Predictive symptoms and comorbidities for severe COVID-19 and intensive care unit admission: a systematic review and meta-analysis

Vageesh Jain, Jin-Min Yuan, Vageesh Jain, Jin-Min Yuan

Abstract

Objectives: COVID-19 has a varied clinical presentation. Elderly patients with comorbidities are more vulnerable to severe disease. This study identifies specific symptoms and comorbidities predicting severe COVID-19 and intensive care unit (ICU) admission.

Methods: A literature search identified studies indexed in MEDLINE, EMBASE and Global Health before 5th March 2020. Two reviewers independently screened the literature and extracted data. Quality appraisal was performed using STROBE criteria. Random effects meta-analysis identified symptoms and comorbidities associated with severe COVID-19 or ICU admission.

Results: Seven studies (including 1813 COVID-19 patients) were included. ICU patients were older (62.4 years) than non-ICU (46 years), with a greater proportion of males. Dyspnoea was the only symptom predictive for severe disease (pOR 3.70, 95% CI 1.83-7.46) and ICU admission (pOR 6.55, 95% CI 4.28-10.0). COPD was the strongest predictive comorbidity for severe disease (pOR 6.42, 95% CI 2.44-16.9) and ICU admission (pOR 17.8, 95% CI 6.56-48.2), followed by cardiovascular disease and hypertension.

Conclusions: Dyspnoea was the only symptom predictive for severe COVID-19 and ICU admission. Patients with COPD, cardiovascular disease and hypertension were at higher risk of severe illness and ICU admission.

Keywords: COVID-19; Disease severity; Epidemiology; Novel coronavirus; Public health; Risk factors.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of included studies. China (2020)
Fig. 2
Fig. 2
Forest plots of the symptoms/comorbidities predictive for severe COVID-19 (a, c, e, g) and intensive care unit admission (b, d, f, h). China (2020)

References

    1. Centers for Disease Control and Prevention (2020a) People who are at higher risk for severe illness. . Accessed 25 April 2020
    1. Centers for Disease Control and Prevention (2020b) Interim Clinical Guidance for Management of Patients with Confirmed Coronavirus Disease (COVID-19). . Accessed 25 April 2020
    1. Cowling BJ, Leung GM. Epidemiological research priorities for public health control of the ongoing global novel coronavirus (2019-nCoV) outbreak. Eurosurveillance. 2020;25:1–5. doi: 10.2807/1560-7917.ES.2020.25.6.2000110.
    1. Gattinoni L, Chiumello D, Caironi P, et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes? Intensive Care Med. 2020 doi: 10.1007/s00134-020-06033-2.
    1. Guan W-J, Ni Z-Y, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020 doi: 10.1056/NEJMoa2002032.
    1. Hedges LV, Vevea JL. Fixed- and random-effects models in meta-analysis. Psychol Methods. 1998;3:486–504. doi: 10.1037/1082-989X.3.4.486.
    1. Henry BM, Lippi G. Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection. Int Urol Nephrol. 2020;2019:9–10. doi: 10.1007/s11255-020-02451-9.
    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497–506. doi: 10.1016/S0140-6736(20)30183-5.
    1. Intensive care national audit & research centre (2020) ICNARC report on COVID-19 in critical care. 4 April 2020
    1. Jain V, Yuan J-M (2020) Systematic review and meta-analysis of predictive symptoms and comorbidities for severe COVID-19 infection. medRxiv. 10.1101/2020.03.15.20035360
    1. Li B, Yang J, Zhao F, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020;109:531–538. doi: 10.1007/s00392-020-01626-9.
    1. Li K, Wu J, Wu F, et al. The clinical and chest CT features associated with severe and critical COVID-19 pneumonia. Invest Radiol. 2020 doi: 10.1097/RLI.0000000000000672.
    1. Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377–382. doi: 10.1136/thorax.58.5.377.
    1. Lipsitch M, Swerdlow DL, Finelli L. Defining the epidemiology of Covid-19—studies needed. N Engl J Med. 2020;382:1194–1196. doi: 10.1056/NEJMp2002125.
    1. Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? Lancet. 2020;395:1225–1228. doi: 10.1016/S0140-6736(20)30627-9.
    1. Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E, et al. Clinical, laboratory and imaging features of COVID-19: a systematic review and meta-analysis. Travel Med Infect Dis. 2020 doi: 10.1016/j.tmaid.2020.101623.
    1. StataCorp. (2015) Stata Statistical Software: Release 14
    1. Sun P, Qie S, Liu Z, et al. Clinical characteristics of hospitalized patients with SARS-CoV-2 infection: a single arm meta-analysis. J Med Virol. 2020;92:612–617. doi: 10.1002/jmv.25735.
    1. Tian S, Hu N, Lou J, et al. Characteristics of COVID-19 infection in Beijing. J Infect. 2020;80:401–406. doi: 10.1016/j.jinf.2020.02.018.
    1. von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Int Med. 2007;147:573. doi: 10.7326/0003-4819-147-8-200710160-00010.
    1. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients With 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020 doi: 10.1001/jama.2020.1585.
    1. WHO-China Joint Mission (2020) Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)
    1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China. JAMA. 2020;323:1239. doi: 10.1001/jama.2020.2648.
    1. Xu Y-H, Dong J-H, An W, et al. Clinical and computed tomographic imaging features of novel coronavirus pneumonia caused by SARS-CoV-2. J Infect. 2020;80:394–400. doi: 10.1016/j.jinf.2020.02.017.
    1. Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities and its effects in coronavirus disease 2019 patients: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91–95. doi: 10.1016/j.ijid.2020.03.017.
    1. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;2600:1–7. doi: 10.1016/S2213-2600(20)30079-5.
    1. Zhang J, Dong X, Cao Y, et al. Clinical characteristics of 140 patients infected with SARS-CoV-2 in Wuhan, China. Allergy. 2020;1:14238. doi: 10.1111/all.14238.

Source: PubMed

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