Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China.
Ann Palliat Med. 2021 Mar;10(3):2723-2735. doi: 10.21037/apm-20-1278. Epub 2021 Feb 1.
New evidence from retrospective cohort studies on risk of death from COVID-19 infection became available. We aimed to systematically review the clinical risk factors for fatal outcome of COVID-19.
We performed meta-analysis, using PubMed, EMBASE and Cochrane databases from December 1 2019 to June 10 2020. The meta-analysis summarized clinical, laboratory, radiological features, and complications of non-survivors with confirmed COVID-19. In addition, a fixed- or random-effects model was adopted based on the heterogeneity among studies. We also used funnel-plot with Egger's tests to screen potential publication bias.
In total, twenty studies with 15,408 COVID-19 cases were included in our meta-analysis. Male, current smoking, and older age were associated with in-hospital death. Patients aged 60 years or over had the highest pooled ORs [OR 4.94 (2.89, 8.44)]. Non-survivors were more likely to have diabetes, hypertension, cardiovascular disease (CVD), respiratory disease, or chronic kidney disease (CKD). Respiratory disease had the highest pooled ORs [OR 2.55 (2.14, 3.05)]. Dyspnea [OR 3.31 (1.78, 6.16); I2 : 83%] and fatigue [OR 1.36 (1.07, 1.73); I2 : 0%] were associated with increased risk of death. Increased white blood cell count, decreased lymphocyte and platelet counts, were also associated with increased risk of death. Biomarkers of coagulation function, inflammation, liver and kidney function, cardiac and muscle injury were also elevated in nonsurvivors.
Male, current smoking patients aged 60 years or over might face a greater risk of in-hospital death and the comorbidities such as diabetes, hypertension, CVD, respiratory disease, and CKD could also influence the prognosis of the COVID-19. Clinical feature such as dyspnea and fatigue could imply the exacerbation and even death. Our findings highlighted early markers of mortality which were beneficial to identify fatal COVID-19.
有新的回顾性队列研究证据表明 COVID-19 感染的死亡风险。我们旨在系统地综述 COVID-19 致死结局的临床危险因素。
我们使用 PubMed、EMBASE 和 Cochrane 数据库，从 2019 年 12 月 1 日至 2020 年 6 月 10 日进行荟萃分析。该荟萃分析总结了确诊 COVID-19 患者中死亡患者的临床、实验室、影像学特征和并发症。此外，根据研究间的异质性，采用固定或随机效应模型。我们还使用漏斗图和 Egger 检验筛选潜在的发表偏倚。
共有 20 项研究纳入 15408 例 COVID-19 患者，纳入本荟萃分析。男性、当前吸烟和年龄较大与院内死亡相关。60 岁及以上患者的合并 OR 值最高[OR 4.94（2.89，8.44）]。非幸存者更有可能患有糖尿病、高血压、心血管疾病（CVD）、呼吸道疾病或慢性肾脏病（CKD）。呼吸道疾病的合并 OR 值最高[OR 2.55（2.14，3.05）]。呼吸困难[OR 3.31（1.78，6.16）；I2：83%]和疲劳[OR 1.36（1.07，1.73）；I2：0%]与死亡风险增加相关。白细胞计数增加、淋巴细胞和血小板计数减少也与死亡风险增加相关。凝血功能、炎症、肝肾功能、心脏和肌肉损伤的生物标志物在非幸存者中也升高。
男性、60 岁及以上当前吸烟患者可能面临更大的院内死亡风险，糖尿病、高血压、CVD、呼吸道疾病和 CKD 等合并症也可能影响 COVID-19 的预后。呼吸困难和疲劳等临床特征可能意味着病情加重甚至死亡。我们的研究结果强调了有助于识别 COVID-19 死亡风险的早期死亡标志物。
