Patient Predisposition at Hospital Admission Indirectly Dictates Disease Severity, Clinical Course and Outcomes of COVID-19 Pneumonia Patients in Wuhan, China

Du, Ronghui; Liang, Lirong; Yang, Chengqing; Li, Ming; Guo, Guangyun; Halm‐Lutterodt, Nicholas Van; Cao, Tanze; Chunlin, Mei; Du, Juan; Zheng, Chunlan; Wang, Tingping; Hu, Ming; Tong, Zhaohui; Wang, Wen; Chu, Shuilian; Li, Xuyan; Chen, Xianxiang; Shi, Hongtao

doi:10.2139/ssrn.3543584

Cited by 3 publications

(2 citation statements)

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“…Eight studies were included in the meta-analysis. Du et al 46 was not included. Due to the nature of its complex outcome, it could not be compared with other studies.…”

Section: Resultsmentioning

confidence: 99%

The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis

et al. 2021

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IntroductionIncreased age has been reported to be a factor for COVID-19 severe outcomes. However, many studies do not consider the age dependency of comorbidities, which influence the course of disease. Protection strategies often target individuals after a certain age, which may not necessarily be evidence based. The aim of this review was to quantify the isolated effect of age on hospitalisation, admission to intensive care unit (ICU), mechanical ventilation and death.MethodsThis review was based on an umbrella review, in which Pubmed, Embase and preprint databases were searched on 10 December 2020, for relevant reviews on COVID-19 disease severity. Two independent reviewers evaluated the primary studies using predefined inclusion and exclusion criteria. The results were extracted, and each study was assessed for risk of bias. The isolated effect of age was estimated by meta-analysis, and the quality of evidence was assessed using Grades of Recommendations, Assessment, Development, and Evaluation framework.ResultsSeventy studies met our inclusion criteria (case mortality: n=14, in-hospital mortality: n=44, hospitalisation: n=16, admission to ICU: n=12, mechanical ventilation: n=7). The risk of in-hospital and case mortality increased per age year by 5.7% and 7.4%, respectively (effect size (ES) in-hospital mortality=1.057, 95% CI 1.038 to 1.054; ES case mortality=1.074, 95% CI 1.061 to 1.087), while the risk of hospitalisation increased by 3.4% per age year (ES=1.034, 95% CI 1.021 to 1.048). No increased risk was observed for ICU admission and intubation by age year. There was no evidence of a specific age threshold at which the risk accelerates considerably. The confidence of evidence was high for mortality and hospitalisation.ConclusionsOur results show a best-possible quantification of the increase in COVID-19 disease severity due to age. Rather than implementing age thresholds, prevention programmes should consider the continuous increase in risk. There is a need for continuous, high-quality research and ‘living’ reviews to evaluate the evidence throughout the pandemic, as results may change due to varying circumstances.

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“…Eight studies were included in the meta-analysis. Du et al 46 was not included. Due to the nature of its complex outcome, it could not be compared with other studies.…”

Section: Resultsmentioning

confidence: 99%

The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis

et al. 2021

View full text Add to dashboard Cite

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“…By further restricting our analysis to age-adjusted estimates, we might have excluded evidence from countries that are now not otherwise represented in our review. Although 14 [138,145,149,171,198,207,218,232,241,259,265,273,288,293] of the primary studies in our selection have not yet been peer-reviewed (but were published on pre-print servers), they were included in our analyses to increase the evidence pool. These studies were reviewed and evaluated in the included systematic reviews; however, their inclusion might limit our work.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Pre-existing health conditions and severe COVID-19 outcomes: an umbrella review approach and meta-analysis of global evidence

