Abstract
COVID-19 clinical presentation is heterogeneous, ranging from asymptomatic to severe cases. While there are a number of early publications relating to risk factors for COVID-19 infection, low sample size and heterogeneity in study design impacted consolidation of early findings. There is a pressing need to identify the factors which predispose patients to severe cases of COVID-19. For rapid and widespread risk stratification, these factors should be easily obtainable, inexpensive, and avoid invasive clinical procedures. The aim of our study is to fill this knowledge gap by systematically mapping all the available evidence on the association of various clinical, demographic, and lifestyle variables with the risk of specific adverse outcomes in patients with COVID-19. The systematic review was conducted using standardized methodology, searching two electronic databases (PubMed and SCOPUS) for relevant literature published between 1st January 2020 and 9th July 2020. Included studies reported characteristics of patients with COVID-19 while reporting outcomes relating to disease severity. In the case of sufficient comparable data, meta-analyses were conducted to estimate risk of each variable. Seventy-six studies were identified, with a total of 17,860,001 patients across 14 countries. The studies were highly heterogeneous in terms of the sample under study, outcomes, and risk measures reported. A large number of risk factors were presented for COVID-19. Commonly reported variables for adverse outcome from COVID-19 comprised patient characteristics, including age >75 (OR: 2.65, 95% CI: 1.81-3.90), male sex (OR: 2.05, 95% CI: 1.39-3.04) and severe obesity (OR: 2.57, 95% CI: 1.31-5.05). Active cancer (OR: 1.46, 95% CI: 1.04-2.04) was associated with increased risk of severe outcome. A number of common symptoms and vital measures (respiratory rate and SpO2) also suggested elevated risk profiles. Based on the findings of this study, a range of easily assessed parameters are valuable to predict elevated risk of severe illness and mortality as a result of COVID-19, including patient characteristics and detailed comorbidities, alongside the novel inclusion of real-time symptoms and vital measurements.
Highlights
SARS-CoV-2, first reported to the WHO on 31 December 2019, has subsequently exponentially spread with cases officially reported in 215 countries and territories [1]
The studies were highly heterogeneous in terms of the sample under study, outcomes, and risk measures reported
A large number of risk factors were presented for COVID-19
Summary
SARS-CoV-2, first reported to the WHO on 31 December 2019, has subsequently exponentially spread with cases officially reported in 215 countries and territories [1]. The clinical pathophysiology of COVID-19 is still the subject of ongoing research It is clear, that clinical presentation is heterogeneous, ranging from asymptomatic to severe disease. Severe symptoms are thought to be the consequence of the SARS-CoV-2 virus invading type II alveolar epithelial cells, causing the release of cytokines and inflammatory markers. This ‘cytokine storm’ attracts neutrophils and T cells, which in turn cause significant lung injury and inflammation, eventually leading to acute respiratory distress syndrome [8]. While most patients recover quickly, a growing number are suffering from so-called ‘long COVID’, a multisystem, post-viral condition with symptoms including fatigue, anxiety, low mood, cognitive problems, and atypical chest pain, stretching over a period of weeks or months without recovery [12]. Mental health conditions (e.g. PTSD, depression, and anxiety) are known to result from extended ICU admission [13]
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