Pre-existing COPD is associated with an increased risk of mortality and severity in COVID-19: a rapid systematic review and meta-analysis

Rabbani, Golam; Islam, Sheikh Mohammed Shariful; Rahman, Muhammad Aziz; Amin, Nuhu; Marzàn, B.; Robin, Rishad Choudhury; Alif, Sheikh M

doi:10.1080/17476348.2021.1866547

Cited by 46 publications

(40 citation statements)

References 66 publications

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“…Some research suggested that diabetic patients' cytokine responses may be related to the severity of COVID-19 [87,88]. Meta-analysis found that pre-existing COPD was significantly associated with disease severity [89]. However, there are no clinical or laboratory results to explain the relationship between comorbidities and the outcomes of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

The Severity of COVID-19 and Its Determinants: A Systematic Review and Meta-Analysis in China

et al. 2021

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To analyse the prevalence of severe and critical COVID-19 cases and its determinants, a systematic review and meta-analysis were conducted using Review Manager. Four English and two Chinese databases were used to identify and explore the relationships between the severity of COVID-19 and its determinants, with no restrictions on publication date. The odds ratio and 95% CI were combined to assess the influencing level of all factors. Twenty-three articles containing a total of 15,828 cases of COVID-19 were included in this systematic review. The prevalence of severe and critical COVID-19 cases was 17.84% and 4.9%, respectively. A total of 148 factors were identified, which included behavioural, symptom, comorbidity, laboratory, radiographic, exposure, and other factors. Among them, 35 factors could be included in the meta-analysis. Specifically, for example, the male (OR 1.55, 95% CI 1.42–1.69) and elderly (OR 1.06, 95% CI 1.03–1.10) populations tended to experience severe and critical illness. Patients with cough, dyspnea, fatigue, fever, and gastrointestinal symptoms could have severe and critical diseases. Regarding laboratory results, albumin, aspartate aminotransferase, creatinine, D-dimer, fibrinogen, neutrophils, procalcitonin, platelets, and respiratory rate were potential factors that could be used to predict the severity of COVID.

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Section: Discussionmentioning

confidence: 99%

The Severity of COVID-19 and Its Determinants: A Systematic Review and Meta-Analysis in China

et al. 2021

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“…12 Multiple studies have also reported increased risk of death among patients with COPD, with an even greater risk among men. 13 Smoking increases the risk of acquiring respiratory infections 14 15 by impairing macrophage and cytokine responses and upregulating pathogen receptors. [16][17][18][19][20] It is the primary risk factor for developing COPD, and contributes to development and exacerbations of asthma.…”

Section: Introductionmentioning

confidence: 99%

Effect modification by age of the association between obstructive lung diseases, smoking, and COVID-19 severity

Moschovis

Hayden

et al. 2021

BMJ Open Resp Res

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IntroductionObstructive lung diseases (asthma and chronic obstructive pulmonary disease (COPD)) and smoking are associated with greater risk of respiratory infections and hospitalisations, but conflicting data exist regarding their association with severity of COVID-19, and few studies have evaluated whether these associations differ by age.ObjectivesTo examine the associations between asthma, COPD and smoking on the severity of COVID-19 among a cohort of hospitalised patients, and to test for effect modification by age.MethodsWe performed a retrospective analysis of electronic health record data of patients admitted to Massachusetts General Hospital, assigning the maximal WHO Clinical Progression Scale score for each patient during the first 28 days following hospital admission. Using ordered logistic regression, we measured the association between maximal severity score and asthma, COPD and smoking and their interaction with age.Measurements and main resultsAmong 1391 patients hospitalised with COVID-19, we found an increased risk of severe disease among patients with COPD and prior smoking, independent of age. We also found evidence of effect modification by age with asthma and current smoking; in particular, asthma was associated with decreased COVID-19 severity among older adults, and current smoking was associated with decreased severity among younger patients.ConclusionsThis cohort study identifies age as a modifying factor for the association between asthma and smoking on severity of COVID-19. Our findings highlight the complexities of determining risk factors for COVID-19 severity, and suggest that the effect of risk factors may vary across the age spectrum.

