Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease 2019: A systematic review and meta-analysis

Yue Zhou, Qing Yang, Jingwei Chi, Bingzi Dong, Wenshan Lv, Liyan Shen, Yangang Wang, Yue Zhou, Qing Yang, Jingwei Chi, Bingzi Dong, Wenshan Lv, Liyan Shen, Yangang Wang

Abstract

Objectives: Existing findings regarding the relationship between comorbidities and the severity of coronavirus disease 2019 (COVID-19) are inconsistent and insufficient. The aim of this study was to evaluate the association between different comorbidities and the severity of COVID-19.

Methods: The PubMed, Embase, and Cochrane Library databases were searched to identify studies reporting the rates of comorbidities in COVID-19 patients with severe/fatal outcomes. Subgroup analyses were conducted according to disease severity and the country of residence. Odds ratios (OR) with 95% confidence intervals (CI) were pooled using random-effects models.

Results: A total of 34 eligible studies were identified. In patients with severe/fatal COVID-19, the most prevalent chronic comorbidities were obesity (42%, 95% CI 34-49%) and hypertension (40%, 95% CI 35-45%), followed by diabetes (17%, 95% CI 15-20%), cardiovascular disease (13%, 95% CI 11-15%), respiratory disease (8%, 95% CI 6-10%), cerebrovascular disease (6%, 95% CI 4-8%), malignancy (4%, 95% CI 3-6%), kidney disease (3%, 95% CI 2-4%), and liver disease (2%, 95% CI 1-3%). In order of the prediction, the pooled ORs of the comorbidities in patients with severe or fatal COVID-19 when compared to patients with non-severe/fatal COVID-19 were as follows: chronic respiratory disease, OR 3.56 (95% CI 2.87-4.41); hypertension, OR 3.17 (95% CI 2.46-4.08); cardiovascular disease, OR 3.13 (95% CI 2.65-3.70); kidney disease, OR 3.02 (95% CI 2.23-4.08); cerebrovascular disease, OR 2.74 (95% CI 1.59-4.74); malignancy, OR 2.73 (95% CI 1.73-4.21); diabetes, OR 2.63 (95% CI 2.08-3.33); and obesity, OR 1.72 (95% CI 1.04-2.85). No correlation was observed between liver disease and COVID-19 aggravation (OR 1.54, 95% CI 0.95-2.49).

Conclusions: Chronic comorbidities, including obesity, hypertension, diabetes, cardiovascular disease, cerebrovascular disease, respiratory disease, kidney disease, and malignancy are clinical risk factors for a severe or fatal outcome associated with COVID-19, with obesity being the most prevalent and respiratory disease being the most strongly predictive. Knowledge of these risk factors could help clinicians better identify and manage the high-risk populations.

Keywords: COVID-19; Comorbidity; Fatality; ICU admission; Severe.

Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
Flowchart of the search and selection process (PRISMA).
Figure 2
Figure 2
Meta-analysis of the proportions of comorbidities in severe or fatal COVID-19 cases stratified by the country of residence. 95% CI, 95% confidence interval.
Figure 3
Figure 3
Association between chronic comorbidities and severe or fatal COVID-19, according to severe clinical outcomes (severe disease based on clinical symptoms, ICU admission, and death). ICU, intensive care unit; OR, odds ratio; 95% CI, 95% confidence interval.
Figure 4
Figure 4
Association between chronic comorbidities and severe or fatal COVID-19 according to country of residence. OR, odds ratio; 95% CI, 95% confidence interval.

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