COVID-19 deaths 4 to 7 X more likely if Diabetic, Hypertensive, or CVD - meta-analysis March 2020

medRxiv preprint doi: https://doi.org/10.1101/2020.03.17.20037572

Note: this data analysis is for China. Many other countries have different emerging data.

Incidence, clinical characteristics and prognostic factor of patients with COVID-19: a systematic review and meta-analysis

Chaoqun Ma, MD1; Jiawei Gu, MD2; Pan Hou, MD1; Liang Zhang, MD1; Yuan Bai, MD1; Zhifu Guo, MD1; Hong Wu, MD1; Bili Zhang,
MD1 ; Pan Li, MD, MD1 ; Xianxian Zhao, MD, FACC, FESC1
1Department of Cardiology, Changhai Hospital, Second Military Medical University, 168 Changhai Rd, Shanghai, 200433, China.
2 Department of General Surgery, The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, 801 Heqing Rd, 200240, China.

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Background: Recently, Coronavirus Disease 2019 (COVID-19) outbreak started in Wuhan, China. Although the clinical features of COVID-19 have been reported previously, data regarding the risk factors associated with the clinical outcomes are lacking.

Objectives: To summary and analyze the clinical characteristics and identify the predictors of disease severity and mortality.

Methods: The PubMed, Web of Science Core Collection, Embase, Cochrane and MedRxiv databases were searched through February 25, 2020. Meta-analysis of Observational Studies in Epidemiology (MOOSE) recommendations were followed. We extracted and pooled data using random-e= ects meta-analysis to summary the clinical feature of the confirmed COVID-19 patients, and further identify risk factors for disease severity and death. Heterogeneity was evaluated using the I2 method and explained with subgroup analysis and meta-regression.

Results: A total of 30 studies including 53000 patients with COVID-19 were included in this study, the mean age was 49.8 years (95% CI, 47.5-52.2 yrs) and 55.5% were male. The pooled incidence of severity and mortality were 20.2% (95% CI, 15.1-25.2%) and 3.1% (95% CI, 1.9-4.2%), respectively. The predictor for disease severity included

• old age 50 yrs, odds ratio [OR] = 2.61; 95% CI, 2.29-2.98),
• male (OR =1.348, 95% CI, 1.195-1.521),
• smoking (OR =1.734, 95% CI, 1.146-2.626) and
• any comorbidity (OR = 2.635, 95% CI, 2.098-3.309),
• especially chronic kidney disease (CKD, OR = 6.017; 95% CI, 2.192-16.514),
• chronic obstructive pulmonary disease (COPD, OR = 5.323; 95% CI, 2.613-10.847) and
• cerebrovascular disease (OR = 3.219; 95% CI, 1.486-6.972)

In terms of laboratory results, increased lactate dehydrogenase (LDH), C-reactive protein (CRP) and D-dimer and decreased blood platelet and lymphocytes count were highly associated with severe COVID-19 (all for P < 0.001). Meanwhile,

• old age (> 60 yrs, RR = 9.45; 95% CI, 8.09-11.04), followed by
• cardiovascular disease (RR =6.75; 95% CI, 5.40-8.43)
• hypertension (RR = 4.48; 95% CI, 3.69-5.45) and
• diabetes (RR = 4.43; 95% CI, 3.49-5.61)

were found to be independent prognostic factors for the COVID-19 related death.

Conclusions: To our knowledge, this is the first evidence-based medicine research to explore the risk factors of prognosis in patients with COVID-19, which is helpful to identify early-stage patients with poor prognosis and adapt effective treatment.

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Increased risk of severe symptoms if: