The Relationship of COVID-19 Severity with Cardiovascular Disease and Its Traditional Risk Factors: A Systematic Review and Meta-Analysis.
The Relationship of COVID-19 Severity with Cardiovascular Disease and Its Traditional Risk Factors: A Systematic Review and Meta-Analysis.
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DOI：
10.5334/gh.814
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发表时间：
2020-09-22
期刊：
影响因子：
3.7
通讯作者：
Appel LJ
中科院分区：
文献类型：
--
作者：
Matsushita K;Ding N;Kou M;Hu X;Chen M;Gao Y;Honda Y;Zhao D;Dowdy D;Mok Y;Ishigami J;Appel LJ
心血管疾病及其传统危险因素是否能预测2019年严重冠状病毒病(新冠肺炎)尚不确定，部分原因是年龄和性别的潜在混淆。我们对既往心血管疾病及其传统危险因素作为严重新冠肺炎的危险因素(定义为死亡、急性呼吸窘迫综合征、机械通气或重症监护病房入院)的研究进行了系统回顾。应用计算机检索PUBMED和EMBASE的英文文献，检索词为≥，限定文献语言种类为英文(10例重症新冠肺炎)。使用随机效应模型，我们汇集了相对风险(RR)估计，并进行了Meta回归分析。在我们搜索到的661篇文章中，有25篇符合我们的纳入标准，涉及76,638名新冠肺炎患者，其中包括11,766名重症患者。在所有8项符合条件的研究中，年龄较大与严重的新冠肺炎一致相关，60-65岁的RR>；~5岁与50岁的RR>；三项研究显示，在调整协变量(S)后，年龄的RR没有变化。在单变量分析中，与严重新冠肺炎密切相关的因素是男性(10项研究；合并RR=1.73，[95%可信区间1.50-2.01])、高血压(8项研究；2.87[2.09-3.93])、糖尿病(9项研究；3.20[2.26-4.53])和心血管疾病(10项研究；4.97[3.76-6.58])。男性的RR可能与年龄无关。对于其他三个因素，元回归分析表明年龄是混淆的。只有4项研究报告了多变量分析，但大多数研究显示高血压、糖尿病和心血管疾病的调整RR~2。没有研究探讨肾素-血管紧张素系统抑制剂是严重新冠肺炎的危险因素。尽管存在混淆的可能性，但这些结果表明高血压、糖尿病和心血管疾病与重度新冠肺炎独立相关，与年龄和男性一起，可以为预测重度新冠肺炎的风险提供信息。
Whether cardiovascular disease (CVD) and its traditional risk factors predict severe coronavirus disease 2019 (COVID-19) is uncertain, in part, because of potential confounding by age and sex. We performed a systematic review of studies that explored pre-existing CVD and its traditional risk factors as risk factors of severe COVID-19 (defined as death, acute respiratory distress syndrome, mechanical ventilation, or intensive care unit admission). We searched PubMed and Embase for papers in English with original data (≥10 cases of severe COVID-19). Using random-effects models, we pooled relative risk (RR) estimates and conducted meta-regression analyses. Of the 661 publications identified in our search, 25 papers met our inclusion criteria, with 76,638 COVID-19 patients including 11,766 severe cases. Older age was consistently associated with severe COVID-19 in all eight eligible studies, with RR >~5 in >60–65 versus <50 years. Three studies showed no change in the RR of age after adjusting for covariate(s). In univariate analyses, factors robustly associated with severe COVID-19 were male sex (10 studies; pooled RR = 1.73, [95% CI 1.50–2.01]), hypertension (8 studies; 2.87 [2.09–3.93]), diabetes (9 studies; 3.20 [2.26–4.53]), and CVD (10 studies; 4.97 [3.76–6.58]). RR for male sex was likely to be independent of age. For the other three factors, meta-regression analyses suggested confounding by age. Only four studies reported multivariable analysis, but most of them showed adjusted RR ~2 for hypertension, diabetes, and CVD. No study explored renin-angiotensin system inhibitors as a risk factor for severe COVID-19. Despite the potential for confounding, these results suggest that hypertension, diabetes, and CVD are independently associated with severe COVID-19 and, together with age and male sex, can be informative for predicting the risk of severe COVID-19.
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