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Meta-Analysis
. 2021 May 3;16(5):e0250602.
doi: 10.1371/journal.pone.0250602. eCollection 2021.

Clinical determinants of the severity of COVID-19: A systematic review and meta-analysis

Xinyang Li  1 , Xianrui Zhong  2 , Yongbo Wang  3 , Xiantao Zeng  3 , Ting Luo  1 , Qing Liu  4
Affiliations
Meta-Analysis

Clinical determinants of the severity of COVID-19: A systematic review and meta-analysis

Xinyang Li et al. PLoS One. .

Abstract

Objective: We aimed to systematically identify the possible risk factors responsible for severe cases.

Methods: We searched PubMed, Embase, Web of science and Cochrane Library for epidemiological studies of confirmed COVID-19, which include information about clinical characteristics and severity of patients' disease. We analyzed the potential associations between clinical characteristics and severe cases.

Results: We identified a total of 41 eligible studies including 21060 patients with COVID-19. Severe cases were potentially associated with advanced age (Standard Mean Difference (SMD) = 1.73, 95% CI: 1.34-2.12), male gender (Odds Ratio (OR) = 1.51, 95% CI:1.33-1.71), obesity (OR = 1.89, 95% CI: 1.44-2.46), history of smoking (OR = 1.40, 95% CI:1.06-1.85), hypertension (OR = 2.42, 95% CI: 2.03-2.88), diabetes (OR = 2.40, 95% CI: 1.98-2.91), coronary heart disease (OR: 2.87, 95% CI: 2.22-3.71), chronic kidney disease (CKD) (OR = 2.97, 95% CI: 1.63-5.41), cerebrovascular disease (OR = 2.47, 95% CI: 1.54-3.97), chronic obstructive pulmonary disease (COPD) (OR = 2.88, 95% CI: 1.89-4.38), malignancy (OR = 2.60, 95% CI: 2.00-3.40), and chronic liver disease (OR = 1.51, 95% CI: 1.06-2.17). Acute respiratory distress syndrome (ARDS) (OR = 39.59, 95% CI: 19.99-78.41), shock (OR = 21.50, 95% CI: 10.49-44.06) and acute kidney injury (AKI) (OR = 8.84, 95% CI: 4.34-18.00) were most likely to prevent recovery. In summary, patients with severe conditions had a higher rate of comorbidities and complications than patients with non-severe conditions.

Conclusion: Patients who were male, with advanced age, obesity, a history of smoking, hypertension, diabetes, malignancy, coronary heart disease, hypertension, chronic liver disease, COPD, or CKD are more likely to develop severe COVID-19 symptoms. ARDS, shock and AKI were thought to be the main hinderances to recovery.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flow diagram of literature selection.
Fig 2
Fig 2. Meta-analysis of the association between demographic characteristics and severe COVID-19 disease.
(A-D) Forest plots of the association between (A) sex, (B) age, (C) smoking history, (D) BMI and severe COVID-19 disease.
Fig 3
Fig 3. Meta-analysis of the association between comorbidities and severe COVID-19 disease.
(A-H) Forest plots of the association between (A) Chronic kidney disease, (B) Chronic obstructive pulmonary disease, (C) Coronary heart disease, (D) Malignancy, (E) Cerebrovascular disease, (F) Hypertension, (G) Diabetes, (H) Chronic liver disease and severe COVID-19 disease.
Fig 4
Fig 4. Meta-analysis of the association between complications and severe COVID-19 disease.
(A-C) Forest plots of the association between (A) Acute respiratory distress syndrome (ARDS), (B) Shock, (C) Acute kidney injury (AKI) and severe COVID-19 disease.
Fig 5
Fig 5. Meta-regression by median age of patients.
See this image and copyright information in PMC

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