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Identification of Individuals at High Risk of Adverse Outcomes from COVID-19: A Systematic Review
17 Pages Posted: 16 Oct 2023
More...Abstract
Background: Understanding who is at highest risk for severe outcomes (hospitalization or mortality) due to COVID-19 is important to target subgroups of patients for early preventative and therapeutic management.
Methods: A systematic literature search was conducted including all English language published retrospective and prospective observational studies which documented clinical outcomes of COVID-19 in adult patients, on Ovid MEDLINE(R) and Epub databases (December 2019 to March 2023).
Findings: Twenty-nine studies involving 7.3 million people were included. Eight studies reported mortality rates for COVID-19 positive cases and 26 documented hospitalization rates (5 reported both). The comorbidities most associated with increased hospitalization risk were immune deficiency (OR 15.23, p=0.009), dementia (OR 7.20, p=0.035), and coronary artery disease (OR 7.06, p=<0.001). The top comorbidities for increased risk of mortality include COPD (OR 25.13, p=<0.001), asthma (OR 12.55, p=0.007), chronic kidney disease (OR 8.45, p=<0.001), and hypertension (OR 6.67, p=<0.001). Male patients (OR 1.40 and 1.37, p=<0.001 and <0.001) and those older than 60 years (OR 2.18 and 73.25, p=<0.001 and <0.001) were at higher risk of hospitalization and death, respectively.
Interpretation: Our COVID-19 systematic review demonstrated that age, BMI, comorbidities (respiratory, renal and cardiovascular), and immune deficiency were associated with higher mortality and/or hospitalization. These findings provide new information to prioritize patients for vaccination and/or treatment. Meta-analysis posed challenges due to inconsistent demographic and comorbidity data reporting. We propose establishing a structured reporting system (CLARITY) for pandemic surveillance.
Trial Registration: PROSPERO Identifier CRD42023449647.
Funding: This study received financial support from Moderna Biopharma Canada Corporation.
Declaration of Interest: Strain has received consulting fees from Pfizer, payment or honoraria from Moderna, Pfizer, and AstraZeneca, payment for testimony from NICE, and holds a leadership or fiduciary role with the British Medical Association. Boivin has received payment or honoraria from Teva, Pfizer, Novo Nordisk, mdBriefcase, J & J, Abbvie, Astra Zeneca, Boehringer Ingelheim, Moderna, Canopy, Valneva, and Abbott Diabetes and participated on advisory board for Novo-Nordisk, Emergent BioSolutions, Pfizer, Novavax, and GSK. Bourbeau has received grants or contracts from Canadian Institute of Heath Research (CIHR), Réseau en santé respiratoire du FRQS, McGill University, McGill University Health Centre Foundation, AstraZeneca Canada Ltd, Boehringer Ingelheim Canada Ltd, GlaxoSmithKline Canada Ltd, Grifols, Novartis, Sanofi, and Trudell Canada Ltd and has had payment or honoraria from AstraZeneca Canada Ltd, Boehringer Ingelheim Canada Ltd, GlaxoSmithKline Canada Ltd, Pfizer Canada Ltd, Trudell Canada Ltd, and COVIS Pharma Canada Ltd. Connelly has received grants or contracts from Pfizer, AstraZeneca, Boehringer Ingelheim, Servier, Novo Nordisk, Merck, Novartis, and Amgen, payment or honoraria from Pfizer, AstraZeneca, and Boehringer Ingelheim, payment for expert testimony from Servier, Novo Nordisk, and Merck, support for attending meetings from Novartis and Amgen, and patents planned, issued or pending from Boehringer Ingelheim. Lin has received payment or honoraria from Moderna, Pfizer, and AstraZeneca. Jain has received consulting fees from Abbott, Acerus, AstraZeneca, Amgen, Bausch Healthcare, Bayer, Boehringer Ingelheim, Dexcom, Eli Lilly, HLS Therapeutics, Insulet, Janssen, Medtronic, Novo Nordisk, Partners in Progressive Medical Education, PocketPills, Sanofi Aventis, and Takeda and payment or honoraria from Abbott, Acerus, AstraZeneca, Amgen, Bausch Healthcare, Bayer, Boehringer Ingelheim, Care to Know, CCRN, Connected in Motion, CPD Network, Dexcom, Diabetes Canada, Eli Lilly, HLS Therapeutics, Janssen, Master Clinician Alliance, MDBriefcase, Merck, Medtronic, Moderna, Novo Nordisk, Partners in Progressive Medical Education, Pfizer, Sanofi Aventis, Timed Right, and WebMD. Mazer holds a leadership or fiduciary role with the COVID-19 Immunity Task Force, Public Health Agency of Canada. Horvat and Sedeno are employees of Respiplus and Bourbeau is an administrator of Respiplus who received funding from Moderna Biopharma Canada Corporation for this publication. Boivin, Connelly, Jain, Li, Lin, Mazer, Noueihed, Saposnik, and Strain have received honoraria from Respiplus. Noueihed, Li, Horvat, Saposnik, and Sedeno have no additional conflict to disclose.
Keywords: high-risk COVID-19, high-risk populations, severe outcomes, COVID-19, mortality, hospitalization, respirology, immunology, cardiovascular disease, nephrology, neurology, endocrinology, preventative management, therapeutic management, COVID-19 risk factors
Suggested Citation: Suggested Citation