Cardiometabolic Risk Factors and COVID-19 Outcomes in the Asia-Pacific Region: A Systematic Review, Meta-analysis and Meta-regression of 84,011 Patients

Abstract

Background: The aim of this study is to consolidate the available evidence to determine the impact of cardiometabolic risk factors (CMRF) – namely diabetes, hypertension, cardiovascular disease, obesity, smoking and hyperlipidaemia – on the mortality and intensive care unit (ICU) admission rates in Asia-Pacific patients with COVID-19. Methods: MEDLINE, Embase, Web of Science, and the WHO COVID-19 global literature on coronavirus disease were systematically searched for relevant cohort studies published up to June 2021. Univariate and multivariate age, sex, and regional-adjusted regression were performed to evaluate the association between CMRF and mortality and ICU admission rates. Results: Of the 5,914 publications identified in our search, 31 studies involving 84,011 patients were included, and all studies were rated as good quality with a low risk of bias. The overall pooled mortality rate was 9.4%. The overall ICU admission rate was 9.6%. Random-effect meta-analysis showed associations with mortality rates as follows for diabetes, hypertension and cardiovascular disease: OR 2.85, 95% CI [2.25–3.62], p<0.001; OR 2.51, 95% CI [1.93–3.27], p<0.001; and OR 2.75, 95% CI [2.09–3.62], p<0.001 respectively. The associations for ICU admission rates were as follows for diabetes, hypertension and cardiovascular disease: OR 2.86, 95% CI [1.76–4.64], p<0.001; OR 2.93, 95% CI [2.37–3.63], p<0.001 and OR 3.32, 95% CI [2.17–5.06], p<0.001 respectively. Multivariate meta-regression for the mortality model demonstrated that age, sex and regional differences had significant interactions with covariates. Conclusion: Diabetes, hypertension and cardiovascular disease showed significant associations with mortality and ICU admission rates. Age, sex, and regional differences were significant confounders for the associations of CMRF on COVID-19 mortality and ICU admission.