Servicio de clínica médica, Hospital Alemán, Buenos Aires, Argentina.
Servicio de clínica médica, Hospital Fernández, Buenos Aires, Argentina.
PLoS One. 2020 Nov 17;15(11):e0241955. doi: 10.1371/journal.pone.0241955. eCollection 2020.
The objective of our systematic review is to identify prognostic factors that may be used in decision-making related to the care of patients infected with COVID-19.
We conducted highly sensitive searches in PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) and Embase. The searches covered the period from the inception date of each database until April 28, 2020. No study design, publication status or language restriction were applied.
We included studies that assessed patients with confirmed or suspected SARS-CoV-2 infectious disease and examined one or more prognostic factors for mortality or disease severity. Reviewers working in pairs independently screened studies for eligibility, extracted data and assessed the risk of bias. We performed meta-analyses and used GRADE to assess the certainty of the evidence for each prognostic factor and outcome.
We included 207 studies and found high or moderate certainty that the following 49 variables provide valuable prognostic information on mortality and/or severe disease in patients with COVID-19 infectious disease: Demographic factors (age, male sex, smoking), patient history factors (comorbidities, cerebrovascular disease, chronic obstructive pulmonary disease, chronic kidney disease, cardiovascular disease, cardiac arrhythmia, arterial hypertension, diabetes, dementia, cancer and dyslipidemia), physical examination factors (respiratory failure, low blood pressure, hypoxemia, tachycardia, dyspnea, anorexia, tachypnea, haemoptysis, abdominal pain, fatigue, fever and myalgia or arthralgia), laboratory factors (high blood procalcitonin, myocardial injury markers, high blood White Blood Cell count (WBC), high blood lactate, low blood platelet count, plasma creatinine increase, high blood D-dimer, high blood lactate dehydrogenase (LDH), high blood C-reactive protein (CRP), decrease in lymphocyte count, high blood aspartate aminotransferase (AST), decrease in blood albumin, high blood interleukin-6 (IL-6), high blood neutrophil count, high blood B-type natriuretic peptide (BNP), high blood urea nitrogen (BUN), high blood creatine kinase (CK), high blood bilirubin and high erythrocyte sedimentation rate (ESR)), radiological factors (consolidative infiltrate and pleural effusion) and high SOFA score (sequential organ failure assessment score).
Identified prognostic factors can help clinicians and policy makers in tailoring management strategies for patients with COVID-19 infectious disease while researchers can utilise our findings to develop multivariable prognostic models that could eventually facilitate decision-making and improve patient important outcomes.
Prospero registration number: CRD42020178802. Protocol available at: https://www.medrxiv.org/content/10.1101/2020.04.08.20056598v1.
本系统评价的目的是确定可能用于与 COVID-19 感染患者护理相关决策的预后因素。
我们在 PubMed/MEDLINE、Cochrane 对照试验中心注册库（CENTRAL）和 Embase 中进行了高度敏感的检索。搜索涵盖了每个数据库的创建日期至 2020 年 4 月 28 日的时间段。未应用研究设计、出版状态或语言限制。
我们纳入了评估确诊或疑似 SARS-CoV-2 传染病患者并检查一个或多个死亡率或疾病严重程度预后因素的研究。审查员成对工作，独立筛选研究的合格性，提取数据并评估偏倚风险。我们进行了荟萃分析，并使用 GRADE 评估每个预后因素和结局的证据确定性。
我们纳入了 207 项研究，发现以下 49 个变量在 COVID-19 传染病患者的死亡率和/或严重疾病方面提供了有价值的预后信息，具有高度或中度确定性：人口统计学因素（年龄、男性、吸烟）、患者病史因素（合并症、脑血管疾病、慢性阻塞性肺疾病、慢性肾脏病、心血管疾病、心律失常、动脉高血压、糖尿病、痴呆、癌症和血脂异常）、体检因素（呼吸衰竭、低血压、低氧血症、心动过速、呼吸困难、厌食、呼吸急促、咯血、腹痛、疲劳、发热和肌痛或关节痛）、实验室因素（血液降钙素原升高、心肌损伤标志物升高、白细胞计数升高、血液乳酸升高、血小板计数降低、血浆肌酐升高、血 D-二聚体升高、血液乳酸脱氢酶升高（LDH）、高血 C 反应蛋白（CRP）、淋巴细胞计数下降、血天门冬氨酸氨基转移酶升高、血白蛋白下降、血白细胞介素-6（IL-6）升高、血中性粒细胞计数升高、血 B 型利钠肽（BNP）升高、血尿素氮升高（BUN）、血肌酸激酶（CK）升高、血胆红素升高、红细胞沉降率升高（ESR））、影像学因素（实变浸润和胸腔积液）和 SOFA 评分升高（序贯器官衰竭评估评分）。
确定的预后因素可以帮助临床医生和决策者针对 COVID-19 传染病患者制定管理策略，而研究人员可以利用我们的发现来开发多变量预后模型，最终有助于决策制定和改善患者重要结局。
Prospéro 注册号：CRD42020178802。方案可在以下网址获得：https://www.medrxiv.org/content/10.1101/2020.04.08.20056598v1.
