Impact of cardiovascular disease and risk factors on fatal outcomes in patients with COVID-19 according to age: a systematic review and meta-analysis

Bae, SungA; Kim, So Ree; Kim, Mina; Shim, Wan Joo; Park, Seong‐Mi

doi:10.1136/heartjnl-2020-317901

Cited by 238 publications

(227 citation statements)

References 38 publications

(30 reference statements)

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“…2 Cardiovascular morbidity and mortality is high in patients with COVID-19, and those with pre-existing cardiovascular disease are at considerably higher risk of worse outcome. 3,4 Several cardiovascular biomarkers-including cardiac troponin and N-terminal probrain natriuretic peptide (NT-proBNP)-have been identified as prognostic markers in COVID-19. [5][6][7] Atrial natriuretic peptide (ANP) is primarily expressed in the right atrium following atrial distension and exerts several physiological effects, including natriuresis, diuresis and vasodilation.…”

Section: Introductionmentioning

confidence: 99%

Mid‐regional pro‐atrial natriuretic peptide independently predicts short‐term mortality in COVID‐19

Kaufmann

Ahmed

Kassem

et al. 2021

Eur J Clin Investigation

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Background: Mid-regional pro-atrial natriuretic peptide (MR-proANP) is a strong prognostic marker in several inflammatory, respiratory and cardiovascular conditions, but has not been studied in COVID-19 yet. Methods: This prospective, observational study of patients with COVID-19 infection was conducted from 6 June to 26 November 2020 in different wards of a tertiary hospital. MR-proANP, N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitive cardiac troponin I levels on admission were collected and tested for their association with disease severity and 28-day mortality. Results: A total of 213 eligible patients with COVID-19 were included in the final analyses of whom 13.2% (n = 28) died within 28 days. Median levels of MR-proANP at admission were significantly higher in nonsurvivors (307 pmol/L IQR, [161 -532] vs 75 pmol/L [IQR, 43 -153], P < .001) compared to survivors and increased with disease severity and level of hypoxaemia. The area under the ROC curve for MR-proANP predicting 28-day mortality was 0.832 (95% CI 0.753 -0.912, P < .001).An optimal cut-off point of 160 pmol/L yielded a sensitivity of 82.1% and a specificity of 76.2%. MR-proANP was a significant predictor of 28-day mortality independent of clinical confounders, comorbidities and established prognostic markers

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Section: Introductionmentioning

confidence: 99%

Mid‐regional pro‐atrial natriuretic peptide independently predicts short‐term mortality in COVID‐19

Kaufmann

Ahmed

Kassem

et al. 2021

Eur J Clin Investigation

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“…Besides, results confirmed previous studies showing a strong predictive value for severe COVID-19 of older age, male sex and coexisting conditions such as hypertension 3 – 8 , 25 – 31 . The fact that we studied non-elderly adults (≤ 70 years) may have limited the identification of significant associations with other reported coexisting conditions such as chronic lung disease 2 , 6 – 8 , 27 , diabetes 2 – 5 , 7 , 8 , 25 , 26 , 30 , 32 , obesity 8 , 31 , 33 or cancer 3 , 34 . Current or previous smoking status 35 and chronic treatment with ACE inhibitors 36 were not associated with COVID-19 severity in our dataset.…”

Section: Discussionmentioning

confidence: 99%

Low birth weight as a potential risk factor for severe COVID-19 in adults

Crispi

Crovetto

Larroya

et al. 2021

Sci Rep

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The identification of factors predisposing to severe COVID-19 in young adults remains partially characterized. Low birth weight (LBW) alters cardiovascular and lung development and predisposes to adult disease. We hypothesized that LBW is a risk factor for severe COVID-19 in non-elderly subjects. We analyzed a prospective cohort of 397 patients (18–70 years) with laboratory-confirmed SARS-CoV-2 infection attended in a tertiary hospital, where 15% required admission to Intensive Care Unit (ICU). Perinatal and current potentially predictive variables were obtained from all patients and LBW was defined as birth weight ≤ 2.500 g. Age (adjusted OR (aOR) 1.04 [1–1.07], P = 0.012), male sex (aOR 3.39 [1.72–6.67], P < 0.001), hypertension (aOR 3.37 [1.69–6.72], P = 0.001), and LBW (aOR 3.61 [1.55–8.43], P = 0.003) independently predicted admission to ICU. The area under the receiver-operating characteristics curve (AUC) of this model was 0.79 [95% CI, 0.74–0.85], with positive and negative predictive values of 29.1% and 97.6% respectively. Results were reproduced in an independent cohort, from a web-based survey in 1822 subjects who self-reported laboratory-positive SARS-CoV-2 infection, where 46 patients (2.5%) needed ICU admission (AUC 0.74 [95% CI 0.68–0.81]). LBW seems to be an independent risk factor for severe COVID-19 in non-elderly adults and might improve the performance of risk stratification algorithms.

