A systematic review and meta-analysis of regional risk factors for critical outcomes of COVID-19 during early phase of the pandemic

Abstract

The mortality rates of COVID-19 vary across the globe. While some risk factors for poor prognosis of the disease are known, regional differences are suspected. We reviewed the risk factors for critical outcomes of COVID-19 according to the location of the infected patients, from various literature databases from January 1 through June 8, 2020. Candidate variables to predict the outcome included patient demographics, underlying medical conditions, symptoms, and laboratory findings. The risk factors in the overall population included sex, age, and all inspected underlying medical conditions. Symptoms of dyspnea, anorexia, dizziness, fatigue, and certain laboratory findings were also indicators of the critical outcome. Underlying respiratory disease was associated higher risk of the critical outcome in studies from Asia and Europe, but not North America. Underlying hepatic disease was associated with a higher risk of the critical outcome from Europe, but not from Asia and North America. Symptoms of vomiting, anorexia, dizziness, and fatigue were significantly associated with the critical outcome in studies from Asia, but not from Europe and North America. Hemoglobin and platelet count affected patients differently in Asia compared to those in Europe and North America. Such regional discrepancies should be considered when treating patients with COVID-19.

Figure 1

Impacts of underlying medical conditions on the critical outcome of COVID-19. The numbers in parenthesis represent the number of studies included in the pooled analysis. (a) Pooled analysis of all included studies. (b)–(d) Pooled analyses of studies performed in Asia, Europe, and North America, respectively.

Figure2

Impacts of patient symptoms on the critical outcome of COVID-19. The numbers in parenthesis represent the number of studies included in the pooled analysis. (a) Pooled analysis of all included studies. (b)–(d) Pooled analyses of studies performed in Asia, Europe, and North America, respectively.

Figure 3

Associations between laboratory findings and the critical outcome of COVID-19. The numbers in parenthesis represent the number of studies included in the pooled analysis. (a) Pooled analysis of all included studies. (b)–(d) Pooled analyses of studies performed in Asia, Europe, and North America, respectively.