Age-Adjusted Risk Factors Associated with Mortality and Mechanical Ventilation Utilization Amongst COVID-19 Hospitalizations-a Systematic Review and Meta-Analysis.
Age-Adjusted Risk Factors Associated with Mortality and Mechanical Ventilation Utilization Amongst COVID-19 Hospitalizations-a Systematic Review and Meta-Analysis.
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DOI：
10.1007/s42399-020-00476-w
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发表时间：
2020-01-01
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影响因子：
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通讯作者：
Sacks, Henry
中科院分区：
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作者：
Patel, Urvish;Malik, Preeti;Sacks, Henry
美国不断增加的COVID-19病例导致医疗保健在有创机械通气（IMV）使用以及死亡率方面负担过重。我们的目标是确定与COVID-19住院患者的不良结局（IMV和死亡率）相关的风险因素。根据MOOSE指南，对PubMed、Web of Science、Scopus和medRxiv中2019年12月1日至2020年5月31日期间具有COVID-19流行病学特征的观察性研究进行了荟萃分析。纳入了29项详细描述流行病学特征、症状、合并症、并发症和结局的全文研究。使用随机效应模型进行荟萃回归以评价合并症和并发症对结局的影响。计算合并相关系数（r）、95% CI和OR。在29项研究（12，258例确诊病例）中，17项报告了IMV，21例报告了死亡。IMV的合并患病率为23.3%（95%CI：17.1-30.9%），死亡率为13%（9.3-18%）。年龄调整后的荟萃回归模型显示，死亡率与男性（r：0.14; OR：1.15; 95% CI：1.07-1.23; I 2：95.2%），合并症包括既存脑血管疾病（r：0.35; 1.42（1.14-1.77）; I2：96.1%），慢性肝病（r：0.08; 1.08（1.01-1.17）; I2：96.23%），并发症如感染性休克（r：0.099; 1.10（1.02-1.2）; I2：78.12%）与ARDS（r：0.04; 1.04（1.02-1.06）; I2：90.3%），ICU入院（r：0.03; 1.03（1.03-1.05）; I2：95.21%）; IMV利用率（r：0.05; 1.05（1.03-1.07）; I2：89.80%）。同样，男性（r：0.08; 1.08（1.02-1.15）; I 2：95%）、合并症如既存脑血管疾病（r：0.29; 1.34（1.09-1.63）; I 2：93.4%）和心血管疾病（r：0.28; 1.32（1.1-1.58）; I 2：89.7%）具有较高的IMV利用率。患有心血管疾病、脑血管疾病和慢性肝病等合并症的COVID-19患者预后较差。糖尿病和高血压患病率较高，但与死亡率和IMV无关。我们的研究结果将有助于正确分配资源给最需要的病人。
The increasing COVID-19 cases in the USA have led to overburdening of healthcare in regard to invasive mechanical ventilation (IMV) utilization as well as mortality. We aim to identify risk factors associated with poor outcomes (IMV and mortality) of COVID-19 hospitalized patients. A meta-analysis of observational studies with epidemiological characteristics of COVID-19 in PubMed, Web of Science, Scopus, and medRxiv from December 1, 2019 to May 31, 2020 following MOOSE guidelines was conducted. Twenty-nine full-text studies detailing epidemiological characteristics, symptoms, comorbidities, complications, and outcomes were included. Meta-regression was performed to evaluate effects of comorbidities, and complications on outcomes using a random-effects model. The pooled correlation coefficient (r), 95% CI, and OR were calculated. Of 29 studies (12,258 confirmed cases), 17 reported IMV and 21 reported deaths. The pooled prevalence of IMV was 23.3% (95% CI: 17.1-30.9%), and mortality was 13% (9.3-18%). The age-adjusted meta-regression models showed significant association of mortality with male (r: 0.14; OR: 1.15; 95% CI: 1.07-1.23; I 2: 95.2%), comorbidities including pre-existing cerebrovascular disease (r: 0.35; 1.42 (1.14-1.77); I 2: 96.1%), and chronic liver disease (r: 0.08; 1.08 (1.01-1.17); I 2: 96.23%), complications like septic shock (r: 0.099; 1.10 (1.02-1.2); I 2: 78.12%) and ARDS (r: 0.04; 1.04 (1.02-1.06); I 2: 90.3%), ICU admissions (r: 0.03; 1.03 (1.03-1.05); I 2: 95.21%), and IMV utilization (r: 0.05; 1.05 (1.03-1.07); I 2: 89.80%). Similarly, male (r: 0.08; 1.08 (1.02-1.15); I 2: 95%), comorbidities like pre-existing cerebrovascular disease (r: 0.29; 1.34 (1.09-1.63); I 2:93.4%), and cardiovascular disease (r: 0.28; 1.32 (1.1-1.58); I 2: 89.7%) had higher odds of IMV utilization. COVID-19 patients with comorbidities including cardiovascular disease, cerebrovascular disease, and chronic liver disease had poor outcomes. Diabetes and hypertension had higher prevalence but no association with mortality and IMV. Our study results will be helpful in right allocation of resources towards patients who need them the most.