Abstract
BackgroundCoronavirus disease 2019 (COVID-19) is an infectious disease characterized by cough, fever, and fatigue and 20% of cases will develop into severe conditions resulting from acute lung injury with the manifestation of the acute respiratory distress syndrome (ARDS) that accounts for more than 50% of mortality. Currently, it has been reported that some comorbidities are linked with an increased rate of severity and mortality among COVID-19 patients. To assess the role of comorbidity in COVID-19 progression, we performed a systematic review with a meta-analysis on the relationship of COVID-19 severity with 8 different underlying diseases.MethodsPubMed, Web of Science, and CNKI were searched for articles investigating the prevalence of comorbidities in severe and non-severe COVID-19 patients. A total of 41 studies comprising 12,526 patients were included.ResultsPrevalence of some commodities was lower than that in general population such as hypertension (19% vs 23.2%), diabetes (9% vs 10.9%), chronic kidney disease (CKD) (2% vs 9.5%), chronic liver diseases (CLD) (3% vs 24.8%) and chronic obstructive pulmonary disease (COPD) (3% vs 8.6%), while some others including cancer (1% vs 0.6%), cardiovascular disease (6% vs 1.8%) and cerebrovascular disease (2% vs 0.9%) exhibited greater percentage in COVID-19. Cerebrovascular disease (OR = 3.70, 95%CI 2.51–5.45) was found to be the strongest risk factor in disease exacerbation, followed by CKD (OR = 3.60, 95%CI 2.18–5.94), COPD (OR = 3.14, 95% CI 2.35–4.19), cardiovascular disease (OR = 2.76, 95% CI 2.18–3.49), malignancy (OR = 2.63, 95% CI 1.75–3.95), diabetes (OR = 2.49, 95% CI 2.10–2.96) and hypertension (OR = 2.13, 95% CI 1.81–2.51). We found no correlation between CLD and increased disease severity (OR = 1.32, 95% CI 0.96–1.82).ConclusionThe impact of all eight underlying diseases on COVID-19 deterioration seemed to be higher in patients outside Hubei. Based on different comorbidities, COVID-19 patients tend to be at risk of developing poor outcomes to a varying degree. Thus, tailored infection prevention and monitoring and treatment strategies targeting these high-risk subgroups might improve prognosis during the COVID-19 pandemic.
Highlights
Coronavirus disease 2019 (COVID-19) is an infectious disease characterized by cough, fever, and fatigue and 20% of cases will develop into severe conditions resulting from acute lung injury with the manifestation of the acute respiratory distress syndrome (ARDS) that accounts for more than 50% of mortality
The results showed that the comorbidities successively arrayed by proportion were hypertension (19, 95% confidence intervals (CI) 16–22%), diabetes (9, 95% confidence intervals (95% CI) 8–11%), cardiovascular diseases (6, 95% CI 4–7%), chronic liver diseases (CLD) (3, 95% CI 2–4%), chronic obstructive pulmonary disease (COPD) (3, 95% CI 2– 4%), cerebrovascular diseases (2, 95% CI 1–2%), chronic kidney disease (CKD) (2, 95% CI 1–2%) and malignancy (1, 95% CI 1–2%)
Evaluation for the impact of these comorbidities on COVID-19 severity was presented as forest plots in Fig. 3, showing that the proportion of all comorbidities in severe patients was significantly higher than that in nonsevere patients, with the exception of CLD (OR = 1.32, 95% CI 0.96–1.82)
Summary
Coronavirus disease 2019 (COVID-19) is an infectious disease characterized by cough, fever, and fatigue and 20% of cases will develop into severe conditions resulting from acute lung injury with the manifestation of the acute respiratory distress syndrome (ARDS) that accounts for more than 50% of mortality. Many patients with COVID19 initially present flu-like symptoms as fever (91.3%), dry cough (67.7%), and fatigue (51.0%), followed by dyspnea (30.4%) [3]. Most patients with these symptoms have a good prognosis, while only a small portion of patients will convert into severe or critical cases, rapidly developing lethal complications (such as acute respiratory distress syndrome, septic shock, and irreversible metabolic acidosis) and even death, especially for the elderly and those with underlying diseases [4]. The assessment of the specific risk factor underlying different comorbidities is conducive to the special care of the targeted population
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