Patel Urvish, Malik Preeti, Usman Muhammad Shariq, Mehta Deep, Sharma Ashish, Malik Faizan Ahmad, Khan Nashmia, Siddiqi Tariq Jamal, Ahmed Jawad, Patel Achint, Sacks Henry
Department of Public Health, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029 USA.
Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
SN Compr Clin Med. 2020;2(10):1740-1749. doi: 10.1007/s42399-020-00476-w. Epub 2020 Aug 29.
The increasing COVID-19 cases in the USA have led to overburdening of healthcare in regard to invasive mechanical ventilation (IMV) utilization as well as mortality. We aim to identify risk factors associated with poor outcomes (IMV and mortality) of COVID-19 hospitalized patients. A meta-analysis of observational studies with epidemiological characteristics of COVID-19 in PubMed, Web of Science, Scopus, and medRxiv from December 1, 2019 to May 31, 2020 following MOOSE guidelines was conducted. Twenty-nine full-text studies detailing epidemiological characteristics, symptoms, comorbidities, complications, and outcomes were included. Meta-regression was performed to evaluate effects of comorbidities, and complications on outcomes using a random-effects model. The pooled correlation coefficient (), 95% CI, and OR were calculated. Of 29 studies (12,258 confirmed cases), 17 reported IMV and 21 reported deaths. The pooled prevalence of IMV was 23.3% (95% CI: 17.1-30.9%), and mortality was 13% (9.3-18%). The age-adjusted meta-regression models showed significant association of mortality with male (: 0.14; OR: 1.15; 95% CI: 1.07-1.23; : 95.2%), comorbidities including pre-existing cerebrovascular disease (: 0.35; 1.42 (1.14-1.77); : 96.1%), and chronic liver disease (: 0.08; 1.08 (1.01-1.17); : 96.23%), complications like septic shock (: 0.099; 1.10 (1.02-1.2); : 78.12%) and ARDS (: 0.04; 1.04 (1.02-1.06); : 90.3%), ICU admissions (: 0.03; 1.03 (1.03-1.05); : 95.21%), and IMV utilization (: 0.05; 1.05 (1.03-1.07); : 89.80%). Similarly, male (: 0.08; 1.08 (1.02-1.15); : 95%), comorbidities like pre-existing cerebrovascular disease (: 0.29; 1.34 (1.09-1.63); :93.4%), and cardiovascular disease (: 0.28; 1.32 (1.1-1.58); : 89.7%) had higher odds of IMV utilization. COVID-19 patients with comorbidities including cardiovascular disease, cerebrovascular disease, and chronic liver disease had poor outcomes. Diabetes and hypertension had higher prevalence but no association with mortality and IMV. Our study results will be helpful in right allocation of resources towards patients who need them the most.
美国新冠肺炎病例不断增加，导致在有创机械通气（IMV）使用及死亡率方面医疗系统负担过重。我们旨在确定新冠肺炎住院患者预后不良（IMV使用及死亡）的相关风险因素。按照MOOSE指南，对2019年12月1日至2020年5月31日期间PubMed、科学网、Scopus和medRxiv上具有新冠肺炎流行病学特征的观察性研究进行了荟萃分析。纳入了29项详细描述流行病学特征、症状、合并症、并发症及预后的全文研究。采用随机效应模型进行荟萃回归，以评估合并症和并发症对预后的影响。计算了合并相关系数（）、95%置信区间及比值比（OR）。在29项研究（12258例确诊病例）中，17项报告了IMV使用情况，21项报告了死亡情况。IMV的合并患病率为23.3%（95%置信区间：17.1 - 30.9%），死亡率为13%（9.3 - 18%）。年龄调整后的荟萃回归模型显示，死亡率与男性（：0.14；OR：1.15；95%置信区间：1.07 - 1.23；：95.2%）、包括既往脑血管疾病在内的合并症（：0.35；1.42（1.14 -
