Age-Adjusted Risk Factors Associated with Mortality and Mechanical Ventilation Utilization Amongst COVID-19 Hospitalizations-a Systematic Review and Meta-Analysis.

ABSTRACT

The increasing COVID-19 cases in the USA have led to overburdening of healthcare in regard to invasive mechanical ventilation (IMV) utilization as well as mortality. We aim to identify risk factors associated with poor outcomes (IMV and mortality) of COVID-19 hospitalized patients. A meta-analysis of observational studies with epidemiological characteristics of COVID-19 in PubMed, Web of Science, Scopus, and medRxiv from December 1, 2019 to May 31, 2020 following MOOSE guidelines was conducted. Twenty-nine full-text studies detailing epidemiological characteristics, symptoms, comorbidities, complications, and outcomes were included. Meta-regression was performed to evaluate effects of comorbidities, and complications on outcomes using a random-effects model. The pooled correlation coefficient (r), 95% CI, and OR were calculated. Of 29 studies (12,258 confirmed cases), 17 reported IMV and 21 reported deaths. The pooled prevalence of IMV was 23.3% (95% CI 17.1-30.9%), and mortality was 13% (9.3-18%). The age-adjusted meta-regression models showed significant association of mortality with male (r 0.14; OR 1.15; 95% CI 1.07-1.23; I 2 95.2%), comorbidities including pre-existing cerebrovascular disease (r 0.35; 1.42 (1.14-1.77); I 2 96.1%), and chronic liver disease (r 0.08; 1.08 (1.01-1.17); I 2 96.23%), complications like septic shock (r 0.099; 1.10 (1.02-1.2); I 2 78.12%) and ARDS (r 0.04; 1.04 (1.02-1.06); I 2 90.3%), ICU admissions (r 0.03; 1.03 (1.03-1.05); I 2 95.21%), and IMV utilization (r 0.05; 1.05 (1.03-1.07); I 2 89.80%). Similarly, male (r 0.08; 1.08 (1.02-1.15); I 2 95%), comorbidities like pre-existing cerebrovascular disease (r 0.29; 1.34 (1.09-1.63); I 293.4%), and cardiovascular disease (r 0.28; 1.32 (1.1-1.58); I 2 89.7%) had higher odds of IMV utilization. COVID-19 patients with comorbidities including cardiovascular disease, cerebrovascular disease, and chronic liver disease had poor outcomes. Diabetes and hypertension had higher prevalence but no association with mortality and IMV. Our study results will be helpful in right allocation of resources towards patients who need them the most.