Risk factors for severe illness and death in COVID-19: a systematic review and meta-analysis

Degarege, Abraham; Naveed, Zaeema; Kabayundo, Josiane; Brett-Major, David

ObjectivesThis systematic review and meta-analysis synthesized the evidence on the impact of demographics and comorbidities with clinical outcomes of COVID-19, including severe illness, admission to the intensive care unit (ICU), and death. MethodsThe PRISMA guidelines were followed to conduct and report this meta-analysis. The protocol is registered in PROSPERO International prospective register of systematic reviews (ID=CRD42020184440). Two authors independently searched literature from PubMed, Embase, Cochrane library and CINHAL on May 6, 2020; removed duplicates; screened titles, abstracts and full text using criteria; and extracted data from eligible articles. A random-effects model was used to estimate the summary odds ratio (OR). Variations among studies were examined using Cochrane Q and I2. ResultsOut of 4,275 articles obtained from the databases and screened, 71 studies that involved 216,843 patients were abstracted and then, where appropriate, analyzed by meta-analysis. The COVID-19 related outcomes reported were death in 26 studies, severe illness in 41 studies, and admission to ICU in 11 studies. Death was significantly correlated with hypertension (OR 2.60, 95% CI 1.95-3.25, I2 = 52.6%, n= 13 studies), cardiovascular disease (5.16, 4.10-6.22, 0.0%, 6), diabetes (2.11, 1.35-2.87, 67.4%, 12), chronic respiratory disease (2.83, 2.14-3.51, 0.0%, 9), cerebrovascular diseases (5.14, 1.08-9.19, 0.0%, 2), male sex (1.34, 1.18 1.50, 38.7%, 16), age older than 60 (6.09, 3.53 8.66, 95.5%, 6) or 65 years (3.56, 1.21 5.90, 18.2%, 6). Severe illness was also significantly associated with hypertension (1.70, 1.30 -2.10, 47.8%, 21), cardiovascular diseases (2.04, 1.01-3.08, 30.6%, 10), diabetes (1.65, 1.23-2.08, 24.9%, 18), male sex (1.35, 1.23 1.47, 0.0%, 32) and age at least 60 (4.91, 1.35 8.47, 0.0%, 4) or 65 (2.55,1.94 3.17, 24.5%, 9) years. Among hospitalized patients, the odds of admission to ICU was greater in individuals who had cardiovascular diseases (1.36,1.04-1.69, 0.0%, 4), diabetes (1.55, 1.20-1.90, 0.0%, 5) and chronic respiratory disease (1.52, 1.09-1.94, 0.0%, 5) than those who were not having these comorbidities. ConclusionsOlder age and chronic diseases increase the risk of developing severe illness, admission to ICU and death among COVID-19 patients. Special strategies are warranted to prevent SARS-CoV-2 infection and manage COVID-19 cases in those with vulnerabilities.