Clinical Features of COVID-19 and Factors Associated with Severe Clinical Course: A Systematic Review and Meta-Analysis

Kumar, Ashish; Arora, Anil; Sharma, Praveen; Anikhindi, Shrihari Anil; Bansal, Naresh; Singla, Vikas; Khare, Shivam; Srivastava, Abhishyant

doi:10.2139/ssrn.3566166

Cited by 61 publications

(73 citation statements)

References 87 publications

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“…Most of the reported results are in consonance with our findings with only a few exceptions. Kumar et.al [246] reported diarrhea, productive cough and high ALT as prognostic factors however we found low certainty evidence on those variables in our primary analysis. Wang et.al [249] reported no association between chronic kidney disease…”

Section: Relation To Prior Workcontrasting

confidence: 66%

“…We identified multiple systematic reviews addressing prognostic factors in patients with COVID-19 infectious disease [232][233][234][235][236][237][238][239][240][241][242][243][244][245][246][247][248][249][250][251]. All analysed certain prognostic factors or groups or prognostic factors that we included in the present review, and measured mortality and/or disease severity as outcomes.…”

Section: Relation To Prior Workmentioning

confidence: 99%

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Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review

et al. 2020

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Background and purpose The objective of our systematic review is to identify prognostic factors that may be used in decision-making related to the care of patients infected with COVID-19. Data sources We conducted highly sensitive searches in PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) and Embase. The searches covered the period from the inception date of each database until April 28, 2020. No study design, publication status or language restriction were applied. Study selection and data extraction We included studies that assessed patients with confirmed or suspected SARS-CoV-2 infectious disease and examined one or more prognostic factors for mortality or disease severity. Reviewers working in pairs independently screened studies for eligibility, extracted data and assessed the risk of bias. We performed meta-analyses and used GRADE to assess the certainty of the evidence for each prognostic factor and outcome. Results We included 207 studies and found high or moderate certainty that the following 49 variables provide valuable prognostic information on mortality and/or severe disease in patients with COVID-19 infectious disease: Demographic factors (age, male sex, smoking), patient history factors (comorbidities, cerebrovascular disease, chronic obstructive pulmonary disease, chronic kidney disease, cardiovascular disease, cardiac arrhythmia, arterial hypertension, diabetes, dementia, cancer and dyslipidemia), physical examination factors (respiratory failure, low blood pressure, hypoxemia, tachycardia, dyspnea, anorexia, tachypnea, haemoptysis, abdominal pain, fatigue, fever and myalgia or arthralgia), laboratory factors (high blood procalcitonin, myocardial injury markers, high blood White Blood Cell count (WBC), high blood lactate, low blood platelet count, plasma creatinine increase, high blood D-dimer, high blood lactate dehydrogenase (LDH), high blood C-reactive protein (CRP), decrease in lymphocyte count, high blood aspartate aminotransferase (AST), decrease in blood albumin, high blood interleukin-6 (IL-6), high blood neutrophil count, high blood B-type natriuretic peptide (BNP), high blood urea nitrogen (BUN), high blood creatine kinase (CK), high blood bilirubin and high erythrocyte sedimentation rate (ESR)), radiological factors (consolidative infiltrate and pleural effusion) and high SOFA score (sequential organ failure assessment score). Conclusion Identified prognostic factors can help clinicians and policy makers in tailoring management strategies for patients with COVID-19 infectious disease while researchers can utilise our findings to develop multivariable prognostic models that could eventually facilitate decision-making and improve patient important outcomes. Systematic review registration Prospero registration number: CRD42020178802. Protocol available at: https://www.medrxiv.org/content/10.1101/2020.04.08.20056598v1.

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Section: Relation To Prior Workcontrasting

confidence: 66%

Section: Relation To Prior Workmentioning

confidence: 99%

Prognostic factors for severity and mortality in patients infected with COVID-19: A systematic review

et al. 2020

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“…4 In a systematic review of 6,892 patients and metaanalysis of 3,496 patients, platelets were low in 22.9% and D-dimer was high in 34.8%; D-dimer was associated with a severe clinical course with an odds ratio (OR) of 4.03, and low platelets with an OR of 1.78. 5 Disseminated intravascular coagulation (DIC) in COVID-19 is accompanied by a significant decrease of fibrinogen, and a marked increase of FDP and D-dimer, which are characteristics of DIC with hyperfibrinolysis, whereas the DIC caused by infection is accompanied by plasminogen activator inhibitor-1 release and suppression of fibrinolysis. Administration of antiproteases may prove beneficial.…”

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confidence: 99%

Bleeding and Bleeding Risk in COVID-19

Dorgalaleh

2020

Semin Thromb Hemost

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“…It was further revealed that non-survivor COVID-19 patients continued to show a decrease in lymphocyte count along the course of their disease until death. [12][13][14][15] Diminished levels of natural killer (NK) cells and B-cells activity in the lesions of PR have been observed. 16 This suggests the role of a T-cell mediated immunity.…”

Section: Discussionmentioning

confidence: 99%