Demographic and clinical features of critically ill patients with COVID-19 in Greece: The burden of diabetes and obesity

Halvatsiotis, Panagiotis; Kotanidou, Anastasia; Tzannis, Kimon; Jahaj, Edison; Magira, Eleni; Θεοδωρακοπούλου, Μαρία; Konstandopoulou, G.; Gkeka, Eleni; Pourzitaki, Chryssa; Kapravelos, N.; Papoti, Sofia; Sileli, Maria; Gogos, Charalambos; Velissaris, Dimitrios; Μάρκου, Νικόλαος; Stefanatou, Eleni; Vlachogianni, Glykeria; Aimoniotou, E.; Komnos, Apostolos; Zafeiridis, Tilemachos; Koulouvaris, Panagiotis; Armaganidis, Apostolos; Bamias, Aristotelis; Dimοpoulos, George

doi:10.1016/j.diabres.2020.108331

Cited by 58 publications

(72 citation statements)

References 24 publications

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“…From this meta-analysis, it was found that obese patients with COVID-19 had a higher risk to die compared to non-obese patients. Consistent results were found from several studies [ 14 , 70 , 72 ]. The history of smoking among COVID-19 patients increased the risk of mortality.…”

Section: Discussionsupporting

confidence: 92%

“…Among the included studies, 26 studies were conducted in China [ 10 – 13 , 26 – 47 ], 8 in USA [ 48 – 55 ], 7 in Italy [ 16 , 56 – 61 ], 4 in Spain [ 14 , 62 – 64 ], 2 in South Korea [ 65 , 66 ], 2 in Mexico [ 67 , 68 ], 1 in Bangladesh [ 69 ], 1 in Brazil [ 70 ], 1 in England [ 71 ], I in Greece [ 72 ], 1 in Iran [ 73 ], 1 in Kuwait [ 74 ], 1 in Switzerland [ 75 ], 1 in Turkey [ 76 ] and 1 in few European countries [ 77 ]. The sample size of the included studies varied from 16 to 51,633 patients and the mean age of the included patients varied from 41 years to 85.5 years.…”

Section: Resultsmentioning

confidence: 99%

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Prevalence and Associated Risk Factors of Mortality Among COVID-19 Patients: A Meta-Analysis

2020

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Objectives The main aim of this study was to find the prevalence of mortality among hospitalized COVID-19 infected patients and associated risk factors for death. Methods Three electronic databases including PubMed, Science Direct and Google Scholar were searched to identify relevant cohort studies of COVID-19 disease from January 1, 2020, to August 11, 2020. A random-effects model was used to calculate pooled prevalence rate (PR), risk ratio (RR) and 95% confidence interval (CI) for both effect measures. Cochrane chi-square test statistic Q, I 2 , and 2 tests were used to measure the presence of heterogeneity. Publication bias and sensitivity of the included studies were also tested. Results In this meta-analysis, a total of 58 studies with 122,191 patients were analyzed. The pooled prevalence rate of mortality among the hospitalized COVID-19 patients was 18.88%, 95% CI (16.46-21.30), p < 0.001. Highest mortality was found in Europe [PR 26.85%, 95% CI (19.41-34.29), p < 0.001] followed by North America [PR 21.47%, 95% CI (16.27-26.68), p < 0.001] and Asia [PR 14.83%, 95% CI (12.46-17.21), p < 0.001]. An significant association were found between mortality among COVID-19 infected patients and older age (> 65 years vs. < 65 years) [RR 3.59, 95% CI (1.87-6.90), p < 0.001], gender (male vs. female) [RR 1.63, 95% CI (1.43-1.87), p < 0.001], ICU admitted patients [RR 3.72, 95% CI (2.70-5.13), p < 0.001], obesity [RR 2.18, 95% CI (1.10-4.34), p < 0.05], hypertension [RR 2.08,95% CI (1.79-2.43) p < 0.001], diabetes [RR 1.87, 95% CI (1.23-2.84), p < 0.001], cardiovascular disease [RR 2.51, 95% CI (1.20-5.26), p < 0.05], and cancer [RR 2.31, 95% CI (1.80-2.97), p < 0.001]. In addition, significant association for high risk of mortality were also found for cerebrovascular disease, COPD, coronary heart disease, chronic renal disease, chronic liver disease, chronic lung disease and chronic kidney disease. Conclusion This meta-analysis revealed that the mortality rate among COVID-19 patients was highest in the European region and older age, gender, ICU patients, patients with comorbidity had a high risk for case fatality. Those findings would help the health care providers to reduce the mortality rate and combat this pandemic to save lives using limited resources.

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Section: Discussionsupporting

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Prevalence and Associated Risk Factors of Mortality Among COVID-19 Patients: A Meta-Analysis

2020

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“…In the group of COVID-19 mortality, the average prevalence of cardio-cerebrovascular disease was 15.15%. Seventeen studies ( Buckner et al, 2020 ; Cao et al, 2020 ; Guan et al, 2020 ; Huang et al, 2020 ; Khamis et al, 2020 ; Y. Li et al, 2020 ; Mao et al, 2020 ; Mendy et al, 2020 ; Petrilli et al, 2020 ; Romero-Sanchez et al, 2020 ; Wang et al, 2020 ; Wei et al, 2020 ; Xie et al, 2020 ; Xu et al, 2020 ; S. Yan et al, 2020 ; G. Zhang et al, 2020 ; J. J. Zhang et al, 2020 ) reported the disease severity of COVID-19 patients with cardio-cerebrovascular disease, and 14 studies ( T. Chen et al, 2020 ; Du et al, 2020 ; Halvatsiotis et al, 2020 ; Inciardi et al, 2020 ; Mehra et al, 2020 ; Nikpouraghdam et al, 2020 ; Ruan et al, 2020 ; Soares et al, 2020 ; Sousa et al, 2020 ; Tu et al, 2020 ; Wu et al, 2020 ; Y. Yan et al, 2020 ; Yuan et al, 2020 ; Zhou et al, 2020 ) reported the mortality of COVID-19 patients with cardio-cerebrovascular disease.…”

