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2020, Number S1

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Revista Habanera de Ciencias Médicas 2020; 19 (S1)

Comorbidities and clinical severity of COVID-19: systematic review and meta-analysis

Plasencia-Urizarri TM, Aguilera-Rodríguez R, Almaguer-Mederos LE

Language: Spanish
References: 54
Page: 1-18
PDF size: 1151.10 Kb.


ABSTRACT

Introduction: The recent emergence of COVID-19 has become a serious global health problem. The identification of comorbidities associated with the clinical severity in COVID-19 patients is of paramount significance for the appropriate therapeutic approach of affected patients.
Objective: To evaluate the risk of severe clinical presentation of COVID-19 in patients with comorbidities.
Materials and methods: A systematic literature search and meta-analysis was conducted in specialized databases to obtain information from articles published until March 20, 2020. All relevant papers with information on the association between clinical severity and comorbidities were included. The odds ratio with 95 % confidence interval and fixed or random effect models were used.
Results: Thirteen studies were included for a total of 99 817 patients. Global effects were obtained for hypertension (OR: 4.05; 95 % CI: 3.45-4.74), cardiovascular disease (OR: 4.39; 95 % CI: 3.29-5.87), diabetes mellitus (OR: 3.53; 95 % CI: 2.79-4.47), smoking (OR: 2.87; 95 % CI: 1.81-4.54), chronic lung disease (OR: 2.73; 95 % CI: 2.55-2.94), chronic kidney disease (OR: 5.60; 95 % CI: 4.13-7.60), chronic liver disease (OR: 1.98; 95 % CI: 1.08-3.64), and immunodeficiency (OR: 2.90; 95 % CI: 2.06-4.09) in severe patients compared with non-severe patients.
Conclusions: Chronic kidney disease, cardiovascular disease, hypertension and diabetes are among the comorbidities with the highest risk of severe clinical presentation in COVID-19 patients, followed in importance by immunodeficiency, smoking, chronic lung disease and chronic liver disease.


REFERENCES

  1. Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun [Internet]. 2020 [Citado 06/04/2020];109:[aprox. 1 p.] .Disponible en: https://pubmed.ncbi.nlm.nih.gov/32113704/

  2. Andersen KG, Rambaut ?A, Lipkin WI, Holmes? EC, Garry RF. The proximal origin of SARS-CoV-2. Nature Medicine. 2020;26:450-5.

  3. Adhikari SP, Meng S, Wu YJ, Mao YP, Ye RX, Wang QZ, et al. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infectious Diseases of Poverty. 2020;9:29.

  4. World Health Organization. Coronavirus disease (COVID-19). Situation Report-105. [Internet]. Ginebra: World Health Organization; 2020 [Citado 06/04/2020]. Disponible en: http://www.who.int/docs/default-source/coronaviruse/situation-reports/20200504-covid-19-sitrep-105.pdf?sfvrsn=4cdda8af_2

  5. Chih Cheng L, Tzu Ping S, Wen Chien K, Hung Jen T, Po Ren H. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and corona virus disease-2019 (COVID-19): the epidemic and the challenges. International Journal of Antimicrobial Agents [Internet]. 2020 [Citado 06/04/2020];55:[aprox. 1 p.]. Disponible en: http://doi.org/10.1016/j.ijantimicag. 2020.105924

  6. Asselta R, Paraboschi EM, Mantovani A, Duga S. ACE2 and TMPRSS2 variants and expression as candidates to sex and country differences in COVID-19 severity in Italy. MedRxiv [Internet]. New York: Cold Spring Harbor; 2020 [Citado 06/04/2020]. Disponible en: Disponible en: https://doi.org/10.1101/2020.03.30. 20047878

  7. Cao Y, Li L, Feng Z, Wan S, Huang P, Sun X, et al. Comparative genetic analysis of the novel coronavirus (2019-nCoV/SARS-CoV-2) receptor ACE2 in different populations. Cell Discovery. 2020;6:11.

  8. Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J Med Virol. 2020;92:441-7.

  9. Jin J M, Bai P, He W, Wu F, Liu X-F, Han D-M, et al. Gender differences in patients with COVID-19: focus on severity and mortality [Internet]. MedRxiv. New York: Cold Spring Harbor; 2020 [Citado 06/04/2020]. Disponible en: https://doi.org/10.1101/2020.02.23.20026864

  10. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020; 382(18):1708-20.

  11. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus and infected pneumonia in Wuhan, China. JAMA [Internet]. 2020 [Citado 06/04/2020];323:[aprox. 1 p.]. Disponible en: https://doi.org/10.1001/jama.2020. 1585

  12. Margulis AV, Pladevall M, Riera Guardia N, Varas Lorenzo C, Hazell L, Berkman ND, et al. Quality assessment of observational studies in a drug-safety systematic review, comparison of two tools: the Newcastle-Ottawa scale and the RTI item bank. Clinical Epidemiology. 2014;6:359.

