Usher Institute, University of Edinburgh, Edinburgh, UK.
Information Services, University of Edinburgh, Edinburgh, UK.
J Glob Health. 2021 Mar 1;11:10001. doi: 10.7189/jogh.11.10001.
Understanding the risk factors for poor outcomes among COVID-19 patients could help identify vulnerable populations who would need prioritisation in prevention and treatment for COVID-19. We aimed to critically appraise and synthesise published evidence on the risk factors for poor outcomes in hospitalised COVID-19 patients.
We searched PubMed, medRxiv and the WHO COVID-19 literature database for studies that reported characteristics of COVID-19 patients who required hospitalisation. We included studies published between January and May 2020 that reported adjusted effect size of any demographic and/or clinical factors for any of the three poor outcomes: mortality, intensive care unit (ICU) admission, and invasive mechanical ventilation. We appraised the quality of the included studies using Joanna Briggs Institute appraisal tools and quantitatively synthesised the evidence through a series of random-effect meta-analyses. To aid data interpretation, we further developed an interpretation framework that indicated strength of the evidence, informed by both quantity and quality of the evidence.
We included a total of 40 studies in our review. Most of the included studies (29/40, 73%) were assessed as "good quality", with assessment scores of 80 or more. We found that male sex (pooled odds ratio (OR) = 1.32 (95% confidence interval (CI) = 1.18-1.48; 20 studies), older age (OR = 1.05, 95% CI = 1.04-1.07, per one year of age increase; 10 studies), obesity (OR = 1.59, 95% CI = 1.02-2.48; 4 studies), diabetes (OR = 1.25, 95% CI = 1.11-1.40; 11 studies) and chronic kidney diseases (6 studies; OR = 1.57, 95% CI = 1.27-1.93) were associated with increased risks for mortality with the greatest strength of evidence based on our interpretation framework. We did not find increased risk of mortality for several factors including chronic obstructive pulmonary diseases (5 studies), cancer (4 studies), or current smoker (5 studies); however, this does not indicate absence of risk due to limited data on each of these factors.
Male sex, older age, obesity, diabetes and chronic kidney diseases are important risk factors of COVID-19 poor outcomes. Our review provides not only an appraisal and synthesis of evidence on the risk factors of COVID-19 poor outcomes, but also a data interpretation framework that could be adopted by relevant future research.
了解 COVID-19 患者不良结局的风险因素有助于确定需要在 COVID-19 预防和治疗中优先考虑的脆弱人群。我们旨在批判性地评估和综合已发表的关于住院 COVID-19 患者不良结局风险因素的证据。
我们在 PubMed、medRxiv 和世界卫生组织 COVID-19 文献数据库中检索了报告需要住院的 COVID-19 患者特征的研究。我们纳入了 2020 年 1 月至 5 月期间发表的研究，这些研究报告了任何人口统计学和/或临床因素对以下三种不良结局之一的调整效应大小：死亡率、重症监护病房（ICU）入院和有创机械通气。我们使用 Joanna Briggs 研究所评估工具评估纳入研究的质量，并通过一系列随机效应荟萃分析对证据进行定量综合。为了帮助解释数据，我们进一步开发了一个解释框架，根据证据的数量和质量来指示证据的强度。
我们的综述共纳入了 40 项研究。纳入的大多数研究（29/40，73%）被评估为“高质量”，评估得分为 80 分或以上。我们发现男性（合并优势比（OR）=1.32（95%置信区间（CI）=1.18-1.48；20 项研究）、年龄较大（OR=1.05，95%CI=1.04-1.07，每增加一岁；10 项研究）、肥胖（OR=1.59，95%CI=1.02-2.48；4 项研究）、糖尿病（OR=1.25，95%CI=1.11-1.40；11 项研究）和慢性肾脏疾病（6 项研究；OR=1.57，95%CI=1.27-1.93）与死亡率增加相关，这是基于我们的解释框架得出的最强证据。我们没有发现慢性阻塞性肺疾病（5 项研究）、癌症（4 项研究）或当前吸烟者（5 项研究）的死亡风险增加；然而，由于对这些因素中的每一个因素的数据有限，这并不表明不存在风险。
男性、年龄较大、肥胖、糖尿病和慢性肾脏疾病是 COVID-19 不良结局的重要危险因素。我们的综述不仅提供了对 COVID-19 不良结局风险因素的评估和综合，还提供了一个数据解释框架，可供未来相关研究采用。
