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Prognostic Factors for Severity and Mortality in Patients Infected with COVID-19: A Systematic Review

56 Pages Posted: 24 Jun 2020

See all articles by Ariel Izcovich

Ariel Izcovich

Hospital Alemán de Buenos Aires

Martín Ragusa

Hospital Alemán de Buenos Aires

Fernando Tortosa

Hospital Regional "Dr. Ramón Carrillo"

María Andrea Lavena Marzio

Hospital Alemán de Buenos Aires

Camila Agnoletti

Hospital Alemán de Buenos Aires

Agustín Bengolea

Hospital Alemán de Buenos Aires

Agustina Ceirano

Hospital Alemán de Buenos Aires

Federico Espinosa

Hospital Alemán de Buenos Aires

Ezequiel Saavedra

Hospital Alemán de Buenos Aires

Verónica Sanguine

Argentine Ministry of Health - Dirección Nacional de Calidad en Servicios de Salud y Regulación Sanitaria

Alfredo Tassara

Hospital Alemán de Buenos Aires

Candelaria Cid

Hospital Alemán de Buenos Aires

Hugo Catalano

Hospital Alemán de Buenos Aires

Arnav Agarwal

University of Toronto - Department of Medicine

Farid Foroutan

McMaster University - Department of Health Research Methods, Evidence, and Impact (HEI)

Gabriel Rada

Fundación Epistemonikos

More...

Abstract

Background: The objective of our systematic review is to identify prognostic factors that may be used in decision-making related to the care of patients infected with COVID-19.

Methods: We conducted highly sensitive searches in PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL) and Embase. The searches covered the period from the inception date of each database until April 28, 2020. No study design, publication status or language restriction were applied. We included studies that assessed patients with confirmed or suspected SARS-CoV-2 infection and examined one or more prognostic factors for mortality or disease severity. Reviewers working in pairs independently screened studies for eligibility, extracted data and assessed the risk of bias. We performed meta-analyses and used GRADE to assess the certainty of the evidence for each prognostic factor and outcome.

Findings: We included 207 studies and found high or moderate certainty that the following 49 variables provide valuable prognostic information on mortality and/or severe disease in patients with COVID-19 infection: Demographic factors (age, male sex, smoking), patient history factors  (comorbidities, cerebrovascular disease, chronic obstructive pulmonary disease, chronic kidney disease, cardiovascular disease, cardiac arrhythmia, arterial hypertension, diabetes, dementia, cancer and dyslipidemia), physical examination factors (respiratory failure, low blood pressure, hypoxemia, tachycardia, dyspnea, anorexia, tachypnea, haemoptysis, abdominal pain, fatigue, fever and myalgia or arthralgia), laboratory factors (high blood procalcitonin, myocardial injury markers, high blood White Blood Cell count (WBC), high blood lactate, low blood platelet count, plasma creatinine increase, high blood D-dimer, high blood lactate dehydrogenase (LDH), high blood C-reactive protein (CRP), decrease in lymphocyte count, high blood aspartate aminotransferase (AST), decrease in blood albumin, high blood interleukin-6 (IL-6), high blood neutrophil count, high blood B-type natriuretic peptide (BNP), high blood urea nitrogen (BUN), high blood creatine kinase (CK), high blood bilirubin  and high erythrocyte sedimentation rate (ESR)), radiological factors (consolidative infiltrate and pleural effusion) and high SOFA score.

Interpretation: Identified prognostic factors can help clinicians and policy makers in tailoring management strategies for patients with COVID-19 infection while researchers can utilise our findings to develop multivariable prognostic models that could eventually facilitate decision-making and improve patient important outcomes.

Funding Statement: None

Declaration of Interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years, no other relationships or activities that could appear to have influenced the submitted work.

Keywords: COVID-19; severe acute respiratory syndrome coronavirus 2; Coronavirus Infections; Systematic review; prognosis; prognostic factor

Suggested Citation

Izcovich, Ariel and Ragusa, Martín and Tortosa, Fernando and Lavena Marzio, María Andrea and Agnoletti, Camila and Bengolea, Agustín and Ceirano, Agustina and Espinosa, Federico and Saavedra, Ezequiel and Sanguine, Verónica and Tassara, Alfredo and Cid, Candelaria and Catalano, Hugo and Agarwal, Arnav and Foroutan, Farid and Rada, Gabriel, Prognostic Factors for Severity and Mortality in Patients Infected with COVID-19: A Systematic Review (6/11/2020). Available at SSRN: https://ssrn.com/abstract=3627285 or http://dx.doi.org/10.2139/ssrn.3627285

Ariel Izcovich (Contact Author)

Hospital Alemán de Buenos Aires

Pueyrredón 1640
Buenos Aires, Buenos Aires 1118
Argentina

Martín Ragusa

Hospital Alemán de Buenos Aires

Pueyrredon 1640
Buenos Aires, 1118
Argentina

Fernando Tortosa

Hospital Regional "Dr. Ramón Carrillo"

Argentina

María Andrea Lavena Marzio

Hospital Alemán de Buenos Aires

Pueyrredon 1640
Buenos Aires, 1118
Argentina

Camila Agnoletti

Hospital Alemán de Buenos Aires

Pueyrredon 1640
Buenos Aires, 1118
Argentina

Agustín Bengolea

Hospital Alemán de Buenos Aires

Pueyrredon 1640
Buenos Aires, 1118
Argentina

Agustina Ceirano

Hospital Alemán de Buenos Aires

Pueyrredon 1640
Buenos Aires, 1118
Argentina

Federico Espinosa

Hospital Alemán de Buenos Aires

Pueyrredon 1640
Buenos Aires, 1118
Argentina

Ezequiel Saavedra

Hospital Alemán de Buenos Aires

Pueyrredon 1640
Buenos Aires, 1118
Argentina

Verónica Sanguine

Argentine Ministry of Health - Dirección Nacional de Calidad en Servicios de Salud y Regulación Sanitaria

Argentina

Alfredo Tassara

Hospital Alemán de Buenos Aires ( email )

Pueyrredon 1640
Buenos Aires, 1118
Argentina

Candelaria Cid

Hospital Alemán de Buenos Aires ( email )

Pueyrredon 1640
Buenos Aires, 1118
Argentina

Hugo Catalano

Hospital Alemán de Buenos Aires ( email )

Pueyrredon 1640
Buenos Aires, 1118
Argentina

Arnav Agarwal

University of Toronto - Department of Medicine ( email )

Toronto
Canada

Farid Foroutan

McMaster University - Department of Health Research Methods, Evidence, and Impact (HEI)

Hamilton, Ontario L8N 3Z5
Canada

Gabriel Rada

Fundación Epistemonikos ( email )

Chile

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