Risk Factors for Severe Disease and Efficacy of Treatment in Patients Infected With COVID-19: A Systematic Review, Meta-Analysis, and Meta-Regression Analysis

Clin Infect Dis. 2020 Nov 19;71(16):2199-2206. doi: 10.1093/cid/ciaa576.

Abstract

The coronavirus disease 2019 (COVID-19) pandemic spread globally in the beginning of 2020. At present, predictors of severe disease and the efficacy of different treatments are not well understood. We conducted a systematic review and meta-analysis of all published studies up to 15 March 2020, which reported COVID-19 clinical features and/or treatment outcomes. Forty-five studies reporting 4203 patients were included. Pooled rates of intensive care unit (ICU) admission, mortality, and acute respiratory distress syndrome (ARDS) were 10.9%, 4.3%, and 18.4%, respectively. On meta-regression, ICU admission was predicted by increased leukocyte count (P < .0001), alanine aminotransferase (P = .024), and aspartate transaminase (P = .0040); elevated lactate dehydrogenase (LDH) (P < .0001); and increased procalcitonin (P < .0001). ARDS was predicted by elevated LDH (P < .0001), while mortality was predicted by increased leukocyte count (P = .0005) and elevated LDH (P < .0001). Treatment with lopinavir-ritonavir showed no significant benefit in mortality and ARDS rates. Corticosteroids were associated with a higher rate of ARDS (P = .0003).

Keywords: COVID-19; coronavirus; risk factor; severe; treatment.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Adrenal Cortex Hormones / adverse effects
  • COVID-19 / drug therapy*
  • COVID-19 / mortality
  • COVID-19 / therapy*
  • Clinical Trials as Topic
  • Coronavirus / drug effects
  • Hospitalization / statistics & numerical data
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Regression Analysis
  • Respiratory Distress Syndrome / drug therapy
  • Respiratory Distress Syndrome / mortality
  • Respiratory Distress Syndrome / virology*
  • Risk Factors
  • Ritonavir / therapeutic use
  • SARS-CoV-2
  • Severity of Illness Index
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Ritonavir