian Center from 21 February to 20 March 2020 Evaluated risk factors (RFs) were: advanced age, gender, hypertension, diabetes, atrial fibrillation, hyperlipidemia, chronic kidney disease, thyroid disease, chronic obstructive pulmonary disease, malignancy, stroke, cardiovascular disease, and peripheral vascular disease. Endpoint of the study was death from any cause. A multivariate logistic regression model was built using covariates that showed as statistically significant at univariate regression analysis.
RESULTS: Median age at presentation was 71.1 years (IQR: 59.1-80.5); 244 (72.2%) were males. Primary outcome occurred in 338 patients (32.2%). In decedents, median survival from Hospitalization was 6 (IQR: 3-10) days. 264 decedents had 1 RF, 120 had 2 RFs and 39 had ≥3 RFs. At multivariate logistic regression model, variables associated with primary outcome were: age class (64-69 years) (OR 3.03, CI 1.75-5.31, p<0.001), age class (70-88 years) (OR 10.08, CI 6.67-15.72, p<0.001), age class (≥ 88 years) (OR 23.99, CI 13.21-44.82, p<0.001), male gender (OR 1.88, CI 1.36-2.62, p<0.001), diabetes (OR 1.56, CI 1.07-2.26, p=0.02), stroke (OR 3.41, CI 1.33-9.91, p=0.015).
CONCLUSIONS: Age, male gender, presence of diabetes and stroke appeared as independent predictors of mortality in COVID-19 patients. A table for risk of 30 days-mortality in SARS-CoV-2 infection was built, based on odds ratios derived from multivariate regression analysis.

DOI: https://doi.org/10.23736/S0026-4806.21.07187-1