Predictors of mortality in patients with coronavirus disease 2019: a systematic review and meta-analysis

BMC Infect Dis. 2021 Jul 8;21(1):663. doi: 10.1186/s12879-021-06369-0.


Background: Coronavirus disease 2019 (COVID-19) is associated with a high mortality rate, especially in patients with severe illness. We conducted a systematic review and meta-analysis to assess the potential predictors of mortality in patients with COVID-19.

Methods: PubMed, EMBASE, the Cochrane Library, and three electronic Chinese databases were searched from December 1, 2019 to April 29, 2020. Eligible studies reporting potential predictors of mortality in patients with COVID-19 were identified. Unadjusted prognostic effect estimates were pooled using the random-effects model if data from at least two studies were available. Adjusted prognostic effect estimates were presented by qualitative analysis.

Results: Thirty-six observational studies were identified, of which 27 were included in the meta-analysis. A total of 106 potential risk factors were tested, and the following important predictors were associated with mortality: advanced age, male sex, current smoking status, preexisting comorbidities (especially chronic kidney, respiratory, and cardio-cerebrovascular diseases), symptoms of dyspnea, complications during hospitalization, corticosteroid therapy and a severe condition. Additionally, a series of abnormal laboratory biomarkers of hematologic parameters, hepatorenal function, inflammation, coagulation, and cardiovascular injury were also associated with fatal outcome.

Conclusion: We identified predictors of mortality in patients with COVID-19. These findings could help healthcare providers take appropriate measures and improve clinical outcomes in such patients.

Keywords: COVID-19; Meta-analysis; Mortality; Predictors; Systematic review.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Adrenal Cortex Hormones / administration & dosage
  • Age Distribution
  • COVID-19 / diagnosis*
  • COVID-19 / mortality*
  • Cardiovascular Diseases / epidemiology
  • Comorbidity
  • Databases, Factual
  • Dyspnea / epidemiology
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Inflammation / epidemiology
  • Kidney / physiopathology
  • Liver / physiopathology
  • Male
  • Observational Studies as Topic
  • Prognosis
  • Risk Factors
  • Sex Distribution
  • Smokers / statistics & numerical data


  • Adrenal Cortex Hormones