COVID-19 住院患者的急性并发症和死亡率：系统评价和荟萃分析。

Acute complications and mortality in hospitalized patients with coronavirus disease 2019: a systematic review and meta-analysis.

机构信息

Department of Medical, Oral and Biotechnological Sciences, "G. D'Annunzio" University, Via Dei Vestini 31, 66100, Chieti, Italy.

Department of Medicine and Ageing Sciences, "G. d'Annunzio" University, Chieti-Pescara, Italy.

出版信息

Crit Care. 2020 Jul 2;24(1):389. doi: 10.1186/s13054-020-03022-1.

DOI:10.1186/s13054-020-03022-1

PMID:32616077

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7330272/

Abstract

BACKGROUND

The incidence of acute complications and mortality associated with COVID-19 remains poorly characterized. The aims of this systematic review and meta-analysis were to summarize the evidence on clinically relevant outcomes in hospitalized patients with COVID-19.

METHODS

MEDLINE, EMBASE, PubMed, and medRxiv were searched up to April 20, 2020, for studies including hospitalized symptomatic adult patients with laboratory-confirmed COVID-19. The primary outcomes were all-cause mortality and acute respiratory distress syndrome (ARDS). The secondary outcomes included acute cardiac or kidney injury, shock, coagulopathy, and venous thromboembolism. The main analysis was based on data from peer-reviewed studies. Summary estimates and the corresponding 95% prediction intervals (PIs) were obtained through meta-analyses.

RESULTS

A total of 44 peer-reviewed studies with 14,866 COVID-19 patients were included. In general, risk of bias was high. All-cause mortality was 10% overall (95% PI, 2 to 39%; 1687/14203 patients; 43 studies), 34% in patients admitted to intensive care units (95% PI, 8 to 76%; 659/2368 patients; 10 studies), 83% in patients requiring invasive ventilation (95% PI, 1 to 100%; 180/220 patients; 6 studies), and 75% in patients who developed ARDS (95% PI, 35 to 94%; 339/455 patients; 11 studies). On average, ARDS occurred in 14% of patients (95% PI, 2 to 59%; 999/6322 patients; 23 studies), acute cardiac injury in 15% (95% PI, 5 to 38%; 452/2389 patients; 10 studies), venous thromboembolism in 15% (95% PI, 0 to 100%; patients; 3 studies), acute kidney injury in 6% (95% PI, 1 to 41%; 318/4682 patients; 15 studies), coagulopathy in 6% (95% PI, 1 to 39%; 223/3370 patients; 9 studies), and shock in 3% (95% PI, 0 to 61%; 203/4309 patients; 13 studies).

CONCLUSIONS

Mortality was very high in critically ill patients based on very low-quality evidence due to striking heterogeneity and risk of bias. The incidence of clinically relevant outcomes was substantial, although reported by only one third of the studies suggesting considerable underreporting.

TRIAL REGISTRATION

PROSPERO registration ID for this study is CRD42020177243 ( https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=177243 ).

摘要

背景

与 COVID-19 相关的急性并发症和死亡率的发生率仍描述不佳。本系统评价和荟萃分析的目的是总结与住院 COVID-19 患者相关的临床相关结局的证据。

方法

截至 2020 年 4 月 20 日，检索 MEDLINE、EMBASE、PubMed 和 medRxiv 以获取包括有实验室确诊 COVID-19 的住院有症状成年患者的研究。主要结局为全因死亡率和急性呼吸窘迫综合征（ARDS）。次要结局包括急性心脏或肾脏损伤、休克、凝血功能障碍和静脉血栓栓塞症。主要分析基于同行评议研究的数据。通过荟萃分析获得汇总估计值及其相应的 95%预测区间（PI）。

结果

共纳入 44 项有 14866 例 COVID-19 患者的同行评议研究。总体而言，偏倚风险较高。全因死亡率总体为 10%（95%PI，2 至 39%；1687/14203 例患者；43 项研究），入住重症监护病房的患者为 34%（95%PI，8 至 76%；659/2368 例患者；10 项研究），需要有创通气的患者为 83%（95%PI，1 至 100%；180/220 例患者；6 项研究），发生 ARDS 的患者为 75%（95%PI，35 至 94%；339/455 例患者；11 项研究）。平均而言，ARDS 发生在 14%的患者中（95%PI，2 至 59%；999/6322 例患者；23 项研究），急性心脏损伤发生在 15%的患者中（95%PI，5 至 38%；452/2389 例患者；10 项研究），静脉血栓栓塞症发生在 15%的患者中（95%PI，0 至 100%；3 项研究），急性肾损伤发生在 6%的患者中（95%PI，1 至 41%；318/4682 例患者；15 项研究），凝血功能障碍发生在 6%的患者中（95%PI，1 至 39%；223/3370 例患者；9 项研究），休克发生在 3%的患者中（95%PI，0 至 61%；203/4309 例患者；13 项研究）。