Prevalence and predictors of death and severe disease in patients hospitalized due to COVID-19: A comprehensive systematic review and meta-analysis of 77 studies and 38,000 patients

Abstract

Introduction: Progression of COVID-19 to severe disease and death is insufficiently understood.

Objective: Summarize the prevalence of risk factors and adverse outcomes and determine their associations in COVID-19 patients who were hospitalized.

Methods: We searched Medline, Embase and Web of Science for case-series and observational studies of hospitalized COVID-19 patients through August 31, 2020. Data were analyzed by fixed-effects meta-analysis using Shore's adjusted confidence intervals to address heterogeneity.

Results: Seventy-seven studies comprising 38906 hospitalized patients met inclusion criteria; 21468 from the US-Europe and 9740 from China. Overall prevalence of death [% (95% CI)] from COVID-19 was 20% (18-23%); 23% (19-27%) in the US and Europe and 11% (7-16%) for China. Of those that died, 85% were aged≥60 years, 66% were males, and 66%, 44%, 39%, 37%, and 27% had hypertension, smoking history, diabetes, heart disease, and chronic kidney disease (CKD), respectively. The case fatality risk [%(95% CI)] were 52% (46-60) for heart disease, 51% (43-59) for COPD, 48% (37-63) for chronic kidney disease (CKD), 39% for chronic liver disease (CLD), 28% (23-36%) for hypertension, and 24% (17-33%) for diabetes. Summary relative risk (sRR) of death were higher for age≥60 years [sRR = 3.6; 95% CI: 3.0-4.4], males [1.3; 1.2-1.4], smoking history [1.3; 1.1-1.6], COPD [1.7; 1.4-2.0], hypertension [1.8; 1.6-2.0], diabetes [1.5; 1.4-1.7], heart disease [2.1; 1.8-2.4], CKD [2.5; 2.1-3.0]. The prevalence of hypertension (55%), diabetes (33%), smoking history (23%) and heart disease (17%) among the COVID-19 hospitalized patients in the US were substantially higher than that of the general US population, suggesting increased susceptibility to infection or disease progression for the individuals with comorbidities.

Conclusions: Public health screening for COVID-19 can be prioritized based on risk-groups. Appropriately addressing the modifiable risk factors such as smoking, hypertension, and diabetes could reduce morbidity and mortality due to COVID-19; public messaging can be accordingly adapted.

Fig 1. PRISMA flow diagram for selection of studies.

Fig 2. Association of hypertension, diabetes and heart disease with death in COVID-19 patients.

Fig 3. Association of smoking, chronic obstructive pulmonary disease, chronic kidney disease and chronic liver disease with death in COVID-19 patients.

Fig 4. Prevalence of acute organ injuries during hospital stay and regional difference in prevalence of death and comorbidities in patients hospitalized for COVID-19.

ARDS, acute respiratory distress syndrome; COPD, chronic obstructive pulmonary disease; ACI, acute cardiac injury; CVD, cardiovascular disease; AKI, acute kidney injury; CKD, chronic kidney disease; HTN, hypertension.