Comorbid Chronic Diseases and Acute Organ Injuries Are Strongly Correlated with Disease Severity and Mortality among COVID-19 Patients: A Systemic Review and Meta-Analysis

Xinhui Wang, Xuexian Fang, Zhaoxian Cai, Xiaotian Wu, Xiaotong Gao, Junxia Min, Fudi Wang, Xinhui Wang, Xuexian Fang, Zhaoxian Cai, Xiaotian Wu, Xiaotong Gao, Junxia Min, Fudi Wang

Abstract

The recent outbreak of COVID-19 has been rapidly spreading on a global scale. To date, there is no specific vaccine against the causative virus, SARS-CoV-2, nor is there an effective medicine for treating COVID-19, thus raising concerns with respect to the effect of risk factors such as clinical course and pathophysiological parameters on disease severity and outcome in patients with COVID-19. By extracting and analyzing all available published clinical data, we identified several major clinical characteristics associated with increased disease severity and mortality among patients with COVID-19. Specifically, preexisting chronic conditions such as hypertension, cardiovascular disease, chronic kidney disease, and diabetes are strongly associated with an increased risk of developing severe COVID-19; surprisingly, however, we found no correlation between chronic liver disease and increased disease severity. In addition, we found that both acute cardiac injury and acute kidney injury are highly correlated with an increased risk of COVID-19-related mortality. Given the high risk of comorbidity and the high mortality rate associated with tissue damage, organ function should be monitored closely in patients diagnosed with COVID-19, and this approach should be included when establishing new guidelines for managing these high-risk patients. Moreover, additional clinical data are needed in order to determine whether a supportive therapy can help mitigate the development of severe, potentially fatal complications, and further studies are needed to identify the pathophysiology and the mechanism underlying this novel coronavirus-associated infectious disease. Taken together, these findings provide new insights regarding clinical strategies for improving the management and outcome of patients with COVID-19.

Conflict of interest statement

The authors declare no competing financial interests.

Copyright © 2020 Xinhui Wang et al.

Figures

Figure 1
Figure 1
Summary of the total number of deaths and mortality rate among SARS-CoV-2-infected patients recorded through April 6, 2020. (a, b) Summary of the total number of deaths (a) and mortality rate (b) in the indicated countries with more than 1,000 total cases reported; data were retrieved from the World Health Organization. (c) Summary of the mortality rate in the indicated regions in China (including Hong Kong, Macao, and Taiwan); data were retrieved from the Chinese Center for Disease Control and Prevention.
Figure 2
Figure 2
Flow-chart depicting the literature search and selection strategy. After applying the inclusion and exclusion criteria, a total of 34 articles were included in the final meta-analysis.
Figure 3
Figure 3
Forest plot showing the effect of comorbid hypertension (top) and cardiovascular disease (bottom) on the risk of severe COVID-19 in SARS-CoV-2-infected patients. In this and subsequent figures, the horizontal lines indicate the lower and upper limits of the 95% CI, and the size of the blue squares reflects the relative weight of each study in the meta-analysis. OR: odds ratio.
Figure 4
Figure 4
Forest plot showing the effect of comorbid chronic kidney disease on the risk of severe COVID-19 in SARS-CoV-2-infected patients.
Figure 5
Figure 5
Forest plot showing the effect of comorbid chronic liver disease on the risk of severe COVID-19 in SARS-CoV-2-infected patients.
Figure 6
Figure 6
Forest plot showing the effect of comorbid diabetes on the risk of severe COVID-19 in SARS-CoV-2-infected patients.
Figure 7
Figure 7
Schematic diagram depicting the putative association between severe COVID-19 and the indicated preexisting chronic diseases and affected organs. The blue line indicates the association between preexisting chronic diseases and COVID-19 severity. The red line indicates organ injuries observed in COVID-19 patients. Expression of ACE2 in the indicated organs is indicated. ACE2: angiotensin-converting enzyme 2; ALT: alanine transaminase; AST: aspartate aminotransferase; BUN: blood urea nitrogen; CK-MB: creatine kinase-MB; cTnI: cardiac troponin I; CVD: cardiovascular disease.

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