Treskova-Schwarzbach

Haas

Reda

et al. 2021

BMC Med

130

119

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Background This study applies an umbrella review approach to summarise the global evidence on the risk of severe COVID-19 outcomes in patients with pre-existing health conditions. Methods Systematic reviews (SRs) were identified in PubMed, Embase/Medline and seven pre-print servers until December 11, 2020. Due to the absence of age-adjusted risk effects stratified by geographical regions, a re-analysis of the evidence was conducted. Primary studies were extracted from SRs and evaluated for inclusion in the re-analysis. Studies were included if they reported risk estimates (odds ratio (OR), hazard ratio (HR), relative risk (RR)) for hospitalisation, intensive care unit admission, intubation or death. Estimated associations were extracted from the primary studies for reported pre-existing conditions. Meta-analyses were performed stratified for each outcome by regions of the World Health Organization. The evidence certainty was assessed using GRADE. Registration number CRD42020215846. Results In total, 160 primary studies from 120 SRs contributed 464 estimates for 42 pre-existing conditions. Most studies were conducted in North America, European, and Western Pacific regions. Evidence from Africa, South/Latin America, and the Eastern Mediterranean region was scarce. No evidence was available from the South-East Asia region. Diabetes (HR range 1.2–2.0 (CI range 1.1–2.8)), obesity (OR range 1.5–1.75 (CI range 1.1–2.3)), heart failure (HR range 1.3–3.3 (CI range 0.9–8.2)), COPD (HR range 1.12–2.2 (CI range 1.1–3.2)) and dementia (HR range 1.4–7.7 (CI range 1.2–39.6)) were associated with fatal COVID-19 in different regions, although the estimates varied. Evidence from Europe and North America showed that liver cirrhosis (OR range 3.2–5.9 (CI range 0.9–27.7)) and active cancer (OR range 1.6–4.7 (CI range 0.5–14.9)) were also associated with increased risk of death. Association between HIV and undesirable COVID-19 outcomes showed regional heterogeneity, with an increased risk of death in Africa (HR 1.7 (CI 1.3–2.2)). GRADE certainty was moderate to high for most associations. Conclusion Risk of undesirable COVID-19 health outcomes is consistently increased in certain patient subgroups across geographical regions, showing high variability in others. The results can be used to inform COVID-19 vaccine prioritisation or other intervention strategies.

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The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis

Starke

Reissig

Petereit-Haack³

et al. 2021

Preprint

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Introduction Increased age has been reported to be a factor for COVID-19 severe outcomes. However, many studies do not consider the age-dependency of comorbidities, which influence the course of disease. Protection strategies often target individuals after a certain age, which may not necessarily be evidence-based. The aim of this review was to quantify the isolated effect of age on hospitalization, admission to ICU, mechanical ventilation, and death. Methods This review was based on an umbrella review, in which Pubmed, Embase, and pre-print databases were searched on December 10, 2020 for relevant reviews on COVID-19 disease severity. Two independent reviewers evaluated the primary studies using predefined inclusion and exclusion criteria. The results were extracted, and each study was assessed for risk of bias. The isolated effect of age was estimated by meta-analysis, and the quality of evidence was assessed using GRADE. Results Seventy studies met our inclusion criteria (case mortality n=14, in-hospital mortality n=44, hospitalization n=16, admission to ICU n=12, mechanical ventilation n=7). The risk of in-hospital and case mortality increased per age year by 5.7% and 7.4%, respectively (Effect Size (ES) in-hospital mortality=1.057, 95% CI:1.038-1.054; ES case mortality= 1.074, 95% CI:1.061-1.087), while the risk of hospitalization increased by 3.4% per age year (ES=1.034, 95% CI:1.021-1.048). No increased risk was observed for ICU admission and intubation by age year. There was no evidence of a specific age threshold at which the risk accelerates considerably. The confidence of evidence was high for mortality and hospitalization. Conclusions Our results show a best-possible quantification of the increase in COVID-19 disease severity due to age. Rather than implementing age thresholds, prevention programs should consider the continuous increase in risk. There is a need for continuous, high-quality research and living reviews to evaluate the evidence throughout the pandemic, as results may change due to varying circumstances.

show abstract

Patient Predisposition at Hospital Admission Indirectly Dictates Disease Severity, Clinical Course and Outcomes of COVID-19 Pneumonia Patients in Wuhan, China

Cited by 3 publications

References 0 publications

The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis

The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis

Pre-existing health conditions and severe COVID-19 outcomes: an umbrella review approach and meta-analysis of global evidence

The isolated effect of age on the risk of COVID-19 severe outcomes: a systematic review with meta-analysis

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