Factors associated with disease severity and mortality among patients with COVID-19: A systematic review and meta-analysis

Vignesh Chidambaram, Nyan Lynn Tun, Waqas Z. Haque, Marie Gilbert Majella, Ranjith Kumar Sivakumar, Amudha Kumar, Angela Ting Wei Hsu, Izza A. Ishak, Aqsha A. Nur, Samuel K. Ayeh, Emmanuella L. Salia, Ahsan Zil-E-Ali, Muhammad A. Saeed, Ayu P.B. Sarena, Bhavna Seth, Muzzammil Ahmadzada, Eman F. Haque, Pranita Neupane, Kuang Heng Wang, Tzu Miao PuSyed M.H. Ali, Muhammad A. Arshad, Lin Wang, Sheriza Baksh, Petros C. Karakousis, Panagis Galiatsatos

Research output: Contribution to journalReview articlepeer-review

11 Scopus citations


Background Understanding the factors associated with disease severity and mortality in Coronavirus disease (COVID-19) is imperative to effectively triage patients. We performed a systematic review to determine the demographic, clinical, laboratory and radiological factors associated with severity and mortality in COVID-19. Methods We searched PubMed, Embase and WHO database for English language articles from inception until May 8, 2020. We included Observational studies with direct comparison of clinical characteristics between a) patients who died and those who survived or b) patients with severe disease and those without severe disease. Data extraction and quality assessment were performed by two authors independently. Results Among 15680 articles from the literature search, 109 articles were included in the analysis. The risk of mortality was higher in patients with increasing age, male gender (RR 1.45, 95% CI 1.23–1.71), dyspnea (RR 2.55, 95%CI 1.88–2.46), diabetes (RR 1.59, 95%CI 1.41–1.78), hypertension (RR 1.90, 95%CI 1.69–2.15). Congestive heart failure (OR 4.76, 95%CI 1.34–16.97), hilar lymphadenopathy (OR 8.34, 95%CI 2.57–27.08), bilateral lung involvement (OR 4.86, 95%CI 3.19–7.39) and reticular pattern (OR 5.54, 95%CI 1.24–24.67) were associated with severe disease. Clinically relevant cut-offs for leukocytosis(>10.0 x109/L), lymphopenia(< 1.1 x109/L), elevated C-reactive protein(>100mg/L), LDH(>250U/L) and D-dimer(>1mg/L) had higher odds of severe disease and greater risk of mortality. Conclusion Knowledge of the factors associated of disease severity and mortality identified in our study may assist in clinical decision-making and critical-care resource allocation for patients with COVID-19.

Original languageEnglish (US)
Article numbere0241541
JournalPloS one
Issue number11 November
StatePublished - Nov 2020

ASJC Scopus subject areas

  • General


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