  13. Hervada Vidal X, Santiago Pérez MI, Vázquez Fernández E, Castillo Salgado C, Loyola Elizondo E, Silva Ayçaguer LC. Epidat 3.0: programa para análisis epidemiológico de datos tabulados. Rev Esp Salud Pública. 2004; 78:277-80.

  14. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020; 395(10223):497-506.

  15. Zhang JJ, Dong X, Cao YY, Yuan YD, Yang YB, Yan YQ, et al. Clinical characteristics of 140 patients infected by SARSCoV-2 in Wuhan, China. Allergy [Internet]. 2020 [Citado 07/04/2020];75:[aprox. 2 p.]. Disponible en: https://doi.org/10.1111/ all.14238

  16. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-62.

  17. Cao J, Tu WJ, Cheng W, Yu L, Liu YK, Hu X, et al. Clinical features and short-term outcomes of 102 patients with corona virus disease 2019 in Wuhan, China. Clin Infect Dis. [Internet]. 2020 [Citado 07/04/2020];70:[aprox. 2 p.]. Disponible en: https://doi.org/10.1093/cid/ciaa243

  18. Young BE, Ong SWX, Kalimuddin S, Low JG, Tan SY, Loh J, et al. Epidemiologic Features and Clinical Course of Patients Infected With SARS-CoV-2 in Singapore. JAMA [Internet]. 2020 [Citado 07/04/2020];323:[aprox. 2 p.]. Disponible en: https://doi.org/10.1001/jama.2020.3204

  19. Deng Y, Liu W, Liu K, Fang YY, Shang J, Zhou L, et al. Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 (COVID-19) in Wuhan, China: a retrospective study. Chin Med J [Internet]. 2020 [Citado 07/04/2020];133:[aprox. 1 p.]. Disponible en: https://doi.org/10.1097/CM9. 0000000000000824

  20. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol [Internet]. 2020 [Citado 07/04/2020];77:[aprox. 1 p.]. Disponible en: https://doi.org/10.1001/jamaneurol.2020.1127

  21. Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, et al. Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. Sci China Life Sci. 2020;63(3):364-374.

  22. Chow N, Fleming Dutra K, Gierke R, Hall A, Hughes M, Pilishvili T, et al. Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019 - United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep. 2020;69:382-6.

  23. Red Nacional de Vigilancia Epidemiológica (RENAVE). Informe sobre la situación de COVID-19 en España. [Internet]. España: Red Nacional de Vigilancia Epidemiológica (RENAVE); 2020 [Citado 08/04/2020]. Disponible en: https://www.isciii.es/QueHacemos/Servicios/VigilanciaSaludPublicaRENAVE/EnfermedadesTransmisibles/Documents/INFORMES/InformesCOVID-19/InformeNo21SituacióndeCOVID-19enEspaña a 06deabrilde2020.pdf

  24. The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) -China, 2020. China CDC Weekly. 2020; 2(8):113-122.

  25. Zhai P, Ding Y, Wu X, Long J, Zhong Y, Li Y. The epidemiology, diagnosis and treatment of COVID-19. Intern J Antimicrob Agents [Internet]. 2020 [Citado 08/04/2020];55:[aprox. 2 p.]. Disponible en: https://doi.org/10.1016/j.ijantimicag.2020. 105955

  26. Yuen KS, Ye ZW, Fung SY, Chan CP, Jin DY. SARS-CoV-2 and COVID-19: The most important research questions. Cell Biosci. 2020;10:40.

  27. Weston S, Frieman MB. COVID-19: Knowns, unknowns, and questions. mSphere [Internet]. 2020 [Citado 08/04/2020];5(2):e00203-20. Disponible en: https://doi.org/10.1128/mSphere.00203-20

  28. Mertz D, Kim TH, Johnstone J, Lam PP, Science M, Kuster SP, et al. Populations at risk for severe or complicated influenza illness: systematic review and meta-analysis. BMJ. 2013;347:f5061.

  29. Hong KW, Cheong HJ, Choi WS, Lee J, Wie SH, Baek JH, et al. Clinical courses and outcomes of hospitalized adult patients with seasonal influenza in Korea, 2011 - 2012: Hospital-based Influenza Morbidity & Mortality (HIMM) surveillance. J Infect Chemother. 2014;20:9-14.

  30. Peiris JS, Chu CM, Cheng VC, Chan KS, Hung IF, Poon LL, et al. Clinical progression and viral load in a community outbreak of coronavirus-associated SARS pneumonia: a prospective study. Lancet. 2003;361(9371):1767-72.

  31. Alraddadi BM, Watson JT, Almarashi A, Abedi GR, Turkistani A, Sadran M, et al. Risk factors for primary Middle East Respiratory Syndrome Coronavirus illness in humans, Saudi Arabia, 2014. Emerg Infect Dis. 2016;22:49-55.

  32. Badawi A, Ryoo SG. Prevalence of comorbidities in the Middle East respiratory syndrome coronavirus (MERS-CoV): a systematic review and meta-analysis. Int J Infect Dis. 2016;49:129-33.