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“…Although extensive, some fundamental information that greatly affects the prognosis of the disease is missing in the SRAG form, mainly regarding smoking, alcohol intake, oncological disorders, and chronic high blood pressure. 39–42 As for our study’s relevance, drawing attention to diabetes, lack of reliable data on Body Mass Index (BMI) prevented us from differentiating the impact of obesity and severe obesity in mortality. This is mainly important because obesity is a chronic inflammatory condition associated with cardiometabolic and immune dysfunction, increased risk of diabetes and hematological disease, leading patients to be more susceptible to develop severe forms of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Prevalent comorbidities among young and underprivileged: Death portrait of COVID-19 among 235 555 hospitalized patients in Brazil

Pietre

et al. 2021

Preprint

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Background COVID 19 has been alarmingly spreading worldwide, with Brazil ranking third in total number of cases and second in deaths. Being a continental country, which comprises many ethnic groups and an engrained social inequality, the pandemic evidenced this heterogeneous discrepancy. We aimed to estimate the impact of associated risk factors, isolated or combined, on COVID 19 severeness, detecting specific epidemiological profiles for multiple age ranges in hospitalized Brazilians. Methods In this large retrospective cohort study, we used open-access data from the Ministry of Health of Brazil with COVID 19 confirmed hospitalized patients annotated in SRAG system between February and August 2020, a total of 235555 entries. The association of COVID 19 death with socio-demographic and clinical characteristics was analysed and presented as odds ratios adjusted by confounding co-variables. We also presented marginal mean aOR values for high-order interactions either by or not another fixed level or condition. We kept all other variables in the multivariate logistic models in their mean values or equal proportions. Findings Younger individuals with one or more comorbidities had an adjusted odds ratio up to four-fold compared to those without it, in the same age interval. Younger diabetic patients either self-declared as brown ethnicity (aOR 5,58, 95% CI 4,97-6,25; p < 0,0001) or with some other associated comorbidities, mainly chronic hematologic disease (21,09, 13,64-32,6; p < 0,0001) and obesity (aOR 21,7, 95% CI not calculated; p < 0,0001), resulted in outstanding death risk. Age over 60, particularly over 90 (28,91, 24,5-34,11; p < 0,001), usage of invasive ventilatory support (16,23, 14,05-18,75; p < 0,001), admission to intensive care units (3,14, 2,82-3,48; p < 0,001), multiple respiratory symptoms (3,24, 2,79-3,75; p < 0,0001), black ethnicity (1,78, 1,52-2,07; p < 0,05), and diagnosis previous to hospitalization (1,32, 1,19-1,47; p < 0,05) were associated with higher death odds. As protective factors, with roughly one third less death risk, we found hospitalization duration of (4, 7] days and illness onset to hospitalization over 6 days. Interpretation We found evidence for increased COVID 19 risk in two distinct groups: younger patients with prevalent comorbidities, especially in brown ethnicity, and patients with black ethnicity. We speculate that the pro-inflammatory synergism of COVID 19 and comorbidities, promoting an overproduction of cytokines, is partially the cause of higher mortality in this young group. Brazilian black and brown are underprivileged populations, with structural social inequality, limited healthcare access and, thus, remarkable disease vulnerability. Our study supplies essential data to patient stratification upon admission, optimizing hospital management, and to guide public policy determinations, including group prioritization for COVID 19 vaccination in Brazil.

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Impact of cardiovascular disease and risk factors on fatal outcomes in patients with COVID-19 according to age: a systematic review and meta-analysis

Cited by 238 publications

References 38 publications

Mid‐regional pro‐atrial natriuretic peptide independently predicts short‐term mortality in COVID‐19

Mid‐regional pro‐atrial natriuretic peptide independently predicts short‐term mortality in COVID‐19

Low birth weight as a potential risk factor for severe COVID-19 in adults

Prevalent comorbidities among young and underprivileged: Death portrait of COVID-19 among 235 555 hospitalized patients in Brazil

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