Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis
Open accessAbstract
Background An epidemic of Coronavirus Disease 2019 (COVID-19) began in December 2019 and triggered a Public Health Emergency of International Concern (PHEIC). We aimed to find risk factors for the progression of COVID-19 to help reducing the risk of critical illness and death for clinical help.Methods The data of COVID-19 patients until March 20, 2020 were retrieved from four databases. We statistically analyzed the risk factors of critical/mortal and non-critical COVID-19 patients with meta-analysis.Results Thirteen studies were included in Meta-analysis, including a total number of 3027 patients with SARS-CoV-2 infection. Male, older than 65, and smoking were risk factors for disease progression in patients with COVID-19 (male: OR = 1.76, 95% CI (1.41, 2.18), P < 0.00001; age over 65 years old: OR =6.06, 95% CI(3.98, 9.22), P < 0.00001; current smoking: OR =2.51, 95% CI(1.39, 3.32), P = 0.0006). The proportion of underlying diseases such as hypertension, diabetes, cardiovascular disease, and respiratory disease were statistically significant higher in critical/mortal patients compared to the non-critical patients (diabetes: OR=3.68, 95% CI (2.68, 5.03), P < 0.00001; hypertension: OR = 2.72, 95% CI (1.60,4.64), P = 0.0002; cardiovascular disease: OR = 5.19, 95% CI(3.25, 8.29), P < 0.00001; respiratory disease: OR = 5.15, 95% CI(2.51, 10.57), P < 0.00001). Clinical manifestations such as fever, shortness of breath or dyspnea were associated with the progression of disease [fever: 0R = 0.56, 95% CI (0.38, 0.82), P = 0.003;shortness of breath or dyspnea: 0R=4.16, 95% CI (3.13, 5.53), P < 0.00001]. Laboratory examination such as aspartate amino transferase(AST) > 40U/L, creatinine(Cr) ≥ 133mol/L, hypersensitive cardiac troponin I(hs-cTnI) > 28pg/mL, procalcitonin(PCT) > 0.5ng/mL, lactatede hydrogenase(LDH) > 245U/L, and D-dimer > 0.5mg/L predicted the deterioration of disease while white blood cells(WBC)<4 × 10 9/L meant a better clinical status[AST > 40U/L:OR=4.00, 95% CI (2.46, 6.52), P < 0.00001; Cr ≥ 133μmol/L: OR = 5.30, 95% CI (2.19, 12.83), P = 0.0002; hs-cTnI > 28 pg/mL: OR = 43.24, 95% CI (9.92, 188.49), P < 0.00001; PCT > 0.5 ng/mL: OR = 43.24, 95% CI (9.92, 188.49), P < 0.00001;LDH > 245U/L: OR = 43.24, 95% CI (9.92, 188.49), P < 0.00001; D-dimer > 0.5mg/L: OR = 43.24, 95% CI (9.92, 188.49), P < 0.00001; WBC < 4 × 10 9/L: OR = 0.30, 95% CI (0.17, 0.51), P < 0.00001].Conclusion Male, aged over 65, smoking patients might face a greater risk of developing into the critical or mortal condition and the comorbidities such as hypertension, diabetes, cardiovascular disease, and respiratory diseases could also greatly affect the prognosis of the COVID-19. Clinical manifestation such as fever, shortness of breath or dyspnea and laboratory examination such as WBC, AST, Cr, PCT, LDH, hs-cTnI and D-dimer could imply the progression of COVID-19.
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In data from Wuhan, age was the main risk factor for COVID-19 progression to acute respiratory distress syndrome and end-organ failure.
“data from Wuhan, China showed that age was the primary risk factor associated with COVID-19 progression to acute respiratory distress syndrome (ARDS) and end-organ failure7”
From SARS-CoV-2, COVID-19 and the aging immune system (2021) · cites this paper as [9]
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- Authors
- Zheng, Z., Peng, F., Xu, B., Zhao, J., Liu, H., Peng, J., Li, Q., Jiang, C., Zhou, Y., Liu, S., Ye, C., Zhang, P., Xing, Y., Guo, H., & Tang, W.
- Affiliations
- Sir Run Run Shaw Hospital (CN)
- Shaoxing People's Hospital (CN)
- Xi'an Jiaotong University (CN)
- Loma Linda University (US)
- Shaoxing University (CN)
- Corresponding author
- Tang, Weiliang
- ORCID
- Venue
- Journal of Infection
- Publisher
- Elsevier BV
- Published
- 2020-08
- Volume
- 81
- Issue
- 2
- Pages
- e16-e25
- ISSN
- 0163-4453 (ISSN-L)
- PMC
- PMC7177098
- OpenAlex
- W3020646040
- Cited by
- 2,074
- References
- 29
- Citations by year
- 2026: 39 · 2025: 51 · 2024: 149 · 2023: 251 · 2022: 447 · 2021: 687 · 2020: 449
- FWCI
- 21.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Infection (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- COVID-19 pandemic, SARS-CoV-2, risk factors, disease progression, critical illness, mortality, comorbidities, diabetes mellitus, hypertension, cardiovascular disease, respiratory diseases, smoking, sex differences, old age, fever, dyspnea, clinical features, prognostic factors, prognostic score, prognostic score 2, prognostic score 3
- MeSH terms
- COVID-19, Acute Disease, Adult, Age Factors, Aged, Female, Humans, Male, Middle Aged, Pneumonia, Viral, Risk Factors, Severity of Illness Index, Sex Factors, Coronavirus Infections, Disease Progression, Pandemics
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