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“…These conflicting findings necessitate more studies to test whether a consistent association might indeed exist. In the context of COPD, a higher risk of developing a severe SARS-CoV-2 infection was reported and COVID-19 infected males with pre-existing COPD showed increased mortality compared to females (5). However, epigenetic alterations such as differences in DNA methylation that have been reported in COPD and asthmatic patients and associated with functionally-relevant gene expression changes (30,31) remain currently unexplored in the 142 context of SARS-CoV-2 infection.…”

Section: Introductionmentioning

confidence: 99%

“…This pandemic has led to an unprecedented burden on health care systems, resource supply chains, and economies worldwide. While populations everywhere are affected by COVID-19, there are inequalities in its impact associated with individual patient characteristics (1)(2)(3)(4)(5). Utilizing data from 17 million case records, a comprehensive study in the United Kingdom demonstrated the association of several patient-level variables with COVID-19 related deaths (3).…”

Section: Introductionmentioning

confidence: 99%

Risk-focused Differences in Molecular Processes Implicated in SARS-CoV-2 Infection: Corollaries in DNA Methylation and Gene Expression

Konwar

Asiimwe

Inkster

et al. 2021

Preprint

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Background Understanding the molecular basis of susceptibility factors to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is a global health imperative. It is well-established that males are more likely to acquire SARS-CoV-2 infection and exhibit more severe outcomes. Similarly, exposure to air pollutants and pre-existing respiratory chronic conditions like asthma and chronic obstructive respiratory disease (COPD) confer an increased risk to coronavirus disease 2019 (COVID-19). Methods We investigated molecular patterns associated with risk factors in 398 candidate genes relevant to COVID-19 biology. To accomplish this, we downloaded DNA methylation and gene expression datasets from publicly available repositories (GEO and GTEx portal) and utilized data from our unpublished controlled human exposure study. Results First, we observed sex-biased DNA methylation patterns in autosomal immune genes such as NLRP2, TLE1, GPX1, and ARRB2 (FDR <0.05, magnitude of DNA methylation difference Δβ >0.05). Second, our analysis on the X-linked genes identified sex associated DNA methylation profiles in genes such as ACE2, CA5B, and HS6ST2 (FDR <0.05, Δβ >0.05). These associations were observed across multiple respiratory tissues (lung, nasal epithelia, airway epithelia, and bronchoalveolar lavage) and in whole blood. Some of these genes, like NLRP2 and CA5B, also exhibited sex-biased expression patterns. Third, we identified modest DNA methylation changes in CpGs associated with PRIM2 and TATDN1 (FDR <0.1, Δβ >0.05) in response to particle-depleted diesel exhaust in bronchoalveolar lavage. Finally, we captured a DNA methylation signature associated with COPD diagnosis in a gene involved in nicotine dependence (COMT) (FDR <0.1, Δβ >0.05). Conclusion Our findings on sex differences are of clinical relevance given they potentially point to an exaggerated immune response in males. We also found tissue-specific DNA methylation differences in response to particulate exposure potentially capturing an NO2 effect – a contributor to COVID-19 susceptibility. While we identified a molecular signature associated with COPD, all COPD-affected individuals were smokers, which may either reflect an association with the disease, smoking, or may highlight a compounded effect of these two risk factors in COVID-19. Overall, the findings point towards the molecular basis of variation in susceptibility factors that may partly explain disparities in SARS-CoV-2 infection.

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Pre-existing COPD is associated with an increased risk of mortality and severity in COVID-19: a rapid systematic review and meta-analysis

Cited by 46 publications

References 66 publications

The Severity of COVID-19 and Its Determinants: A Systematic Review and Meta-Analysis in China

The Severity of COVID-19 and Its Determinants: A Systematic Review and Meta-Analysis in China

Effect modification by age of the association between obstructive lung diseases, smoking, and COVID-19 severity

Risk-focused Differences in Molecular Processes Implicated in SARS-CoV-2 Infection: Corollaries in DNA Methylation and Gene Expression

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