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Review
. 2020 Dec;6(12):e05684.
doi: 10.1016/j.heliyon.2020.e05684. Epub 2020 Dec 15.

Impact of age, sex, comorbidities and clinical symptoms on the severity of COVID-19 cases: A meta-analysis with 55 studies and 10014 cases

Md Abdul Barek  1 , Md Abdul Aziz  1 , Mohammad Safiqul Islam  1
Affiliations
Review

Impact of age, sex, comorbidities and clinical symptoms on the severity of COVID-19 cases: A meta-analysis with 55 studies and 10014 cases

Md Abdul Barek et al. Heliyon. 2020 Dec.

Abstract

Purpose: Severe acute respiratory coronavirus 2 (SARS-CoV-2) cases are overgrowing globally and now become a pandemic. A meta-analysis was conducted to evaluate the impact of age, sex, comorbidities, and clinical characteristics on the severity of COVID-19 to help diagnose and evaluate the current outbreak in clinical decision-making.

Methods: PubMed, ScienceDirect, and BMC were searched to collect data about demographic, clinical characteristics, and comorbidities of COVID-19 patients. Meta-analysis was conducted with Review Manager 5.3. Publication bias was assessed using Egger's test and Begg-Mazumdar's rank correlation.

Results: Fifty-five studies were included in this meta-analysis, including 10014 patients with SARS-CoV-2 infection. Male cases and cases with an age of ≥50 years (OR = 2.41, p < 0.00001; RR = 3.36, p = 0.0002, respectively) were severely affected by SARS-CoV-2. Patients having age≥65 years are not associated (p = 0.110) with the severity of COVID-19. Presence of at least one comorbidity or hypertension, diabetes, cerebrovascular disease, cardiovascular diseases, respiratory disease, malignancy, chronic kidney disease and chronic liver diseases individually increased the severity of COVID-19 cases significantly (OR = 3.13, p < 0.00001; OR = 2.35, p < 0.00001; OR = 2.42, p < 0.00001; OR = 3.78, p < 0.00001; OR = 3.33, p < 0.00001; OR = 2.58, p < 0.00001; OR = 2.32, p < 0.00001; OR = 2.27, p = 0.0007; OR = 1.70, p = 0.003, respectively). Clinical manifestation such as fever, cough, fatigue, anorexia, dyspnea, chest tightness, hemoptysis, diarrhea and abdominal pain (OR = 1.68, p = 0.0001; OR = 1.41, p = 0.004; OR = 1.26, p = 0.03; OR = 2.38, p < 0.0001; OR = 4.30, p < 0.00001; OR = 2.11, p = 0.002; OR = 4.93, p < 0.0001; OR = 1.35, p = 0.03; OR = 2.38, p = 0.008, respectively) were significantly associated with the severity of cases. No association of severity was found with myalgia, pharyngalgia, nausea, vomiting, headache, dizziness and sore throat (p > 0.05). No publication bias was found in case of age (≥50 years, age≥65 years), comorbidities and clinical manifestations.

Conclusions: Males patients and elderly or older patients (age ≥50 years) are at higher risk of developing severity, whereas comorbidities and clinical manifestations could significantly affect the prognosis and severity of COVID-19.

Keywords: Clinical manifestation; Comorbidity; Covid-19; Critical care; Health informatics; Meta-analysis; Microbiology; Nonsevere; Pneumonia; Risk factor; Severe; Travel medicine; Viral disease; Virology.

