Predictors of adverse prognosis in COVID‐19: A systematic review and meta‐analysis
Open accessAbstract
Background: Identification of reliable outcome predictors in coronavirus disease 2019 (COVID‐19) is of paramount importance for improving patient's management. Methods: A systematic review of literature was conducted until 24 April 2020. From 6843 articles, 49 studies were selected for a pooled assessment; cumulative statistics for age and sex were retrieved in 587 790 and 602 234 cases. Two endpoints were defined: (a) a composite outcome including death, severe presentation, hospitalization in the intensive care unit (ICU) and/or mechanical ventilation; and (b) in‐hospital mortality. We extracted numeric data on patients’ characteristics and cases with adverse outcomes and employed inverse variance random‐effects models to derive pooled estimates. Results: We identified 18 and 12 factors associated with the composite endpoint and death, respectively. Among those, a history of CVD (odds ratio (OR) = 3.15, 95% confidence intervals (CIs) 2.26‐4.41), acute cardiac (OR = 10.58, 5.00‐22.40) or kidney (OR = 5.13, 1.78‐14.83) injury, increased procalcitonin (OR = 4.8, 2.034‐11.31) or D‐dimer (OR = 3.7, 1.74‐7.89), and thrombocytopenia (OR = 6.23, 1.031‐37.67) conveyed the highest odds for the adverse composite endpoint. Advanced age, male sex, cardiovascular comorbidities, acute cardiac or kidney injury, lymphocytopenia and D‐dimer conferred an increased risk of in‐hospital death. With respect to the treatment of the acute phase, therapy with steroids was associated with the adverse composite endpoint (OR = 3.61, 95% CI 1.934‐6.73), but not with mortality. Conclusions: Advanced age, comorbidities, abnormal inflammatory and organ injury circulating biomarkers captured patients with an adverse clinical outcome. Clinical history and laboratory profile may then help identify patients with a higher risk of in‐hospital mortality.
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As the case fatality from covid-19 is strongly related to age, comparisons between countries should account for this by stratifying or standardising excess deaths for age.
“In addition, as the case fatality from covid-19 is strongly related to age, comparisons between countries should account for this by stratifying or standardising excess deaths for age.”
From Excess deaths associated with covid-19 pandemic in 2020: age and sex disaggregated time series analysis in 29 high income countries (2021) · cites this paper as [26]
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- Authors
- Figliozzi, S., Masci, P. G., Ahmadi, N., Tondi, L., Koutli, E., Aimo, A., Stamatelopoulos, K., Dimopoulos, M., Caforio, A. L. P., & Georgiopoulos, G.
- Affiliations
- King's College London (GB)
- Poznan University of Medical Sciences (PL)
- IRCCS Policlinico San Donato (IT)
- The Royal Free Hospital (GB)
- University of Pisa (IT)
- National and Kapodistrian University of Athens (GR)
- University of Padua (IT)
- Corresponding author
- Georgiopoulos, Georgios
- ORCID
- Venue
- European Journal of Clinical Investigation
- Publisher
- Wiley
- Published
- 2020-08-27
- Volume
- 50
- Issue
- 10
- Pages
- e13362-e13362
- ISSN
- 0014-2972 (ISSN-L)
- 1365-2362
- OpenAlex
- W3046118641
- Cited by
- 361
- References
- 54
- Citations by year
- 2026: 7 · 2025: 15 · 2024: 25 · 2023: 73 · 2022: 96 · 2021: 123 · 2020: 22
- FWCI
- 3.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Clinical Investigation (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- CINECA IRIS Institutional Research Information System (Sant'Anna School of Advanced Studies) (submittedVersion, other-oa)
- Padua Research Archive (University of Padova) (submittedVersion)
- Funders
- European Association of Cardiovascular Imaging
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Neurology › Long-Term Effects of COVID-19
- Keywords
- COVID-19 pandemic, poor prognosis, risk factors, in-hospital mortality, cardiovascular comorbidity, acute kidney injury, acute cardiac injury, procalcitonin, D-dimer, thrombocytopenia, lymphopenia, corticosteroid therapy, intensive care unit admission, mechanical ventilation
- MeSH terms
- Betacoronavirus, Procalcitonin, COVID-19, SARS-CoV-2, Acute Disease, Adrenal Cortex Hormones, Adult, Age Factors, Aged, Aged, 80 and over, C-Reactive Protein, Cardiovascular Diseases, Cerebrovascular Disorders, Diabetes Mellitus, Female, Ferritins, Fibrin Fibrinogen Degradation Products, Heart Diseases, Hospitalization, Humans, Hypertension, Intensive Care Units, Liver Diseases, Lymphopenia, Male, Middle Aged, Neoplasms, Obesity, Pneumonia, Viral, Prognosis, Respiration, Artificial, Severity of Illness Index, Sex Factors, Smoking, Thrombocytopenia, Interleukin-6, Hospital Mortality, Coronavirus Infections, Pulmonary Disease, Chronic Obstructive, Young Adult, Acute Kidney Injury, Pandemics
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