新冠病毒肺炎住院患者的心血管危险因素与死亡率：45项研究及18300例患者的系统评价与荟萃分析
Cardiovascular risk factors and mortality in hospitalized patients with COVID-19: systematic review and meta-analysis of 45 studies and 18,300 patients.
作者信息
Silverio Angelo, Di Maio Marco, Citro Rodolfo, Esposito Luca, Iuliano Giuseppe, Bellino Michele, Baldi Cesare, De Luca Giuseppe, Ciccarelli Michele, Vecchione Carmine, Galasso Gennaro
机构信息
Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Salerno, Italy.
Division of Cardiology, Cardiovascular and Thoracic Department, University Hospital ''San Giovanni di Dio e Ruggi d'Aragona'', Salerno, Italy.
出版信息
BMC Cardiovasc Disord. 2021 Jan 7;21(1):23. doi: 10.1186/s12872-020-01816-3.
BACKGROUND
A high prevalence of cardiovascular risk factors including age, male sex, hypertension, diabetes, and tobacco use, has been reported in patients with Coronavirus disease 2019 (COVID-19) who experienced adverse outcome. The aim of this study was to investigate the relationship between cardiovascular risk factors and in-hospital mortality in patients with COVID-19.
METHODS
MEDLINE, Cochrane, Web of Sciences, and SCOPUS were searched for retrospective or prospective observational studies reporting data on cardiovascular risk factors and in-hospital mortality in patients with COVID-19. Univariable and multivariable age-adjusted analyses were conducted to evaluate the association between cardiovascular risk factors and the occurrence of in-hospital death.
RESULTS
The analysis included 45 studies enrolling 18,300 patients. The pooled estimate of in-hospital mortality was 12% (95% CI 9-15%). The univariable meta-regression analysis showed a significant association between age (coefficient: 1.06; 95% CI 1.04-1.09; p < 0.001), diabetes (coefficient: 1.04; 95% CI 1.02-1.07; p < 0.001) and hypertension (coefficient: 1.01; 95% CI 1.01-1.03; p = 0.013) with in-hospital death. Male sex and smoking did not significantly affect mortality. At multivariable age-adjusted meta-regression analysis, diabetes was significantly associated with in-hospital mortality (coefficient: 1.02; 95% CI 1.01-1.05; p = 0.043); conversely, hypertension was no longer significant after adjustment for age (coefficient: 1.00; 95% CI 0.99-1.01; p = 0.820). A significant association between age and in-hospital mortality was confirmed in all multivariable models.
CONCLUSIONS
This meta-analysis suggests that older age and diabetes are associated with higher risk of in-hospital mortality in patients infected by SARS-CoV-2. Conversely, male sex, hypertension, and smoking did not independently correlate with fatal outcome.
背景
在经历不良结局的2019冠状病毒病（COVID-19）患者中，已报告心血管危险因素（包括年龄、男性、高血压、糖尿病和吸烟）的高患病率。本研究的目的是调查COVID-19患者心血管危险因素与院内死亡率之间的关系。
方法
检索MEDLINE、Cochrane、科学网和SCOPUS，查找报告COVID-19患者心血管危险因素和院内死亡率数据的回顾性或前瞻性观察性研究。进行单变量和多变量年龄调整分析，以评估心血管危险因素与院内死亡发生之间的关联。
结果
分析纳入了45项研究，共18300例患者。院内死亡率的合并估计值为12%（95%CI 9%-15%）。单变量meta回归分析显示，年龄（系数：1.06；95%CI 1.04-1.09；p<0.001）、糖尿病（系数：1.04；95%CI 1.02-1.07；p<0.001）和高血压（系数：1.01；95%CI 1.01-1.03；p=0.013）与院内死亡之间存在显著关联。男性和吸烟对死亡率没有显著影响。在多变量年龄调整meta回归分析中，糖尿病与院内死亡率显著相关（系数：1.02；95%CI 1.01-1.05；p=0.043）；相反，在调整年龄后，高血压不再具有显著性（系数：1.00；95%CI 0.99-1.01；p=0.820）。在所有多变量模型中，年龄与院内死亡率之间的显著关联均得到证实。
结论
这项meta分析表明，年龄较大和糖尿病与感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）患者的院内死亡风险较高相关。相反，男性、高血压和吸烟与致命结局没有独立相关性。
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