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. 2021 Mar:33:100789.
doi: 10.1016/j.eclinm.2021.100789. Epub 2021 Mar 18.

COPD and the risk of poor outcomes in COVID-19: A systematic review and meta-analysis

Firoozeh V Gerayeli  1 , Stephen Milne  1   2   3 , Chung Cheung  1 , Xuan Li  1 , Cheng Wei Tony Yang  1 , Anthony Tam  1 , Lauren H Choi  1 , Annie Bae  1 , Don D Sin  1   2
Affiliations

COPD and the risk of poor outcomes in COVID-19: A systematic review and meta-analysis

Firoozeh V Gerayeli et al. EClinicalMedicine. 2021 Mar.

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) are highly susceptible from respiratory exacerbations from viral respiratory tract infections. However, it is unclear whether they are at increased risk of COVID-19 pneumonia or COVID-19-related mortality. We aimed to determine whether COPD is a risk factor for adverse COVID-19 outcomes including hospitalization, severe COVID-19, or death.

Methods: Following the PRISMA guidelines, we performed a systematic review of COVID-19 clinical studies published between November 1st, 2019 and January 28th, 2021 (PROSPERO ID: CRD42020191491). We included studies that quantified the number of COPD patients, and reported at least one of the following outcomes stratified by COPD status: hospitalization; severe COVID-19; ICU admission; mechanical ventilation; acute respiratory distress syndrome; or mortality. We meta-analyzed the results of individual studies to determine the odds ratio (OR) of these outcomes in patients with COPD compared to those without COPD.

Findings: Fifty-nine studies met the inclusion criteria, and underwent data extraction. Most studies were retrospective cohort studies/case series of hospitalized patients. Only four studies examined the effects of COPD on COVID-19 outcomes as their primary endpoint. In aggregate, COPD was associated with increased odds of hospitalization (OR 4.23, 95% confidence interval [CI] 3.65-4.90), ICU admission (OR 1.35, 95% CI 1.02-1.78), and mortality (OR 2.47, 95% CI 2.18-2.79).

Interpretation: Having a clinical diagnosis of COPD significantly increases the odds of poor clinical outcomes in patients with COVID-19. COPD patients should thus be considered a high-risk group, and targeted for preventative measures and aggressive treatment for COVID-19 including vaccination.

Keywords: COPD; COVID-19; Meta-analysis; mortality.

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Conflict of interest statement

SM reports personal fees from Novartis and Boehringer-Ingelheim, outside the submitted work. DDS reports grants and personal fees from AstraZeneca, personal fees from Boehringer Ingelheim, and personal fees from Grifols outside the submitted work. FVG, CC, XL, CWTY, AT, LC, and AB have nothing to disclose.

Figures

Fig 1:
Fig. 1
PRISMA flow chart for the systematic review. We screened 1,292 records identified by digital search of MedRxiv, Google Scholar, Pubmed and Ovid Medline for COVID-19 clinical studies that were published between November 1st, 2019 and January 28th, 2021. We excluded any preprint papers that were initially identified but not peer-reviewed and published by 28th January, 2021. In total, 59 studies were selected for the qualitative synthesis, of which 39 were utilized for quantitative synthesis (meta-analysis).
Fig 2:
Fig. 2
Pooled odds ratio of COVID-19-related hospitalization in COPD patients: Only studies with no overlapping study populations were analyzed. Odds ratios [95% confidence intervals] for individual studies (squares and bars) and the pooled odds ratio [95% CI] (diamond). Results are following stepwise removal of two studies contributing to heterogeneity (Cochran's Q and I2 tests).
Fig3:
Fig.3
Pooled odds ratio of severe COVID-19 (ICU admission) in COPD patients: Only studies with no overlapping study populations were analyzed. Odds ratios [95% confidence intervals] for individual studies (squares and bars) and the pooled odds ratio [95% CI] (diamond). Results are following stepwise removal of three studies contributing to heterogeneity (Cochran's Q and I2 tests).
Fig 4:
Fig. 4
Pooled odds ratio of COVID-19-related mortality in COPD patients: Only studies with no overlapping study populations were analyzed. Odds ratios [95% confidence intervals] for individual studies (squares and bars) and the pooled odds ratio [95% CI] (diamond). Results are following stepwise removal of six studies contributing greatest to the heterogeneity (Cochran's Q and I2 tests).
See this image and copyright information in PMC

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