Risk factors for poor outcomes in hospitalised COVID-19 patients: A systematic review and meta-analysis

Li, You; Ashcroft, Thulani; Chung, Alexandria; Dighero, Izzie; Dozier, Marshall; Horne, Margaret; McSwiggan, Emilie; Shamsuddin, Azwa; Nair, Harish

Abstract

Background
Understanding the risk factors for poor outcomes among
COVID-19 patients could help identify vulnerable populations who
would need prioritisation in prevention and treatment for COVID-19.
We aimed to critically appraise and synthesise published evidence on
the risk factors for poor outcomes in hospitalised COVID-19 patients.

Methods
We searched PubMed, medRxiv and the WHO COVID-19 literature
database for studies that reported characteristics of COVID-19
patients who required hospitalisation. We included studies published
between January and May 2020 that reported adjusted effect size of any demographic and/or clinical factors for any of the three poor outcomes: mortality, intensive care unit (ICU) admission, and invasive mechanical ventilation. We appraised the quality of the included studies using Joanna Briggs Institute appraisal tools and quantitatively synthesised the evidence through a series of random-effect meta-analyses. To aid data interpretation, we further developed an interpretation framework that indicated strength of the evidence, informed by both quantity and quality of the evidence.

Results
We included a total of 40 studies in our review. Most of the included
studies (29/40, 73%) were assessed as “good quality”, with assessment scores of 80 or more. We found that male sex (pooled odds ratio (OR) = 1.32 (95% confidence interval (CI) = 1.18-1.48; 20 studies), older age (OR = 1.05, 95% CI = 1.04-1.07, per one year of age increase; 10 studies), obesity (OR = 1.59, 95% CI = 1.02-2.48; 4 studies), diabetes (OR = 1.25, 95% CI = 1.11-1.40; 11 studies) and chronic kidney diseases (6 studies; OR = 1.57, 95% CI = 1.27-1.93) were associated with increased risks for mortality with the greatest strength of evidence based on our interpretation framework. We did not find increased risk of mortality for several factors including chronic obstructive pulmonary diseases (5 studies), cancer (4 studies), or current smoker (5 studies); however, this does not indicate absence of risk due to limited data on each of these factors.

Conclusion
Male sex, older age, obesity, diabetes and chronic kidney diseases are important risk factors of COVID-19 poor outcomes. Our review provides not only an appraisal and synthesis of evidence on the risk factors of COVID-19 poor outcomes, but also a data interpretation
framework that could be adopted by relevant future research.

Citation

Li, Y., Ashcroft, T., Chung, A., Dighero, I., Dozier, M., Horne, M., …Nair, H. (2021). Risk factors for poor outcomes in hospitalised COVID-19 patients: A systematic review and meta-analysis. Journal of Global Health, 11(10001), https://doi.org/10.7189/jogh.11.10001

• Journal Article Type: Article
• Acceptance Date: May 1, 2021
• Online Publication Date: Sep 7, 2021
• Publication Date: Sep 7, 2021
• Deposit Date: Apr 22, 2022
• Publicly Available Date: Apr 22, 2022
• Journal: Journal of Global Health
• Print ISSN: 2047-2978
• Peer Reviewed: Peer Reviewed
• Volume: 11
• Issue: 10001
• DOI: https://doi.org/10.7189/jogh.11.10001
• Public URL: https://hull-repository.worktribe.com/output/3866438