Department of Respiratory and Critical Care Medicine, West China Medical School/West China Hospital, Sichuan University, Chengdu, Sichuan, China.
PLoS One. 2020 Nov 30;15(11):e0243124. doi: 10.1371/journal.pone.0243124. eCollection 2020.
Early and accurate prognosis prediction of the patients was urgently warranted due to the widespread popularity of COVID-19. We performed a meta-analysis aimed at comprehensively summarizing the clinical characteristics and laboratory abnormalities correlated with increased risk of mortality in COVID-19 patients.
PubMed, Scopus, Web of Science, and Embase were systematically searched for studies considering the relationship between COVID-19 and mortality up to 4 June 2020. Data were extracted including clinical characteristics and laboratory examination.
Thirty-one studies involving 9407 COVID-19 patients were included. Dyspnea (OR = 4.52, 95%CI [3.15, 6.48], P < 0.001), chest tightness (OR = 2.50, 95%CI [1.78, 3.52], P<0.001), hemoptysis (OR = 2.00, 95%CI [1.02, 3.93], P = 0.045), expectoration (OR = 1.52, 95%CI [1.17, 1.97], P = 0.002) and fatigue (OR = 1.27, 95%CI [1.09, 1.48], P = 0.003) were significantly related to increased risk of mortality in COVID-19 patients. Furthermore, increased pretreatment absolute leukocyte count (OR = 11.11, 95%CI [6.85,18.03], P<0.001) and decreased pretreatment absolute lymphocyte count (OR = 9.83, 95%CI [6.72, 14.38], P<0.001) were also associated with increased mortality of COVID-19. We also compared the mean value of them between survivors and non-survivors, and found that non-survivors showed significantly raise in pretreatment absolute leukocyte count (WMD: 3.27×109/L, 95%CI [2.34, 4.21], P<0.001) and reduction in pretreatment absolute lymphocyte count (WMD = -0.39×109/L, 95%CI [-0.46, -0.33], P<0.001) compared with survivors. The results of pretreatment lactate dehydrogenase (LDH), procalcitonin (PCT), D-Dimer and ferritin showed the similar trend with pretreatment absolute leukocyte count.
Among the common symptoms of COVID-19 infections, fatigue, expectoration, hemoptysis, dyspnea and chest tightness were independent predictors of death. As for laboratory examinations, significantly increased pretreatment absolute leukocytosis count, LDH, PCT, D-Dimer and ferritin, and decreased pretreatment absolute lymphocyte count were found in non-survivors, which also have an unbeneficial impact on mortality among COVID-19 patients. Motoring these indicators during the hospitalization plays a very important role in predicting the prognosis of patients.
由于 COVID-19 的广泛流行，迫切需要对患者进行早期和准确的预后预测。我们进行了一项荟萃分析，旨在全面总结与 COVID-19 患者死亡率升高相关的临床特征和实验室异常。
系统检索了截至 2020 年 6 月 4 日的 PubMed、Scopus、Web of Science 和 Embase 中考虑 COVID-19 与死亡率之间关系的研究。提取的数据包括临床特征和实验室检查。
纳入了 31 项涉及 9407 例 COVID-19 患者的研究。呼吸困难（OR = 4.52，95%CI [3.15, 6.48]，P < 0.001）、胸闷（OR = 2.50，95%CI [1.78, 3.52]，P<0.001）、咯血（OR = 2.00，95%CI [1.02, 3.93]，P = 0.045）、咳痰（OR = 1.52，95%CI [1.17, 1.97]，P = 0.002）和乏力（OR = 1.27，95%CI [1.09, 1.48]，P = 0.003）与 COVID-19 患者的死亡风险增加显著相关。此外，治疗前绝对白细胞计数升高（OR = 11.11，95%CI [6.85,18.03]，P<0.001）和治疗前绝对淋巴细胞计数降低（OR = 9.83，95%CI [6.72, 14.38]，P<0.001）也与 COVID-19 的死亡率增加相关。我们还比较了幸存者和非幸存者之间的这些指标的平均值，发现非幸存者的治疗前绝对白细胞计数显著升高（WMD：3.27×109/L，95%CI [2.34, 4.21]，P<0.001），治疗前绝对淋巴细胞计数降低（WMD = -0.39×109/L，95%CI [-0.46, -0.33]，P<0.001）。治疗前乳酸脱氢酶（LDH）、降钙素原（PCT）、D-二聚体和铁蛋白的结果也显示出与治疗前绝对白细胞计数相似的趋势。
在 COVID-19 感染的常见症状中，乏力、咳痰、咯血、呼吸困难和胸闷是死亡的独立预测因素。在实验室检查方面，非幸存者的治疗前绝对白细胞计数、LDH、PCT、D-二聚体和铁蛋白显著升高，治疗前绝对淋巴细胞计数降低，这也对 COVID-19 患者的死亡率产生不利影响。在住院期间监测这些指标对预测患者的预后具有非常重要的作用。
