Xinyang Li, Xianrui Zhong, Yongbo Wang, Xiantao Zeng, Ting Luo, Qing Liu.
Abstract
We aimed to systematically identify the possible risk factors responsible for severe cases.
Introduction
Coronavirus Disease 2019(COVID-19) which, was first identified in Wuhan, Hubei Province, China in December 2019, has already swept across the world. The World Health Organization (WHO) has officially declared the outbreak as a pandemic and a public health emergency [1]. As of 9th March 2021, according to WHO, the number of confirmed cases around the world has surged dramatically to 116,166,652 with 2,582,528 deaths, which suggests the general mortality rate is approximately 2.22% [2]. The severity of symptoms among patients infected with COVID-19 varies considerably from being varies considerably from being asymptomatic to being a critical illness with lethal complications [3, 4].
Method
Search strategy.
The literature search was performed using international databases PubMed, Embase, Web of science and Cochrane Library using the search terms: (“COVID-19” OR “SARS-Cov-2”) AND (“characteristics” OR “clinical”): The specific search strategy is listed in S1 Table. Included studies were published between December 2019 and February 2021. The meta-analysis was conducted in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement [8].
Discussion
This study has examined the potential risk factors of severe COVID-19 such as demographic characteristics, comorbidities and complications to assist clinicians with allocation of medical resources. The higher the ORs of the risk factors, the greater the risks they bring. Our analysis has shown that males, obese patients (BMI ≥ 30kg/m2), patients with advanced age or a smoking history faced a greater risk of having severe COVID-19. This finding has also been supported by some previous studies [52–54]. However, some of the results of one meta-analysis were not consistent with our analysis, since they found gender irrelevant to the severity of COVID-19, which may possibly be due to the relatively small sample size [55].
Conclusion
In summary, patients with COVID-19 who have the following characteristics: male gender, advanced age, a history of smoking, obesity, hypertension, diabetes, malignancy, coronary heart disease, hypertension, COPD, CKD and chronic liver disease, were more likely to develop the severe form of the disease. The emergence of complications like shock, ARDS, AKI generally increased the risk of the disease developing into the severe condition.
Citation: Li X, Zhong X, Wang Y, Zeng X, Luo T, Liu Q (2021) Clinical determinants of the severity of COVID-19: A systematic review and meta-analysis. PLoS ONE 16(5): e0250602. https://doi.org/10.1371/journal.pone.0250602
Editor: Chiara Lazzeri, Azienda Ospedaliero Universitaria Careggi, ITALY
Received: November 13, 2020; Accepted: April 11, 2021; Published: May 3, 2021.
Copyright: © 2021 Li et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper and its Supporting Information files.
Funding: The authors received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Abbreviations: COVID-19, Coronavirus Disease 2019; WHO, World Health Organization; OR, odds ratio; SMD, standard mean difference; COPD, Chronic obstructive pulmonary disease; CKD, Chronic kidney disease; AKI, acute kidney injury; ARDS, acute respiratory distress syndrome; CI, confidence interval.
