Prognostic factors for mortality, intensive care unit and hospital admission due to SARS-CoV-2: a systematic review and meta-analysis of cohort studies in Europe

Abstract

Background: As mortality from coronavirus disease 2019 (COVID-19) is strongly age-dependent, we aimed to identify population subgroups at an elevated risk for adverse outcomes from COVID-19 using age-/gender-adjusted data from European cohort studies with the aim to identify populations that could potentially benefit from booster vaccinations.

Methods: We performed a systematic literature review and meta-analysis to investigate the role of underlying medical conditions as prognostic factors for adverse outcomes due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including death, hospitalisation, intensive care unit (ICU) admission and mechanical ventilation within three separate settings (community, hospital and ICU). Cohort studies that reported at least age and gender-adjusted data from Europe were identified through a search of peer-reviewed articles published until 11 June 2021 in Ovid Medline and Embase. Results are presented as odds ratios with 95% confidence intervals and absolute risk differences in deaths per 1000 COVID-19 patients.

Findings: We included 88 cohort studies with age-/gender-adjusted data from 6 653 207 SARS-CoV-2 patients from Europe. Hospital-based mortality was associated with high and moderate certainty evidence for solid organ tumours, diabetes mellitus, renal disease, arrhythmia, ischemic heart disease, liver disease and obesity, while a higher risk, albeit with low certainty, was noted for chronic obstructive pulmonary disease and heart failure. Community-based mortality was associated with a history of heart failure, stroke, diabetes and end-stage renal disease. Evidence of high/moderate certainty revealed a strong association between hospitalisation for COVID-19 and solid organ transplant recipients, sleep apnoea, diabetes, stroke and liver disease.

Interpretation: The results confirmed the strong association between specific prognostic factors and mortality and hospital admission. Prioritisation of booster vaccinations and the implementation of nonpharmaceutical protective measures for these populations may contribute to a reduction in COVID-19 mortality, ICU and hospital admissions.

FIGURE 1

PRISMA flowchart of the included studies.

FIGURE 2

Association between prognostic factors and mortality among coronavirus disease 2019 (COVID-19) cases within a) community, b) hospital and c) intensive care unit (ICU) settings. Odds ratios (ORs) (95% confidence intervals (CIs)), I² test for heterogeneity, absolute risk differences (95% CIs) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment are presented. COPD: chronic obstructive pulmonary disease; IHD: ischaemic heart disease; N (n): number of studies (number of population); VTE: venous thromboembolism

FIGURE 3

Association between prognostic factors and hospital admission among coronavirus disease 2019 (COVID-19) within the community setting. Odds ratios (ORs) (95% confidence intervals (CIs)), I² test for heterogeneity, absolute risk differences (95% CIs) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment are presented for all studies. ACE: angiotensin-converting enzyme; ARB: angiotensin receptor blocker; COPD: chronic obstructive pulmonary disease; IHD: ischaemic heart disease; N (n): number of studies (number of population).

FIGURE 4

Association between prognostic factors and intensive care unit (ICU) admission among coronavirus disease 2019 (COVID-19) cases within the hospital setting. Odds ratios (ORs) (95% confidence intervals (CIs)), I² test for heterogeneity, absolute risk differences (95% CIs) and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) assessment are presented for all studies. COPD: chronic obstructive pulmonary disease; N (n): number of studies (number of population).