lancet-header
Preprints with The Lancet is part of SSRN´s First Look, a place where journals and other research experts identify content of interest prior to publication. These preprint papers are not peer-reviewed. Authors have either opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet, or submitted directly via SSRN. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These papers should not be used for clinical decision making or reporting of research to a lay audience without indicating that this is preliminary research that has not been peer-reviewed. For more information see the Comment published in The Lancet, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com

Severity and Case Fatality Rates of COVID-19: A Systematic Review, Meta-Analysis and an Exploratory Meta-Regression of Risk Factors

38 Pages Posted: 15 Apr 2020

See all articles by Chanaka Kahathuduwa

Chanaka Kahathuduwa

Texas Tech University - Department of Laboratory Science and Primary Care

Chathurika Dhanasekara

Texas Tech University - Department of Surgery

Shao-Hua Chin

Protech Pharmaservices Corporation - Department of Medical Science

More...

Abstract

Background: Estimating the prevalence of severe or critical illness and case fatality of COVID-19 outbreak in December, 2019 remains a challenge due to biases associated with surveillance, data synthesis and reporting. We aimed to address this limitation in a systematic review and meta-analysis and to examine the clinical, biochemical and radiological risk factors in a meta-regression.

Methods: PRISMA guidelines were followed. PubMed, Scopus and Web of Science were searched using pre-specified keywords on March 07, 2020. Peer-reviewed empirical studies examining prevalence rates of severe illness, critical illness and mortality among COVID-19 patients were examined. Numerators and denominators to compute the prevalence rates and risk factors were extracted. Random-effects meta-analyses were performed. Results were corrected for publication bias. Meta-regression analyses examined the moderator effects of potential risk factors.

Findings: The meta-analysis included 29 studies representing 2,090 individuals. Pooled rates of severe illness, critical illness and case fatality among COVID-19 patients were 15%, 5% and 0.8% respectively. Adjusting for potential underreporting and publication bias, increased these estimates to 26%, 16% and 7.4% respectively. Increasing age and elevated LDH consistently predicted severe / critical disease and case fatality. Hypertension; fever and dyspnea at presentation; and elevated CRP predicted increased severity.

Interpretation: Risk factors that emerged in our analyses predicting severity and case fatality should inform clinicians to define endophenotypes possessing a greater risk. Estimated case fatality rate of 7.4% after correcting for publication bias underscores the importance of strict adherence to preventive measures, case detection, surveillance and reporting.

Funding Statement: None

Declaration of Interests: The authors declare no competing interests.

Keywords: COVID-19; Mortality; Case fatality; Systematic review; Meta-analysis; Metaregression

Suggested Citation

Kahathuduwa, Chanaka and Dhanasekara, Chathurika and Chin, Shao-Hua, Severity and Case Fatality Rates of COVID-19: A Systematic Review, Meta-Analysis and an Exploratory Meta-Regression of Risk Factors (3/27/2020). Available at SSRN: https://ssrn.com/abstract=3564410 or http://dx.doi.org/10.2139/ssrn.3564410

Chanaka Kahathuduwa (Contact Author)

Texas Tech University - Department of Laboratory Science and Primary Care ( email )

United States

Chathurika Dhanasekara

Texas Tech University - Department of Surgery

United States

Shao-Hua Chin

Protech Pharmaservices Corporation - Department of Medical Science

Taiwan

Click here to go to TheLancet.com

Paper statistics

Abstract Views
937
Downloads
167