Risk factors and interventions associated with mortality or survival in adult COVID-19 patients admitted to critical care: a systematic review and meta-analysis

Abstract

Background: Patients with confirmed COVID-19 admitted to intensive care units have a high mortality rate, which appears to be associated with increasing age, male sex, smoking history, hypertension and diabetes mellitus. Methods: A systematic review to determine risk factors and interventions associated with mortality/survival in adult patients admitted to an intensive care unit (ICU) with confirmed COVID-19/SARS-CoV-2 infection. The protocol was registered with PROSPERO (CRD42020181185). Results: The search identified 483 abstracts between 1 January and 7 April 2020, of which nine studies were included in the final review. Only one study was of low bias. Advanced age (odds ratio [OR] 11.99, 95% confidence interval [CI] 5.35–18.62) and a history of hypertension were associated with mortality (OR 4.17, 95% CI 2.90–5.99). Sex was not associated with mortality. There was insufficient data to assess the association between other comorbidities, laboratory results or critical care risk indices and mortality. The critical care interventions of mechanical ventilation (OR 6.25, 95% CI 0.75–51.93), prone positioning during ventilation (OR 2.06, 95% CI 0.20–21.72), and extracorporeal membrane oxygenation (ECMO) (OR 8.00, 95% CI 0.69, 92.33) were not associated with mortality. The sample size was insufficient to conclusively determine the association between these interventions and ICU mortality. The need for inotropes or vasopressors was associated with mortality (OR 6.36, 95% CI 1.89–21.36). Conclusion: The studies provided little granular data to inform risk stratification or prognostication of patients requiring intensive care admission. Larger collaborative research is needed to address this limitation.

Patient care and clinical outcomes for patients with COVID-19 infection admitted to African high-care or intensive care units (ACCCOS): a multicentre, prospective, observational cohort study

“…A post-hoc decision was taken to update the critical care meta-analyses of COVID-19 mortality by region, 6,8 done by EHT, KDMM, MElh, and JS. We have presented the case fatality rate for COVID-19 infections by region and did a meta-analysis of the mean age and SOFA score per region.…”

“…Finally, patient outcomes following critical care for COVID-19 were not sufficiently documented in this under-resourced environment, 6 despite a call for prevention and response measures in low-income and middle-income countries. 7 As there were little data for the management of critically ill patients with COVID-19, 8 we designed the African COVID-19 Critical Care Outcomes Study (ACCCOS) to determine which resources, patient comor bidities, and critical care interventions were associated with mortality or survival in these patients. Wide dissemination of these findings could help to inform resource prioritisation necessary to manage patients who are critically ill with COVID-19 in Africa.…”

Global Impact of Coronavirus Disease 2019 Infection Requiring Admission to the ICU

“…More than 80% of coronavirus cases experience mild-tomoderate symptoms; approximately 15% have severe disease that requires hospitalization, and around 5% require intensive care support. 66,67 Previous metaanalyses have examined risk factors for mortality rates in COVID-19 infections; however, these studies included a majority of data within a certain region [68][69][70][71][72] or included patients with COVID-19 infections but less severe chestjournal.org symptoms. [73][74][75][76][77][78][79] To address this limitation, the current systematic review and meta-analysis provides a comprehensive global overview of patient demographic, comorbidities, signs and symptoms, initial laboratory and imaging results, treatment, organ dysfunction, and outcomes in adults with severe and critical COVID-19.…”

Ambient air pollution and COVID-19 risk: Evidence from 35 observational studies

“…On the one hand, air pollutants directly impair lung function through inflammation and oxidative stress, including decreased pulmonary defense function and phagocytic function of macrophages ( Becker et al, 2003 ; Guarnieri and Sinha, 2014 ; Selley et al, 2020 ). On the other hand, air pollutants indirectly affect the occurrence and development of COVID-19 through a series of predisposing factors for COVID-19, such as diabetes and high blood pressure ( Mantovani et al, 2020 ; Taylor et al, 2020 ). Air pollutants directly damage the vascular system, or indirectly damage it by stimulating inflammatory factors produced by the body, and affect the autonomic nervous system that regulates vascular functions, causing vascular endothelial dysfunction ( Fiorito et al, 2018 ; Miller, 2014 ; Shanley et al, 2016 ).…”