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Figures

Figure 1
Figure 1
Flow chart illustrating the literature search and study selection.
Figure 2
Figure 2
Comorbidities of COVID-19 cases of the included studies
Figure 3
Figure 3
Clinical symptoms of COVID-19 cases of the included studies
Figure 4
Figure 4
Distribution of sex of included studies to analyze the effect of sex on for the severity of COVID-19.
Figure 5
Figure 5
Meta-analysis for the effect of sex on the severity of COVID-19 cases. Forest plots depict the comparison of the incidences of male and female in severe and nonsevere patients.
Figure 6
Figure 6
Distribution of age A. ≥ 50 Vs. <50 years and B. ≥ 65 and <65 years among the included studies to analyze the effect of age on for the severity of COVID-19.
Figure 7
Figure 7
Meta-analysis for the effect of age on the severity of COVID-19 cases. Forest plots depict the comparison of the incidences of A) age ≥50 vs. age<50 years B) age ≥65 vs. age<65 years in severe patients.
Figure 8
Figure 8
Meta-analysis for the effect of comorbidities on the severity of COVID-19 cases. Random effect model for any comorbidity, hypertension, diabetes, cerebrovascular disease, cardiovascular disease, respiratory disease, malignancy, chronic kidney disease and chronic liver disease.
Figure 8
Figure 8
Meta-analysis for the effect of comorbidities on the severity of COVID-19 cases. Random effect model for any comorbidity, hypertension, diabetes, cerebrovascular disease, cardiovascular disease, respiratory disease, malignancy, chronic kidney disease and chronic liver disease.
Figure 8
Figure 8
Meta-analysis for the effect of comorbidities on the severity of COVID-19 cases. Random effect model for any comorbidity, hypertension, diabetes, cerebrovascular disease, cardiovascular disease, respiratory disease, malignancy, chronic kidney disease and chronic liver disease.
Figure 8
Figure 8
Meta-analysis for the effect of comorbidities on the severity of COVID-19 cases. Random effect model for any comorbidity, hypertension, diabetes, cerebrovascular disease, cardiovascular disease, respiratory disease, malignancy, chronic kidney disease and chronic liver disease.
Figure 8
Figure 8
Meta-analysis for the effect of comorbidities on the severity of COVID-19 cases. Random effect model for any comorbidity, hypertension, diabetes, cerebrovascular disease, cardiovascular disease, respiratory disease, malignancy, chronic kidney disease and chronic liver disease.
Figure 9
Figure 9
Meta-analysis for the effect of clinical symptoms on the severity of COVID-19 cases. Random effect model for fever, cough, fatigue, anorexia, myalgia, dyspnea, chest tightness, sputum production, hemoptysis, pharyngalgia, diarrhea, nausea, vomiting, abdominal pain, headache, dizziness and sore throat.
Figure 9
Figure 9
Meta-analysis for the effect of clinical symptoms on the severity of COVID-19 cases. Random effect model for fever, cough, fatigue, anorexia, myalgia, dyspnea, chest tightness, sputum production, hemoptysis, pharyngalgia, diarrhea, nausea, vomiting, abdominal pain, headache, dizziness and sore throat.
Figure 9
Figure 9
Meta-analysis for the effect of clinical symptoms on the severity of COVID-19 cases. Random effect model for fever, cough, fatigue, anorexia, myalgia, dyspnea, chest tightness, sputum production, hemoptysis, pharyngalgia, diarrhea, nausea, vomiting, abdominal pain, headache, dizziness and sore throat.
Figure 9
Figure 9
Meta-analysis for the effect of clinical symptoms on the severity of COVID-19 cases. Random effect model for fever, cough, fatigue, anorexia, myalgia, dyspnea, chest tightness, sputum production, hemoptysis, pharyngalgia, diarrhea, nausea, vomiting, abdominal pain, headache, dizziness and sore throat.
Figure 9
Figure 9
Meta-analysis for the effect of clinical symptoms on the severity of COVID-19 cases. Random effect model for fever, cough, fatigue, anorexia, myalgia, dyspnea, chest tightness, sputum production, hemoptysis, pharyngalgia, diarrhea, nausea, vomiting, abdominal pain, headache, dizziness and sore throat.
Figure 9
Figure 9
Meta-analysis for the effect of clinical symptoms on the severity of COVID-19 cases. Random effect model for fever, cough, fatigue, anorexia, myalgia, dyspnea, chest tightness, sputum production, hemoptysis, pharyngalgia, diarrhea, nausea, vomiting, abdominal pain, headache, dizziness and sore throat.
Figure 9
Figure 9
Meta-analysis for the effect of clinical symptoms on the severity of COVID-19 cases. Random effect model for fever, cough, fatigue, anorexia, myalgia, dyspnea, chest tightness, sputum production, hemoptysis, pharyngalgia, diarrhea, nausea, vomiting, abdominal pain, headache, dizziness and sore throat.
Figure 9
Figure 9
Meta-analysis for the effect of clinical symptoms on the severity of COVID-19 cases. Random effect model for fever, cough, fatigue, anorexia, myalgia, dyspnea, chest tightness, sputum production, hemoptysis, pharyngalgia, diarrhea, nausea, vomiting, abdominal pain, headache, dizziness and sore throat.
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