Eur J Clin Invest. 2020 Jul 29:e13362. doi: 10.1111/eci.13362. Online ahead of print.
BACKGROUND: Identification of reliable outcome predictors in Corona virus disease-2019 (Covid-19) is of paramount importance for improving patient's management.
METHODS: A systematic review of literature was conducted until April 24th , 2020. From 6,843 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: 1) a composite outcome including death, severe presentation, hospitalization in intensive care unit (ICU) and/or mechanical ventilation; 2) 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 (CI) 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.