  33. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395:565-74.

  34. Hoffmann M, Kleine Weber H, Schroeder S, Kruger N, Herrler T, Erichsen S, et al. SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by a clinically proven protease inhibitor. Cell. 2020;181:1-10.

  35. Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579: 270-3.

  36. Turner AJ, Hooper NM. The angiotensin-converting enzyme gene family: genomics and pharmacology. Trends Pharm Sci. 2002;23(4):177-83.

  37. Liu F, Long X, Zou W, Fang M, Wu W, Li W, et al. Highly ACE2 expression in pancreas may cause pancreas damage after SARS-CoV-2 infection [Internet]. MedRxiv. New York: Cold Spring Harbor; 2020 [Citado 10/04/2020]. Disponible en: https://2020.2002.2028.20029181

  38. Zou X, Zou JKC, Han P, Hao J, Han Z. The single-cell RNAseq data analysis on the receptor ACE2 expression reveals the potential risk of different human organs vulnerable to Wuhan 2019-nCoV infection. Front Med [Internet]. 2020 [Citado 10/04/2020];13:[aprox. 2 p.]. Disponible en: https://doi.org/10.1007/ s11684-020-0754-0

  39. Tikellis K, Thomas MC. Angiotensin-Converting Enzyme 2 (ACE2) is a key modulator of the Renin-Angiotensin System in health and disease. International J Peptid [Internet]. 2020 [Citado 10/04/2020];26:[aprox. 2 p.]. Disponible en: https://doi.org/10.1155/2012/256294

  40. Rao S, Lau A, So HC. Exploring diseases/traits and blood proteins causally related to expression of ACE2, the putative receptor of 2019-nCov: A Mendelian randomization analysis [Internet]. MedRxiv. New York: Cold Spring Harbor; 2020 [Citado 10/04/2020]. Disponible en: https://2020.2003.2004. 20031237

  41. Kuba K, Imai Y, Rao S. A crucial role of angiotensin converting enzyme 2 (ACE2) in SARS coronavirus-induced lung injury. Nat Med. 2005;11(8):875-9.

  42. Meng J, Xiao G, Zhang J, He X, Ou M, Bi J, et al. Renin-angiotensin system inhibitors improve the clinical outcomes of COVID-19 patients with hypertension. Emerg Microb & Infect. 2020;9(1):57-760.

  43. Tisoncik JR, Korth MJ, Simmons CP, Farrar J, Martin TR, Katze MG. Into the eye of the cytokine storm. Microbiol Mol Biol Rev. 2012;76(1):16-32.

  44. Harrison DG. The immune system in hypertension. Trans Am Clin Climatol Assoc. 2014;125:130-40.

  45. Atamas SP, Chapoval SP, Keegan AD. Cytokines in chronic respiratory diseases. F1000 Biol Rep. 2013;5:3.

  46. Mann DL. Innate immunity and the failing heart: the cytokine hypothesis revisited. Circ Res. 2015;116(7):1254-68.

  47. Akchurin OM, Kaskel F. Update on inflammation in chronic kidney disease. Blood Purif. 2015; 39(1-3):84-92.

  48. Cao X. COVID-19: immunopathology and its implications for therapy. Nat Rev Immunol. 2020;20(5):269-70.

  49. Ye Q, Wang B, Mao J. The pathogenesis and treatment of the 'Cytokine Storm' in COVID-19. J Infect [Internet]. 2020 [Citado 14/04/2020];80:[aprox. 2 p.]. Disponible en: https://doi.org/10.1016/j.jinf.2020.03.037

  50. Leung JM, Yang CX, Tam A, Shaipanich T, Hackett TL, Singhera GK, et al. ACE-2 Expression in the small airway epithelia of smokers and COPD patients: implications for COVID-19. Eur Respir J [Internet]. 2020 [Citado 14/04/2020];55:[aprox. 2 p.]. Disponible en: https://doi.org/10.1183/ 13993003.00688-2020

  51. Lippi G, Henry BM. Active smoking is not associated with severity of coronavirus disease 2019 (COVID-19). Eur J Intern Med [Internet]. 2020 [Citado 14/04/2020];55:[aprox. 2 p.]. Disponible en: https://doi.org/10.1016/ j.ejim.2020.03.014

  52. Rossato M, Russo L, Mazzocut S, Di Vincenzo A, Fioretto P, Vettor R. Current smoking is not associated with COVID-19. Eur Resp J [Internet]. 2020 [Citado 14/04/2020];55:[aprox. 2 p.]. Disponible en: https://doi.org/ 10.1183/13993003.01290-2020

  53. Vardavas CI, Nikitara K. COVID-19 and smoking: A systematic review of the evidence. Tob Induc Dis. 2020;20(18):20.

  54. Oakes JM, Fuchs RM, Gardner JD, Lazartigues E, Xinping Y. Nicotine and the Renin-Angiotensin System. Am J Physiol Regul Integr Comp Physiol. 2018; 315:R895-R906.




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