糖尿病、高血压、体重指数、吸烟与 COVID-19 相关死亡率：观察性研究的系统评价和荟萃分析。
Diabetes, hypertension, body mass index, smoking and COVID-19-related mortality: a systematic review and meta-analysis of observational studies.
机构信息
Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France
Paris-Saclay University, UVSQ, Inserm, Gustave Roussy, "Exposome and Heredity" team, CESP, F-94805, Villejuif, France.
出版信息
BMJ Open. 2021 Oct 25;11(10):e052777. doi: 10.1136/bmjopen-2021-052777.
OBJECTIVES
We conducted a systematic literature review and meta-analysis of observational studies to investigate the association between diabetes, hypertension, body mass index (BMI) or smoking with the risk of death in patients with COVID-19 and to estimate the proportion of deaths attributable to these conditions.
METHODS
Relevant observational studies were identified by searches in the PubMed, Cochrane library and Embase databases through 14 November 2020. Random-effects models were used to estimate summary relative risks (SRRs) and 95% CIs. Certainty of evidence was assessed using the Cochrane methods and the Grading of Recommendations, Assessment, Development and Evaluations framework.
RESULTS
A total of 186 studies representing 210 447 deaths among 1 304 587 patients with COVID-19 were included in this analysis. The SRR for death in patients with COVID-19 was 1.54 (95% CI 1.44 to 1.64, I=92%, n=145, low certainty) for diabetes and 1.42 (95% CI 1.30 to 1.54, I=90%, n=127, low certainty) for hypertension compared with patients without each of these comorbidities. Regarding obesity, the SSR was 1.45 (95% CI 1.31 to 1.61, I=91%, n=54, high certainty) for patients with BMI ≥30 kg/m compared with those with BMI <30 kg/m and 1.12 (95% CI 1.07 to 1.17, I=68%, n=25) per 5 kg/m increase in BMI. There was evidence of a J-shaped non-linear dose-response relationship between BMI and mortality from COVID-19, with the nadir of the curve at a BMI of around 22-24, and a 1.5-2-fold increase in COVID-19 mortality with extreme obesity (BMI of 40-45). The SRR was 1.28 (95% CI 1.17 to 1.40, I=74%, n=28, low certainty) for ever, 1.29 (95% CI 1.03 to 1.62, I=84%, n=19) for current and 1.25 (95% CI 1.11 to 1.42, I=75%, n=14) for former smokers compared with never smokers. The absolute risk of COVID-19 death was increased by 14%, 11%, 12% and 7% for diabetes, hypertension, obesity and smoking, respectively. The proportion of deaths attributable to diabetes, hypertension, obesity and smoking was 8%, 7%, 11% and 2%, respectively.
CONCLUSION
Our findings suggest that diabetes, hypertension, obesity and smoking were associated with higher COVID-19 mortality, contributing to nearly 30% of COVID-19 deaths.
TRIAL REGISTRATION NUMBER
CRD42020218115.
目的
我们进行了系统的文献回顾和荟萃分析，以调查糖尿病、高血压、体重指数（BMI）或吸烟与 COVID-19 患者死亡风险之间的关系，并估计这些因素导致的死亡比例。
方法
通过在 PubMed、Cochrane 图书馆和 Embase 数据库中进行搜索，于 2020 年 11 月 14 日之前确定了相关的观察性研究。使用随机效应模型估计汇总相对风险（SRR）和 95%置信区间（CI）。使用 Cochrane 方法和推荐评估、制定与评估分级框架（Grading of Recommendations, Assessment, Development and Evaluations framework）评估证据的确定性。
结果
这项分析共纳入了 186 项研究，涉及 1304587 例 COVID-19 患者中的 210447 例死亡。与没有这些合并症的患者相比，患有 COVID-19 的患者中糖尿病的死亡率为 1.54（95%CI 1.44-1.64，I=92%，n=145，低确定性），高血压的死亡率为 1.42（95%CI 1.30-1.54，I=90%，n=127，低确定性）。关于肥胖，与 BMI<30 kg/m 的患者相比，BMI≥30 kg/m 的患者的 SRR 为 1.45（95%CI 1.31-1.61，I=91%，n=54，高确定性），BMI 每增加 5 kg/m 时为 1.12（95%CI 1.07-1.17，I=68%，n=25）。BMI 与 COVID-19 死亡率之间存在 J 形非线性剂量-反应关系，曲线的最低点约为 22-24，肥胖症（BMI 为 40-45）导致 COVID-19 死亡率增加 1.5-2 倍。与从不吸烟者相比，当前吸烟者、曾经吸烟者和目前吸烟者的 SRR 分别为 1.28（95%CI 1.17-1.40，I=74%，n=28，低确定性）、1.29（95%CI 1.03-1.62，I=84%，n=19）和 1.25（95%CI 1.11-1.42，I=75%，n=14）。糖尿病、高血压、肥胖和吸烟导致 COVID-19 死亡的绝对风险分别增加了 14%、11%、12%和 7%。糖尿病、高血压、肥胖和吸烟导致的死亡比例分别为 8%、7%、11%和 2%。
结论
我们的研究结果表明，糖尿病、高血压、肥胖和吸烟与 COVID-19 死亡率较高相关，导致近 30%的 COVID-19 死亡。
试验注册号
CRD42020218115。
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