Comorbidities and the risk of severe or fatal outcomes associated with coronavirus disease 2019: A systematic review and meta-analysis. (October 2020)

• Record Type: Journal Article
• Authors: Zhou, Yue; Yang, Qing; Chi, Jingwei; Dong, Bingzi; Lv, Wenshan; Shen, Liyan; Wang, Yangang
• Is Part Of: International journal of infectious diseases. Volume 99(2020)
• Page Start: 47
• Page End: 56
• Publication Date: 2020-10
• Subjects: Comorbidity -- Severe -- ICU admission -- Fatality -- COVID-19; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.07.029
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Among patients with severe or fatal coronavirus disease 2019 (COVID-19), the most prevalent comorbidities were obesity and hypertension, followed by diabetes, cardiovascular disease, respiratory disease, cerebrovascular disease, malignancy, chronic kidney disease, and liver disease. Comorbid respiratory disease was identified as the strongest risk factor for COVID-19 severity, followed by hypertension, cardiovascular disease, chronic kidney disease, cerebrovascular disease, malignancy, diabetes, and obesity. Subgroup analyses were conducted according to severe clinical outcomes and country of residence in the study population. Knowledge of these risk factors could help clinicians better identify and manage the high-risk populations. 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.