Factors associated with mortality in patients with COVID-19 admitted to intensive care: a systematic review and meta-analysis |
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| Authors: | E. H. Taylor E. J. Marson M. Elhadi K. D. M. Macleod Y. C. Yu R. Davids R. Boden R. C. Overmeyer R. Ramakrishnan D. A. Thomson J. Coetzee B. M. Biccard |
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| Affiliation: | 1. Global Surgery Division, University of Cape Town, Cape Town, South Africa;2. College of Medical and Dental Sciences, Birmingham, UK;3. Faculty of Medicine, University of Tripoli, Tripoli, Libya;4. Glasgow Royal Infirmary, Glasgow, UK;5. Department of Anaesthesiology and Critical Care, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa;6. Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa;7. National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK;8. Division of Critical Care, University of Cape Town, Cape Town, South Africa;9. Department of Anaesthesia and Peri-operative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa |
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| Abstract: | Identification of high-risk patients admitted to intensive care with COVID-19 may inform management strategies. The objective of this meta-analysis was to determine factors associated with mortality among adults with COVID-19 admitted to intensive care by searching databases for studies published between 1 January 2020 and 6 December 2020. Observational studies of COVID-19 adults admitted to critical care were included. Studies of mixed cohorts and intensive care cohorts restricted to a specific patient sub-group were excluded. Dichotomous variables were reported with pooled OR and 95%CI, and continuous variables with pooled standardised mean difference (SMD) and 95%CI. Fifty-eight studies (44,305 patients) were included in the review. Increasing age (SMD 0.65, 95%CI 0.53–0.77); smoking (OR 1.40, 95%CI 1.03–1.90); hypertension (OR 1.54, 95%CI 1.29–1.85); diabetes (OR 1.41, 95%CI 1.22–1.63); cardiovascular disease (OR 1.91, 95%CI 1.52–2.38); respiratory disease (OR 1.75, 95%CI 1.33–2.31); renal disease (OR 2.39, 95%CI 1.68–3.40); and malignancy (OR 1.81, 95%CI 1.30–2.52) were associated with mortality. A higher sequential organ failure assessment score (SMD 0.86, 95%CI 0.63–1.10) and acute physiology and chronic health evaluation-2 score (SMD 0.89, 95%CI 0.65–1.13); a lower PaO2:FIO2 (SMD −0.44, 95%CI −0.62 to −0.26) and the need for mechanical ventilation at admission (OR 2.53, 95%CI 1.90–3.37) were associated with mortality. Higher white cell counts (SMD 0.37, 95%CI 0.22–0.51); neutrophils (SMD 0.42, 95%CI 0.19–0.64); D-dimers (SMD 0.56, 95%CI 0.43–0.69); ferritin (SMD 0.32, 95%CI 0.19–0.45); lower platelet (SMD −0.22, 95%CI −0.35 to −0.10); and lymphocyte counts (SMD −0.37, 95%CI −0.54 to −0.19) were all associated with mortality. In conclusion, increasing age, pre-existing comorbidities, severity of illness based on validated scoring systems, and the host response to the disease were associated with mortality; while male sex and increasing BMI were not. These factors have prognostic relevance for patients admitted to intensive care with COVID-19. |
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| Keywords: | COVID-19 critical care meta-analysis mortality |
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