预测 COVID-19 院内死亡率的因素：一项全面的系统综述和荟萃分析，探讨了年龄、性别和健康状况的差异。
Predictors of in-hospital COVID-19 mortality: A comprehensive systematic review and meta-analysis exploring differences by age, sex and health conditions.
机构信息
Health and Social Research Centre, Universidad de Castilla-La Mancha, Cuenca, Spain.
Postgraduate Program in Public Health, Universidade Estadual de Londrina, Londrina, Paraná, Brasil.
出版信息
PLoS One. 2020 Nov 3;15(11):e0241742. doi: 10.1371/journal.pone.0241742. eCollection 2020.
OBJECTIVE
Risk factors for in-hospital mortality in confirmed COVID-19 patients have been summarized in numerous meta-analyses, but it is still unclear whether they vary according to the age, sex and health conditions of the studied populations. This study explored these variables as potential mortality predictors.
METHODS
A systematic review was conducted by searching the MEDLINE, Scopus, and Web of Science databases of studies available through July 27, 2020. The pooled risk was estimated with the odds ratio (p-OR) or effect size (p-ES) obtained through random-effects meta-analyses. Subgroup analyses and meta-regression were applied to explore differences by age, sex and health conditions. The MOOSE guidelines were strictly followed.
RESULTS
The meta-analysis included 60 studies, with a total of 51,225 patients (12,458 [24.3%] deaths) from hospitals in 13 countries. A higher in-hospital mortality risk was found for dyspnoea (p-OR = 2.5), smoking (p-OR = 1.6) and several comorbidities (p-OR range: 1.8 to 4.7) and laboratory parameters (p-ES range: 0.3 to -2.6). Age was the main source of heterogeneity, followed by sex and health condition. The following predictors were more markedly associated with mortality in studies with patients with a mean age ≤60 years: dyspnoea (p-OR = 4.3), smoking (p-OR = 2.8), kidney disease (p-OR = 3.8), hypertension (p-OR = 3.7), malignancy (p-OR = 3.7), diabetes (p-OR = 3.2), pulmonary disease (p-OR = 3.1), decreased platelet count (p-ES = -1.7), decreased haemoglobin concentration (p-ES = -0.6), increased creatinine (p-ES = 2.4), increased interleukin-6 (p-ES = 2.4) and increased cardiac troponin I (p-ES = 0.7). On the other hand, in addition to comorbidities, the most important mortality predictors in studies with older patients were albumin (p-ES = -3.1), total bilirubin (p-ES = 0.7), AST (p-ES = 1.8), ALT (p-ES = 0.4), urea nitrogen (p-ES), C-reactive protein (p-ES = 2.7), LDH (p-ES = 2.4) and ferritin (p-ES = 1.7). Obesity was associated with increased mortality only in studies with fewer chronic or critical patients (p-OR = 1.8).
CONCLUSION
The prognostic effect of clinical conditions on COVID-19 mortality vary substantially according to the mean age of patients.
PROSPERO REGISTRATION NUMBER
CRD42020176595.
目的
已有大量荟萃分析总结了确诊 COVID-19 患者住院期间死亡的危险因素，但目前仍不清楚这些危险因素是否因研究人群的年龄、性别和健康状况而有所不同。本研究旨在探讨这些变量是否为潜在的死亡预测因素。
方法
通过检索 MEDLINE、Scopus 和 Web of Science 数据库，对截至 2020 年 7 月 27 日的研究进行了系统评价。采用随机效应荟萃分析估算合并风险比（p-OR）或效应量（p-ES）。采用亚组分析和 meta 回归来探讨年龄、性别和健康状况的差异。严格遵循 MOOSE 指南。
结果
meta 分析纳入了 60 项研究，共 51225 例来自 13 个国家的医院患者（12458 例[24.3%]死亡）。呼吸困难（p-OR=2.5）、吸烟（p-OR=1.6）和多种合并症（p-OR 范围：1.8-4.7）及实验室参数（p-ES 范围：0.3-2.6）与更高的住院死亡率相关。年龄是异质性的主要来源，其次是性别和健康状况。以下预测因素与平均年龄≤60 岁的患者研究中的死亡率相关性更强：呼吸困难（p-OR=4.3）、吸烟（p-OR=2.8）、肾脏疾病（p-OR=3.8）、高血压（p-OR=3.7）、恶性肿瘤（p-OR=3.7）、糖尿病（p-OR=3.2）、肺部疾病（p-OR=3.1）、血小板计数降低（p-ES=-1.7）、血红蛋白浓度降低（p-ES=-0.6）、肌酐升高（p-ES=2.4）、白细胞介素 6 升高（p-ES=2.4）和肌钙蛋白 I 升高（p-ES=0.7）。另一方面，除了合并症外，老年患者研究中最重要的死亡预测因素为白蛋白（p-ES=-3.1）、总胆红素（p-ES=0.7）、AST（p-ES=1.8）、ALT（p-ES=0.4）、尿素氮（p-ES）、C 反应蛋白（p-ES=2.7）、乳酸脱氢酶（p-ES=2.4）和铁蛋白（p-ES=1.7）。肥胖仅与慢性或危重症患者较少的研究中死亡率升高相关（p-OR=1.8）。
结论
临床状况对 COVID-19 死亡率的预后影响因患者的平均年龄而异。
PROSPERO 注册号：CRD42020176595。
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