Risk Factors of 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 May 14;ciaa576. doi: 10.1093/cid/ciaa576. Online ahead of print.

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 March 15, 2020 which reported COVID-19 clinical features and/or treatment outcomes. 45 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 raised leukocyte count (p<0.0001), raised alanine aminotransferase (p=0.024), raised aspartate transaminase (p=0.0040), elevated lactate dehydrogenase (LDH) (p<0.0001) and increased procalcitonin (p<0.0001). ARDS was predicted by elevated LDH (p<0.0001), while mortality was predicted by raised leukocyte count (p=0.0005) and elevated LDH (p<0.0001). Treatment with lopinavir-ritonavir showed no significant benefit in mortality and ARDS rates. Corticosteroids were associated with a higher rate of ARDS (p=0.0003).

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