Background
An epidemic of Coronavirus Disease 2019 (COVID-19) began in December 2019 and triggered
a Public Health Emergency of International Concern (PHEIC). We aimed to find risk
factors for the progression of COVID-19 to help reducing the risk of critical illness
and death for clinical help.
Methods
The data of COVID-19 patients until March 20, 2020 were retrieved from four databases.
We statistically analyzed the risk factors of critical/mortal and non-critical COVID-19
patients with meta-analysis.
Results
Thirteen studies were included in Meta-analysis, including a total number of 3027
patients with SARS-CoV-2 infection. Male, older than 65, and smoking were risk factors
for disease progression in patients with COVID-19 (male: OR = 1.76, 95% CI (1.41,
2.18), P < 0.00001; age over 65 years old: OR =6.06, 95% CI(3.98, 9.22), P < 0.00001;
current smoking: OR =2.51, 95% CI(1.39, 3.32), P = 0.0006). The proportion of underlying
diseases such as hypertension, diabetes, cardiovascular disease, and respiratory disease
were statistically significant higher in critical/mortal patients compared to the
non-critical patients (diabetes: OR=3.68, 95% CI (2.68, 5.03), P < 0.00001; hypertension:
OR = 2.72, 95% CI (1.60,4.64), P = 0.0002; cardiovascular disease: OR = 5.19, 95%
CI(3.25, 8.29), P < 0.00001; respiratory disease: OR = 5.15, 95% CI(2.51, 10.57),
P < 0.00001). Clinical manifestations such as fever, shortness of breath or dyspnea
were associated with the progression of disease [fever: 0R = 0.56, 95% CI (0.38, 0.82),
P = 0.003;shortness of breath or dyspnea: 0R=4.16, 95% CI (3.13, 5.53), P < 0.00001].
Laboratory examination such as aspartate amino transferase(AST) > 40U/L, creatinine(Cr)
≥ 133mol/L, hypersensitive cardiac troponin I(hs-cTnI) > 28pg/mL, procalcitonin(PCT)
> 0.5ng/mL, lactatede hydrogenase(LDH) > 245U/L, and D-dimer > 0.5mg/L predicted the
deterioration of disease while white blood cells(WBC)<4 × 109/L meant a better clinical
status[AST > 40U/L:OR=4.00, 95% CI (2.46, 6.52), P < 0.00001; Cr ≥ 133μmol/L: OR = 5.30,
95% CI (2.19, 12.83), P = 0.0002; hs-cTnI > 28 pg/mL: OR = 43.24, 95% CI (9.92, 188.49),
P < 0.00001; PCT > 0.5 ng/mL: OR = 43.24, 95% CI (9.92, 188.49), P < 0.00001;LDH >
245U/L: OR = 43.24, 95% CI (9.92, 188.49), P < 0.00001; D-dimer > 0.5mg/L: OR = 43.24,
95% CI (9.92, 188.49), P < 0.00001; WBC < 4 × 109/L: OR = 0.30, 95% CI (0.17, 0.51),
P < 0.00001].
Conclusion
Male, aged over 65, smoking patients might face a greater risk of developing into
the critical or mortal condition and the comorbidities such as hypertension, diabetes,
cardiovascular disease, and respiratory diseases could also greatly affect the prognosis
of the COVID-19. Clinical manifestation such as fever, shortness of breath or dyspnea
and laboratory examination such as WBC, AST, Cr, PCT, LDH, hs-cTnI and D-dimer could
imply the progression of COVID-19.