Section: Resultsmentioning

confidence: 99%

Cardio-Cerebrovascular Disease is Associated With Severity and Mortality of COVID-19: A Systematic Review and Meta-Analysis

Yang

et al. 2020

Biological Research For Nursing

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At present, COVID-19 is raging all over the world. Many comorbidities, such as diabetes mellitus (OR = 2.67, 95% CI = 1.91–3.74) and hypertension (OR = 2.3, 95% CI = 1.76–3.00), have been shown to worsen the patient’s condition. However, whether cardio-cerebrovascular disease will affect COVID-19 remains unclear. In this meta-analysis, we collected studies from PubMed, Wed of Science and CNKI (Chinese) to July 25, which reported COVID-19 patients with and without cardio-cerebrovascular disease as well as their severity and mortality. The random-effect model meta-analysis was used to analyze them and get overall odds ratios (OR) with 95% CIs. Funnel plots and the Begg’s and Egger’s test were used to assess publication bias. Thirty-one studies with 23,632 patients were finally included in the meta-analysis. The results showed an OR of 3.004 (95% CI = 2.097–4.303) for COVID-19 severity and an OR of 5.587 (95% CI = 2.810–11.112) for COVID-19 mortality. Compared with cardiovascular disease, the subgroup analysis indicated that cerebrovascular disease was more likely to increase the severity (OR = 3.400, 95% CI = 1.569–7.368) and mortality (OR = 23.477, 95% CI = 3.050–180.735) of COVID-19. Therefore, it can be inferred that cardio-cerebrovascular disease is associated with an increase in the risk of severe illness and death among COVID-19 patients. This meta-analysis showed that cardio-cerebrovascular disease has a significant relation with severe and death outcomes of COVID-19. Nurses should pay special attention to COVID-19 patients with the cardio-cerebrovascular disease.

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“…Another Mexican study with 51,633 patients showed similar results, with a significant increased lethality rate in patients with obesity (HR: 1.25 (1.17–1.34, p < 0.001) [ 27 ]. These reports with large patient cohorts are further strengthened by multiple clinical studies with smaller collectives worldwide [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ]. Interestingly, Lighter et al and Ebinger et al showed that middle aged patients with an age below 52 and up to 60 years were more affected by obesity (BMI 30–34 and ≥35) with an HR: 2.0 (1.6–2.6, p < 0.0001)) and HR: 2.2 (1.7–2.9, p < 0.0001), respectively, resulting in increased morbidity rates compared to >60 years old patients [ 31 , 43 ].…”

Section: Clinical Correlation Of Covid-19 With Obesitymentioning

confidence: 92%

Obesity and COVID-19: Molecular Mechanisms Linking Both Pandemics

Ritter

Kreis

Louwen

et al. 2020

IJMS

118

122

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The coronavirus disease 2019 COVID-19 pandemic is rapidly spreading worldwide and is becoming a major public health crisis. Increasing evidence demonstrates a strong correlation between obesity and the COVID-19 disease. We have summarized recent studies and addressed the impact of obesity on COVID-19 in terms of hospitalization, severity, mortality, and patient outcome. We discuss the potential molecular mechanisms whereby obesity contributes to the pathogenesis of COVID-19. In addition to obesity-related deregulated immune response, chronic inflammation, endothelium imbalance, metabolic dysfunction, and its associated comorbidities, dysfunctional mesenchymal stem cells/adipose-derived mesenchymal stem cells may also play crucial roles in fueling systemic inflammation contributing to the cytokine storm and promoting pulmonary fibrosis causing lung functional failure, characteristic of severe COVID-19. Moreover, obesity may also compromise motile cilia on airway epithelial cells and impair functioning of the mucociliary escalators, reducing the clearance of severe acute respiratory syndrome coronavirus (SARS-CoV-2). Obese diseased adipose tissues overexpress the receptors and proteases for the SARS-CoV-2 entry, implicating its possible roles as virus reservoir and accelerator reinforcing violent systemic inflammation and immune response. Finally, anti-inflammatory cytokines like anti-interleukin 6 and administration of mesenchymal stromal/stem cells may serve as potential immune modulatory therapies for supportively combating COVID-19. Obesity is conversely related to the development of COVID-19 through numerous molecular mechanisms and individuals with obesity belong to the COVID-19-susceptible population requiring more protective measures.

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Demographic and clinical features of critically ill patients with COVID-19 in Greece: The burden of diabetes and obesity

Cited by 58 publications

References 24 publications

Prevalence and Associated Risk Factors of Mortality Among COVID-19 Patients: A Meta-Analysis

Prevalence and Associated Risk Factors of Mortality Among COVID-19 Patients: A Meta-Analysis

Cardio-Cerebrovascular Disease is Associated With Severity and Mortality of COVID-19: A Systematic Review and Meta-Analysis

Obesity and COVID-19: Molecular Mechanisms Linking Both Pandemics

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