Wu Ting, Zuo Zhihong, Kang Shuntong, Jiang Liping, Luo Xuan, Xia Zanxian, Liu Jing, Xiao Xiaojuan, Ye Mao, Deng Meichun
1Department of Biochemistry and Molecular Biology & Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Hunan 410013, China.
2Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, Hunan 410013, China.
Aging Dis. 2020 May 13;11(4):874-894. doi: 10.14336/AD.2020.0520. eCollection 2020 Jul.
This study aimed to provide systematic evidence for the association between multiorgan dysfunction and COVID-19 development. Several online databases were searched for articles published until May 13, 2020. Two investigators independently selected trials, extracted data, and evaluated the quality of individual trials. Single-arm meta-analysis was performed to summarize the clinical features of confirmed COVID-19 patients. Fixed effects meta-analysis was performed for clinically relevant parameters that were closely related to the patients' various organ functions. A total of 73 studies, including 171,108 patients, were included in this analysis. The overall incidence of severe COVID-19 and mortality were 24% (95% confidence interval [CI], 20%-28%) and 2% (95% CI, 1%-3%), respectively. Patients with hypertension (odds ratio [OR] = 2.40; 95% CI, 2.08-2.78), cardiovascular disease (CVD) (OR = 3.54; 95% CI, 2.68-4.68), chronic obstructive pulmonary disease (COPD) (OR=3.70; 95% CI, 2.93-4.68), chronic liver disease (CLD) (OR=1.48; 95% CI, 1.09-2.01), chronic kidney disease (CKD) (OR = 1.84; 95% CI, 1.47-2.30), chronic cerebrovascular diseases (OR = 2.53; 95% CI, 1.84-3.49) and chronic gastrointestinal (GI) disease (OR = 2.13; 95% CI, 1.12-4.05) were more likely to develop severe COVID-19. Increased levels of lactate dehydrogenase (LDH), creatine kinase (CK), high-sensitivity cardiac troponin I (hs-cTnI), myoglobin, creatinine, urea, alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin were highly associated with severe COVID-19. The incidence of acute organ injuries, including acute cardiac injury (ACI); (OR = 11.87; 95% CI, 7.64-18.46), acute kidney injury (AKI); (OR=10.25; 95% CI, 7.60-13.84), acute respiratory distress syndrome (ARDS); (OR=27.66; 95% CI, 18.58-41.18), and acute cerebrovascular diseases (OR=9.22; 95% CI, 1.61-52.72) was more common in patients with severe COVID-19 than in patients with non-severe COVID-19. Patients with a history of organ dysfunction are more susceptible to severe conditions. COVID-19 can aggravate an acute multiorgan injury.
本研究旨在为多器官功能障碍与新型冠状病毒肺炎（COVID-19）病情发展之间的关联提供系统性证据。检索了多个在线数据库，查找截至2020年5月13日发表的文章。两名研究人员独立筛选试验、提取数据并评估单个试验的质量。采用单臂荟萃分析总结确诊COVID-19患者的临床特征。对与患者各器官功能密切相关的临床相关参数进行固定效应荟萃分析。本分析共纳入73项研究，包括171,108例患者。重症COVID-19的总体发生率和死亡率分别为24%（95%置信区间[CI]，20%-28%）和2%（95%CI，1%-3%）。高血压患者（比值比[OR]=2.40；95%CI，2.08-2.78）、心血管疾病（CVD）患者（OR=3.54；95%CI，2.68-4.68）、慢性阻塞性肺疾病（COPD）患者（OR=3.70；95%CI，2.93-4.68）、慢性肝病（CLD）患者（OR=1.48；95%CI，1.09-2.01）、慢性肾病（CKD）患者（OR = 1.84；95%CI，1.47-2.30）、慢性脑血管疾病患者（OR = 2.53；95%CI，1.84-3.49）和慢性胃肠道（GI）疾病患者（OR = 2.13；95%CI，1.12-4.05）更易发展为重症COVID-19。乳酸脱氢酶（LDH）、肌酸激酶（CK）、高敏心肌肌钙蛋白I（hs-cTnI）、肌红蛋白、肌酐、尿素、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）和总胆红素水平升高与重症COVID-19高度相关。急性器官损伤的发生率，包括急性心脏损伤（ACI）；（OR = 11.87；95%CI，7.64-18.46）、急性肾损伤（AKI）；（OR=10.25；95%CI，7.60-13.84）、急性呼吸窘迫综合征（ARDS）；（OR=27.66；95%CI，18.58-41.18）和急性脑血管疾病（OR=9.22；95%CI，1.61-52.72）在重症COVID-19患者中比非重症COVID-19患者更常见。有器官功能障碍病史的患者更容易出现重症情况。COVID-19可加重急性多器官损伤。
