Abstract

Mortality rates of coronavirus disease 2019 (COVID-19) continue to rise across the world. Information regarding the predictors of mortality in COVID-19 patients remains scarce. Herein, we performed a systematic review of published articles, from January 1 to April 24, 2020, to evaluate the risk factors associated with mortality in COVID-19. Two investigators independently searched the articles and collected the data, in accordance with PRISMA guidelines. We looked for associations between mortality and patient characteristics, comorbidities, and laboratory abnormalities. A total of 14 studies documenting the outcomes of 4659 patients were included. The presence of comorbidities such as hypertension (OR 2.5; 95% CI 2.1-3.1; P<0.00001), coronary heart disease (OR 3.8; 95% CI 2.1-6.9; P<0.00001) and diabetes (OR 2.0; 95% CI 1.7-2.3; P<0.00001) were associated with significantly higher risk of death amongst COVID-19 patients. Those who died, compared to those who survived, differed on multiple biomarker levels on admission including elevated levels of cardiac troponin (+44.2 ng/L, 95% CI 19.0-69.4; P=0.0006); C-reactive protein (+66.3 microg/mL, 95% CI 46.7-85.9; P<0.00001); interleukin-6 (+4.6 ng/mL, 95% CI 3.6-5.6; P<0.00001); D-dimer (+4.6 microg/mL, 95% CI 2.8-6.4; P<0.00001); creatinine (+15.3 micromol/L, 95% CI 6.2-24.3; P=0.001) and alanine transaminase (+5.7 U/L, 95% CI 2.6-8.8; P=0.0003); as well as decreased levels of albumin (-3.7 g/L, 95% CI -5.3 to -2.1; P<0.00001). Individuals with underlying cardiometabolic disease and that present with evidence for acute inflammation and end-organ damage are at higher risk of mortality due to COVID-19 infection and should be managed with greater intensity. This article is protected by copyright. All rights reserved.
All age groups Risk group Risk factor COVID-19