The common risk factors for progression and mortality in COVID-19 patients: a meta-analysis

Abstract

Coronavirus disease 2019 (COVID-19), defined by the World Health Organization (WHO), has affected more than 50 million patients worldwide and caused a global public health emergency. Therefore, there is a recognized need to identify risk factors for COVID-19 severity and mortality. A systematic search of electronic databases (PubMed, Embase and Cochrane Library) for studies published before September 29, 2020, was performed. Studies that investigated risk factors for progression and mortality in COVID-19 patients were included. A total 344,431 participants from 34 studies were included in this meta-analysis. Regarding comorbidities, cerebrovascular disease (CVD), chronic kidney disease (CKD), coronary heart disease (CHD), and malignancy were associated with an increased risk of progression and mortality in COVID-19 patients. Regarding clinical manifestations, sputum production was associated with a dramatically increased risk of progression and mortality. Hemoptysis was a risk factor for death in COVID-19 patients. In laboratory examinations, increased neutrophil count, decreased lymphocyte count, decreased platelet count, increased C-reactive protein (CRP), coinfection with bacteria or fungi, increased alanine aminotransferase (ALT) and creatine kinase (CK), increased N-terminal pronatriuretic peptide (NT-proBNP), and bilateral pneumonia in CT/X-ray were significantly more frequent in the severe group compared with the non-severe group. Moreover, the proportion of patients with increased CRP and total bilirubin (TBIL) was also significantly higher in the deceased group than in the survival group. CVD, CKD, sputum production, increased neutrophil count, decreased lymphocyte count, decreased platelet count, increased CRP, coinfection with bacteria or fungi, increased ALT and CK, increased NT-proBNP, and bilateral pneumonia in CT/X-ray were associated with an increased risk of progression in COVID-19 patients. Moreover, the proportion of patients with increased sputum production, hemoptysis, CRP and TBIL was also significantly higher in the deceased group.

Fig. 1

Preferred reporting items for systematic reviews and meta-analyses flow chart of the study selection process, showing the number of studies excluded at each step and the reasons for exclusion from the systematic review and meta-analysis

Fig. 2

Association of general characteristics with progression and mortality in COVID-19. Forest plots are shown for the effects of (A) sex (male/total), (B) age ≥ 65 years, and (C) smoking.

Fig. 3

Comorbidity risk factors for progression and mortality in COVID-19. Forest plots are shown for the effects of (A) diabetes, (B) COPD, (C) hypertension, (D) CHD, (E) CVD, (F) CKD, (G) malignancy, (H) Hep B infection, (I) abnormal liver function, and (J) immunodeficiency.

Fig. 4

Routine blood test risk factors for progression and mortality in COVID-19. Forest plots are shown for the effects of (A) elevated WBC, (B) decreased WBC, (C) elevated neutrophils, (D) decreased neutrophils, (E) decreased platelets, and (F) decreased lymphocytes.

Fig. 5

Infection-related risk factors for progression and mortality in COVID-19. Forest plots are shown for the effects of (A) elevated CRP, (B) elevated PCT, (C) elevated IL-6, (D) and co-infection.

Fig. 6

Blood biochemistry test risk factors for progression and mortality in COVID-19. Forest plots are shown for the effects of (A) elevated AST, (B) elevated ALT, (C) elevated TBIL, (D) elevated LDH, (E) elevated CK, and (F) elevated sCr.

Fig. 7

Other lab examination risk factors for progression and mortality in COVID-19. Forest plots are shown for the effects of (A) elevated hs-cTnl, (B) elevated NT-pro BNP, (C) elevated D-dimer, and (D) bilateral pneumonia in CT/X-ray.

Fig. 8

Trim-and-fill analysis for the publication bias for dyspnea