This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research
Jinwoo Lee
Seoul National University Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0958-106X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
The mortality rates of the coronavirus disease 2019 (COVID-19) differ across the globe. While some risk factors for poor prognosis of the disease are known, regional differences are suspected. We reviewed the risk factors for critical outcomes in extensive number of studies according to the study location.
Methods
We searched the PubMed, Embase, Cochrane Library, and Web of Science literature databases from January 1, 2020 to June 8, 2020. We defined the critical outcome as death, admission to the intensive care unit, or critical type of COVID-19. Candidate variables to predict the critical outcome included patient demographics, underlying medical condition, symptoms, and laboratory findings. Pooled relative risks (RRs) and standardized mean differences were calculated for each variable and were also determined according to the study’s continent.
Results
A total of 80 studies were included from Asia (n = 48), Europe (n = 22), and North America (n = 10). The risk factors for the critical outcome in the overall population included male sex, age, and all inspected underlying medical conditions. Symptoms of dyspnea, anorexia, dizziness, fatigue, and certain laboratory findings were also indicators of the critical outcome. Subgroup analysis was performed according to study location, and we found several discrepancies. Underlying respiratory disease was associated higher risk of the critical outcome in studies from Asia (pooled RR 2.16 [1.60–2.92] and Europe (pooled RR 1.50 [1.32–1.69]), but not North America. Underlying hepatic disease was associated with a higher risk of the critical outcome from Europe (pooled RR 1.34 [1.15–1.56]), but not from Asia and North America. Symptoms of vomiting (pooled RR 2.43 [1.60–3.69]), anorexia (pooled RR 2.38 [1.45–3.91]), dizziness (pooled RR 2.23 [1.51–3.28]), and fatigue (pooled RR 1.92 [1.23–3.02]) were significantly associated with the critical outcome in studies from Asia, but not from Europe and North America. Hemoglobin and platelet count affected patients differently in Asia compared to those in Europe and North America.
Conclusions
There are several discrepancies among risk factors for critical outcomes among patients with COVID-19 according to the location of the infected patient.
Keywords
COVID-19, prognostic factor, location, meta-analysis, systematic review
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- Additionalfile1.docx
This file includes the detailed search strategy used for our systematic review and meta-analysis.
- Additionalfile2.doc
This file includes the checklist recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines
- Additionalfile3.docx
This file includes Figures S1 to S5, and Tables S1 to S4. The titles of each figure and table are as follows: Figure E1. Flow diagram of the systematic literature review Figure E2. Impact of male sex on the critical outcome including death, intensive care unit admission, and critical type of COVID-19. Figure E3. Impact of patient age on the critical outcome including death, intensive care unit admission, and critical type of COVID-19. Figure E4. Association between ethnicity and the critical outcome including intensive care unit admission and death compared to non-Hispanic White ethnicity with a random effects model. a) Hispanic ethnicity. b) non-Hispanic black ethnicity. c) Asian ethnicity. Table E1. Definition of underlying disease mentioned in each study Table E2. Evaluation of the quality of studies included in the systematic review Table E3. Degree of heterogeneity and publication bias according to each analysis Figure E5. Impact of (a) underlying medical condition, (b) patient symptom, and (c) laboratory findings on death of patients with COVID-19. Table E4. Detailed results from the sensitivity analysis with selected studies
- Additionalfile4.xlsx
This file includes the full list of the included articles used in our systematic review and meta-analysis.
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This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research
Jinwoo Lee
Seoul National University Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0003-0958-106X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 23 Dec, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
The mortality rates of the coronavirus disease 2019 (COVID-19) differ across the globe. While some risk factors for poor prognosis of the disease are known, regional differences are suspected. We reviewed the risk factors for critical outcomes in extensive number of studies according to the study location.
Methods
We searched the PubMed, Embase, Cochrane Library, and Web of Science literature databases from January 1, 2020 to June 8, 2020. We defined the critical outcome as death, admission to the intensive care unit, or critical type of COVID-19. Candidate variables to predict the critical outcome included patient demographics, underlying medical condition, symptoms, and laboratory findings. Pooled relative risks (RRs) and standardized mean differences were calculated for each variable and were also determined according to the study’s continent.
Results
A total of 80 studies were included from Asia (n = 48), Europe (n = 22), and North America (n = 10). The risk factors for the critical outcome in the overall population included male sex, age, and all inspected underlying medical conditions. Symptoms of dyspnea, anorexia, dizziness, fatigue, and certain laboratory findings were also indicators of the critical outcome. Subgroup analysis was performed according to study location, and we found several discrepancies. Underlying respiratory disease was associated higher risk of the critical outcome in studies from Asia (pooled RR 2.16 [1.60–2.92] and Europe (pooled RR 1.50 [1.32–1.69]), but not North America. Underlying hepatic disease was associated with a higher risk of the critical outcome from Europe (pooled RR 1.34 [1.15–1.56]), but not from Asia and North America. Symptoms of vomiting (pooled RR 2.43 [1.60–3.69]), anorexia (pooled RR 2.38 [1.45–3.91]), dizziness (pooled RR 2.23 [1.51–3.28]), and fatigue (pooled RR 1.92 [1.23–3.02]) were significantly associated with the critical outcome in studies from Asia, but not from Europe and North America. Hemoglobin and platelet count affected patients differently in Asia compared to those in Europe and North America.
Conclusions
There are several discrepancies among risk factors for critical outcomes among patients with COVID-19 according to the location of the infected patient.
Figure 1
Figure 2
Figure 3
This is a list of supplementary files associated with this preprint. Click to download.
- Additionalfile1.docx
This file includes the detailed search strategy used for our systematic review and meta-analysis.
- Additionalfile2.doc
This file includes the checklist recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines
- Additionalfile3.docx
This file includes Figures S1 to S5, and Tables S1 to S4. The titles of each figure and table are as follows: Figure E1. Flow diagram of the systematic literature review Figure E2. Impact of male sex on the critical outcome including death, intensive care unit admission, and critical type of COVID-19. Figure E3. Impact of patient age on the critical outcome including death, intensive care unit admission, and critical type of COVID-19. Figure E4. Association between ethnicity and the critical outcome including intensive care unit admission and death compared to non-Hispanic White ethnicity with a random effects model. a) Hispanic ethnicity. b) non-Hispanic black ethnicity. c) Asian ethnicity. Table E1. Definition of underlying disease mentioned in each study Table E2. Evaluation of the quality of studies included in the systematic review Table E3. Degree of heterogeneity and publication bias according to each analysis Figure E5. Impact of (a) underlying medical condition, (b) patient symptom, and (c) laboratory findings on death of patients with COVID-19. Table E4. Detailed results from the sensitivity analysis with selected studies
- Additionalfile4.xlsx
This file includes the full list of the included articles used in our systematic review and meta-analysis.
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