Background

Early and accurate prognosis prediction of the patients was urgently warranted due to the widespread popularity of COVID-19. We performed a meta-analysis aimed at comprehensively summarizing the clinical characteristics and laboratory abnormalities correlated with increased risk of mortality in COVID-19 patients.

Methods

PubMed, Scopus, Web of Science, and Embase were systematically searched for studies considering the relationship between COVID-19 and mortality up to 4 June 2020. Data were extracted including clinical characteristics and laboratory examination.

Results

Thirty-one studies involving 9407 COVID-19 patients were included. Dyspnea (OR = 4.52, 95%CI [3.15, 6.48], P < 0.001), chest tightness (OR = 2.50, 95%CI [1.78, 3.52], P<0.001), hemoptysis (OR = 2.00, 95%CI [1.02, 3.93], P = 0.045), expectoration (OR = 1.52, 95%CI [1.17, 1.97], P = 0.002) and fatigue (OR = 1.27, 95%CI [1.09, 1.48], P = 0.003) were significantly related to increased risk of mortality in COVID-19 patients. Furthermore, increased pretreatment absolute leukocyte count (OR = 11.11, 95%CI [6.85,18.03], P<0.001) and decreased pretreatment absolute lymphocyte count (OR = 9.83, 95%CI [6.72, 14.38], P<0.001) were also associated with increased mortality of COVID-19. We also compared the mean value of them between survivors and non-survivors, and found that non-survivors showed significantly raise in pretreatment absolute leukocyte count (WMD: 3.27×10⁹/L, 95%CI [2.34, 4.21], P<0.001) and reduction in pretreatment absolute lymphocyte count (WMD = -0.39×10⁹/L, 95%CI [-0.46, -0.33], P<0.001) compared with survivors. The results of pretreatment lactate dehydrogenase (LDH), procalcitonin (PCT), D-Dimer and ferritin showed the similar trend with pretreatment absolute leukocyte count.

Conclusions

Among the common symptoms of COVID-19 infections, fatigue, expectoration, hemoptysis, dyspnea and chest tightness were independent predictors of death. As for laboratory examinations, significantly increased pretreatment absolute leukocytosis count, LDH, PCT, D-Dimer and ferritin, and decreased pretreatment absolute lymphocyte count were found in non-survivors, which also have an unbeneficial impact on mortality among COVID-19 patients. Motoring these indicators during the hospitalization plays a very important role in predicting the prognosis of patients.

中文翻译：

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预测COVID-19患者死亡率的危险因素：系统评价和荟萃分析

背景

由于COVID-19的广泛普及，迫切需要对患者进行早期和准确的预后预测。我们进行了一项荟萃分析，旨在全面总结与COVID-19患者死亡风险增加相关的临床特征和实验室异常。

方法

系统地搜索PubMed，Scopus，Web of Science和Embase，以考虑COVID-19与2020年6月4日之前的死亡率之间的关系。研究提取了包括临床特征和实验室检查在内的数据。

结果

包括31项研究，涉及9407例COVID-19患者。呼吸困难（OR = 4.52，95％CI [3.15，6.48]，P <0.001），胸闷（OR = 2.50，95％CI [1.78，3.52]，P <0.001），咯血（OR = 2.00，95％CI [1.02，3.93]，P = 0.045），排痰（OR = 1.52，95％CI [1.17，1.97]，P = 0.002）和疲劳（OR = 1.27，95％CI [1.09，1.48]，P = 0.003）与COVID-19患者的死亡风险增加显着相关。此外，治疗前绝对白细胞计数增加（OR = 11.11，95％CI [6.85,18.03]，P <0.001），治疗前绝对白细胞计数减少（OR = 9.83，95％CI [6.72，14.38]，P <0.001）。还与COVID-19的死亡率增加有关。我们还比较了幸存者和非幸存者之间的平均值，⁹ / L，95％CI [2.34，4.21]，P <0.001）和治疗前绝对淋巴细胞计数的减少（WMD = -0.39×10 ⁹ / L，95％CI [-0.46，-0.33]，P <0.001）与幸存者相比。预处理乳酸脱氢酶（LDH），降钙素原（PCT），D-Dimer和铁蛋白的结果与绝对白细胞计数相似。

结论

在COVID-19感染的常见症状中，疲劳，咳痰，咯血，呼吸困难和胸闷是死亡的独立预测因素。至于实验室检查，在非幸存者中发现治疗前绝对白细胞计数，LDH，PCT，D-二聚体和铁蛋白显着增加，而治疗前绝对淋巴细胞计数降低，这也对COVID-19患者的死亡率产生了不利影响。在住院期间操作这些指标在预测患者的预后中起着非常重要的作用。