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Cardiovascular risk factors and mortality in hospitalized patients with COVID-19: systematic review and meta-analysis of 45 studies and 18,300 patients.

ABSTRACT:

Background

A high prevalence of cardiovascular risk factors including age, male sex, hypertension, diabetes, and tobacco use, has been reported in patients with Coronavirus disease 2019 (COVID-19) who experienced adverse outcome. The aim of this study was to investigate the relationship between cardiovascular risk factors and in-hospital mortality in patients with COVID-19.

Methods

MEDLINE, Cochrane, Web of Sciences, and SCOPUS were searched for retrospective or prospective observational studies reporting data on cardiovascular risk factors and in-hospital mortality in patients with COVID-19. Univariable and multivariable age-adjusted analyses were conducted to evaluate the association between cardiovascular risk factors and the occurrence of in-hospital death.

Results

The analysis included 45 studies enrolling 18,300 patients. The pooled estimate of in-hospital mortality was 12% (95% CI 9-15%). The univariable meta-regression analysis showed a significant association between age (coefficient: 1.06; 95% CI 1.04-1.09; p < 0.001), diabetes (coefficient: 1.04; 95% CI 1.02-1.07; p < 0.001) and hypertension (coefficient: 1.01; 95% CI 1.01-1.03; p = 0.013) with in-hospital death. Male sex and smoking did not significantly affect mortality. At multivariable age-adjusted meta-regression analysis, diabetes was significantly associated with in-hospital mortality (coefficient: 1.02; 95% CI 1.01-1.05; p = 0.043); conversely, hypertension was no longer significant after adjustment for age (coefficient: 1.00; 95% CI 0.99-1.01; p = 0.820). A significant association between age and in-hospital mortality was confirmed in all multivariable models.

Conclusions

This meta-analysis suggests that older age and diabetes are associated with higher risk of in-hospital mortality in patients infected by SARS-CoV-2. Conversely, male sex, hypertension, and smoking did not independently correlate with fatal outcome.

SUBMITTER: Silverio A

PROVIDER: S-EPMC7789083 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundEarly and accurate prognosis prediction of the patients was urgently warranted due to the widespread popularity of COVID-19. We performed a meta-analysis aimed at comprehensively summarizing the clinical characteristics and laboratory abnormalities correlated with increased risk of mortality in COVID-19 patients.MethodsPubMed, Scopus, Web of Science, and Embase were systematically searched for studies considering the relationship between COVID-19 and mortality up to 4 June 2020. Data were extracted including clinical characteristics and laboratory examination.ResultsThirty-one studies involving 9407 COVID-19 patients were included. Dyspnea (OR = 4.52, 95%CI [3.15, 6.48], P < 0.001), chest tightness (OR = 2.50, 95%CI [1.78, 3.52], P<0.001), hemoptysis (OR = 2.00, 95%CI [1.02, 3.93], P = 0.045), expectoration (OR = 1.52, 95%CI [1.17, 1.97], P = 0.002) and fatigue (OR = 1.27, 95%CI [1.09, 1.48], P = 0.003) were significantly related to increased risk of mortality in COVID-19 patients. Furthermore, increased pretreatment absolute leukocyte count (OR = 11.11, 95%CI [6.85,18.03], P<0.001) and decreased pretreatment absolute lymphocyte count (OR = 9.83, 95%CI [6.72, 14.38], P<0.001) were also associated with increased mortality of COVID-19. We also compared the mean value of them between survivors and non-survivors, and found that non-survivors showed significantly raise in pretreatment absolute leukocyte count (WMD: 3.27×109/L, 95%CI [2.34, 4.21], P<0.001) and reduction in pretreatment absolute lymphocyte count (WMD = -0.39×109/L, 95%CI [-0.46, -0.33], P<0.001) compared with survivors. The results of pretreatment lactate dehydrogenase (LDH), procalcitonin (PCT), D-Dimer and ferritin showed the similar trend with pretreatment absolute leukocyte count.ConclusionsAmong the common symptoms of COVID-19 infections, fatigue, expectoration, hemoptysis, dyspnea and chest tightness were independent predictors of death. As for laboratory examinations, significantly increased pretreatment absolute leukocytosis count, LDH, PCT, D-Dimer and ferritin, and decreased pretreatment absolute lymphocyte count were found in non-survivors, which also have an unbeneficial impact on mortality among COVID-19 patients. Motoring these indicators during the hospitalization plays a very important role in predicting the prognosis of patients.