TY - JOUR
TI - Predictors of adverse prognosis in COVID-19: A systematic review and meta-analysis
AU - Figliozzi, S.
AU - Masci, P.G.
AU - Ahmadi, N.
AU - Tondi, L.
AU - Koutli, E.
AU - Aimo, A.
AU - Stamatelopoulos, K.
AU - Dimopoulos, M.-A.
AU - Caforio, A.L.P.
AU - Georgiopoulos, G.
JO - European Journal of Clinical Investigation
PY - 2020
VL - 50
TODO - 10
SP - null
PB - Wiley-Blackwell Publishing Ltd
SN - 0014-2972, 1365-2362
TODO - 10.1111/eci.13362
TODO - biological marker;  D dimer;  procalcitonin;  steroid;  C reactive protein;  corticosteroid;  ferritin;  fibrin degradation product;  fibrin fragment D;  interleukin 6;  procalcitonin, acute kidney failure;  adverse outcome;  age;  Article;  artificial ventilation;  cardiovascular disease;  comorbidity;  coronavirus disease 2019;  heart injury;  hospital mortality;  hospitalization;  human;  intensive care unit;  lymphocytopenia;  medical history;  meta analysis;  organ injury;  priority journal;  prognosis;  protein blood level;  steroid therapy;  systematic review;  thrombocytopenia;  acute disease;  acute kidney failure;  adult;  aged;  Betacoronavirus;  cardiovascular disease;  cerebrovascular disease;  chronic obstructive lung disease;  Coronavirus infection;  diabetes mellitus;  female;  heart disease;  hypertension;  liver disease;  lymphocytopenia;  male;  metabolism;  middle aged;  mortality;  neoplasm;  obesity;  pandemic;  prognosis;  severity of illness index;  sex factor;  smoking;  thrombocytopenia;  very elderly;  virus pneumonia;  young adult, Acute Disease;  Acute Kidney Injury;  Adrenal Cortex Hormones;  Adult;  Age Factors;  Aged;  Aged, 80 and over;  Betacoronavirus;  C-Reactive Protein;  Cardiovascular Diseases;  Cerebrovascular Disorders;  Coronavirus Infections;  Diabetes Mellitus;  Female;  Ferritins;  Fibrin Fibrinogen Degradation Products;  Heart Diseases;  Hospital Mortality;  Hospitalization;  Humans;  Hypertension;  Intensive Care Units;  Interleukin-6;  Liver Diseases;  Lymphopenia;  Male;  Middle Aged;  Neoplasms;  Obesity;  Pandemics;  Pneumonia, Viral;  Procalcitonin;  Prognosis;  Pulmonary Disease, Chronic Obstructive;  Respiration, Artificial;  Severity of Illness Index;  Sex Factors;  Smoking;  Thrombocytopenia;  Young Adult
TODO - Background: Identification of reliable outcome predictors in coronavirus disease 2019 (COVID-19) is of paramount importance for improving patient's management. Methods: A systematic review of literature was conducted until 24 April 2020. From 6843 articles, 49 studies were selected for a pooled assessment; cumulative statistics for age and sex were retrieved in 587 790 and 602 234 cases. Two endpoints were defined: (a) a composite outcome including death, severe presentation, hospitalization in the intensive care unit (ICU) and/or mechanical ventilation; and (b) in-hospital mortality. We extracted numeric data on patients’ characteristics and cases with adverse outcomes and employed inverse variance random-effects models to derive pooled estimates. Results: We identified 18 and 12 factors associated with the composite endpoint and death, respectively. Among those, a history of CVD (odds ratio (OR) = 3.15, 95% confidence intervals (CIs) 2.26-4.41), acute cardiac (OR = 10.58, 5.00-22.40) or kidney (OR = 5.13, 1.78-14.83) injury, increased procalcitonin (OR = 4.8, 2.034-11.31) or D-dimer (OR = 3.7, 1.74-7.89), and thrombocytopenia (OR = 6.23, 1.031-37.67) conveyed the highest odds for the adverse composite endpoint. Advanced age, male sex, cardiovascular comorbidities, acute cardiac or kidney injury, lymphocytopenia and D-dimer conferred an increased risk of in-hospital death. With respect to the treatment of the acute phase, therapy with steroids was associated with the adverse composite endpoint (OR = 3.61, 95% CI 1.934-6.73), but not with mortality. Conclusions: Advanced age, comorbidities, abnormal inflammatory and organ injury circulating biomarkers captured patients with an adverse clinical outcome. Clinical history and laboratory profile may then help identify patients with a higher risk of in-hospital mortality. © 2020 Stichting European Society for Clinical Investigation Journal Foundation
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