Predictors of COVID-19 severity: a systematic review and meta-analysis.

Mudatsir, Mudatsir; Fajar, Jonny Karunia; Wulandari, Laksmi; Soegiarto, Gatot; Ilmawan, Muhammad; Purnamasari, Yeni; Mahdi, Bagus Aulia; Jayanto, Galih Dwi; Suhendra, Suhendra; Setianingsih, Yennie Ayu; Hamdani, Romi; Suseno, Daniel Alexander; Agustina, Kartika; Naim, Hamdan Yuwafi; Muchlas, Muchamad; Alluza, Hamid Hunaif Dhofi; Rosida, Nikma Alfi; Mayasari, Mayasari; Mustofa, Mustofa; Hartono, Adam; Aditya, Richi; Prastiwi, Firman; Meku, Fransiskus Xaverius; Sitio, Monika; Azmy, Abdullah; Santoso, Anita Surya; Nugroho, Radhitio Adi; Gersom, Camoya; Rabaan, Ali A; Masyeni, Sri; Nainu, Firzan; Wagner, Abram L; Dhama, Kuldeep; Harapan, Harapan

Background: The unpredictability of the progression of coronavirus disease 2019 (COVID-19) may be attributed to the low precision of the tools used to predict the prognosis of this disease. Objective: To identify the predictors associated with poor clinical outcomes in patients with COVID-19. Methods: Relevant articles from PubMed, Embase, Cochrane, and Web of Science were searched as of April 5, 2020. The quality of the included papers was appraised using the Newcastle-Ottawa scale (NOS). Data of interest were collected and evaluated for their compatibility for the meta-analysis. Cumulative calculations to determine the correlation and effect estimates were performed using the Z test. Results: In total, 19 papers recording 1,934 mild and 1,644 severe cases of COVID-19 were included. Based on the initial evaluation, 62 potential risk factors were identified for the meta-analysis. Several comorbidities, including chronic respiratory disease, cardiovascular disease, diabetes mellitus, and hypertension were observed more frequent among patients with severe COVID-19 than with the mild ones. Compared to the mild form, severe COVID-19 was associated with symptoms such as dyspnea, anorexia, fatigue, increased respiratory rate, and high systolic blood pressure. Lower levels of lymphocytes and hemoglobin; elevated levels of leukocytes, aspartate aminotransferase, alanine aminotransferase, blood creatinine, blood urea nitrogen, high-sensitivity troponin, creatine kinase, high-sensitivity C-reactive protein, interleukin 6, D-dimer, ferritin, lactate dehydrogenase, and procalcitonin; and a high erythrocyte sedimentation rate were also associated with severe COVID-19. Conclusion: More than 30 risk factors are associated with a higher risk of severe COVID-19. These may serve as useful baseline parameters in the development of prediction tools for COVID-19 prognosis.