The negative impact of comorbidities on the disease course of COVID-19
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LETTER
The negative impact of comorbidities on the disease course of COVID‑19 Noémi Zádori1,2, Szilárd Váncsa1,2, Nelli Farkas1,3, Péter Hegyi1,2,4 and Bálint Erőss1,2* on behalf of the KETLAK Study Group © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
Dear Editor, Coronavirus Disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with a mortality rate of 3–7% [1]. The high mortality results from fulminant pneumonia leading to acute respiratory distress syndrome and multiple organ failure [2, 3]. Initial reports suggest that comorbidities cause a more severe course of infection and a poorer prognosis [4, 5]. Considering the fast spread and high mortality of COVID-19, it is necessary to understand the possible risk factors affecting its progression. We aimed to perform a systematic search to evaluate the potential role of all reported comorbidities on the disease course. Details of our report are provided in Supplementary file 1. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Scopus between 01/01/2020 and 05/11/2020. The main outcomes were mortality, intensive care unit (ICU) admission and severity. Definitions of the investigated outcomes are available in Supplementary file 2, Table 2. Odds ratios (OR) with 95% confidence intervals (CI) were calculated to objectify the association between comorbidities and the outcomes by the random-effects model. The study was registered on PROSPERO (CRD42020176781). Of 33,987 records screened, 61 cohort studies with 31,089 (median 162; IQR: 103–338) patients were included in the meta-analysis. The overall mortality rate was 10.0%, 19.9% of patients needed intensive, while the reported severity was 24.0%. Underlying chronic
*Correspondence: [email protected] 1 Institute for Translational Medicine, Medical School, University of Pécs, Pécs 7624, Hungary Full author information is available at the end of the article Members of the KETLAK Study Group are given in the Acknowledgements section.
kidney disease (OR:5.3 CI 3.2–8.7), cardiovascular disease (OR:4.7, CI 2.9–7.6), cerebrovascular disease (OR:3.9, CI 1.8–8.3), chronic obstructive pulmonary disease (OR:3.7, CI 2.7–5.1), hypertension (OR:2.7, CI 1.7– 4.4), malignancy (OR:2.6, CI 1.5–4.3), diabetes (OR:2.5, CI 1.7–3.6) and immunodeficiency (OR:1.6, CI 1.0–2.5) were associated with increased risk of mortality. The analysis could not prove that Hepatitis B infection or chronic liver disease were associated with mortality due to the low number of participants with comorbidities (Fig. 1, Suppl. File 2. Figs. 4–13). Patients with a history of cerebrovascular disease (OR:3.5, CI 1.9–6.5), chronic obstructive pulmonary disease (OR:2.2, CI 1.5–3.4), cardiovascular disease (OR:2.1, CI 1.5–3.0), hypertension (OR:1.9, CI 1.5–2.5), diabetes (OR:1.8, CI 1.3–2.5), malignancy (OR:1.7, CI 1.0–2.7) needed intensive care more often. The analysis could not prove that chronic liver disease, immunodeficiency, chronic kidn
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