Elevated D-dimer levels on admission are associated with severity and increased risk of mortality in COVID-19: A systematic review and meta-analysis

AbstractIntroductionThe 2019 novel Coronavirus (2019-nCoV), now declared a pandemic has an overall case fatality of 2–3% but it is as high as 50% in critically ill patients. D-dimer is an important prognostic tool, often elevated in patients with severe COVID-19 infection and in those who suffered death. In this systematic review, we aimed to investigate the prognostic role of D-dimer in COVID-19 infected patients.MethodsWe searched PubMed, Medline, Embase, Ovid, and Cochrane for studies reporting admission D-dimer levels in COVID-19 patients and its effect on mortality.Results18 studies (16 retrospective and 2 prospective) with a total of 3,682 patients met the inclusion criteria. The pooled mean difference (MD) suggested significantly elevated D-dimer levels in patients who died versus those survived (MD 6.13 mg/L, 95% CI 4.16 − 8.11, p <0.001). Similarly, the pooled mean D-dimer levels were significantly elevated in patients with severe COVID-19 infection (MD 0.54 mg/L, 95% CI 0.28 − 0.8, p< 0.001). In addition, the risk of mortality was four-fold higher in patients with positive D-dimer vs negative D-dimer (RR 4.11, 95% CI 2.48 − 6.84, p< 0.001) and the risk of developing the severe disease was two-fold higher in patients with positive D-dimer levels vs negative D-dimer (RR 2.04, 95% CI 1.34 − 3.11, p < 0.001).ConclusionOur meta-analysis demonstrates that patients with COVID-19 presenting with elevated D-dimer levels have an increased risk of severe disease and mortality.

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Renin-angiotensin system blocker and outcomes of COVID-19: a systematic review and meta-analysis

Thorax ◽

10.1136/thoraxjnl-2020-215322 ◽

2021 ◽

pp. thoraxjnl-2020-215322

Author(s):

Hyun Woo Lee ◽

Chang-Hwan Yoon ◽

Eun Jin Jang ◽

Chang-Hoon Lee

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Severe Disease ◽

Renin Angiotensin System ◽

Angiotensin Ii Receptor ◽

Angiotensin System ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Receptor Blockers

BackgroundThe association of ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) with disease severity of patients with COVID-19 is still unclear. We conducted a systematic review and meta-analysis to investigate if ACEI/ARB use is associated with the risk of mortality and severe disease in patients with COVID-19.MethodsWe searched all available clinical studies that included patients with confirmed COVID-19 who could be classified into an ACEI/ARB group and a non-ACEI/ARB group up until 4 May 2020. A meta-analysis was performed, and primary outcomes were all-cause mortality and severe disease.ResultsACEI/ARB use did not increase the risk of all-cause mortality both in meta-analysis for 11 studies with 12 601 patients reporting ORs (OR=0.52 (95% CI=0.37 to 0.72), moderate certainty of evidence) and in 2 studies with 8577 patients presenting HRs. For 12 848 patients in 13 studies, ACEI/ARB use was not related to an increased risk of severe disease in COVID-19 (OR=0.68 (95% CI=0.44 to 1.07); I2=95%, low certainty of evidence).ConclusionsACEI/ARB therapy was not associated with increased risk of all-cause mortality or severe manifestations in patients with COVID-19. ACEI/ARB therapy can be continued without concern of drug-related worsening in patients with COVID-19.

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Gamma-glutamyltransferase predicts increased risk of mortality: A systematic review and meta-analysis of prospective observational studies

Free Radical Research ◽

10.3109/10715762.2014.902055 ◽

2014 ◽

Vol 48 (6) ◽

pp. 716-728 ◽

Cited By ~ 12

Author(s):

Y. Long ◽

F. Zeng ◽

J. Shi ◽

H. Tian ◽

T. Chen

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Meta Analysis ◽

Gamma Glutamyltransferase ◽

Risk Of Mortality ◽

Increased Risk

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Pre-existing COPD is associated with an increased risk of mortality and severity in COVID-19: a rapid systematic review and meta-analysis

Expert Review of Respiratory Medicine ◽

10.1080/17476348.2021.1866547 ◽

2021 ◽

pp. 1-12

Author(s):

Golam Rabbani ◽

Sheikh Mohammad Shariful Islam ◽

Muhammad Aziz Rahman ◽

Nuhu Amin ◽

Bushra Marzan ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Risk Of Mortality ◽

Increased Risk

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D-dimer levels on admission and all-cause mortality risk in COVID-19 patients: a meta-analysis

Epidemiology and Infection ◽

10.1017/s0950268820002022 ◽

2020 ◽

Vol 148 ◽

Author(s):

Daniel Martin Simadibrata ◽

Anna Mira Lubis

Keyword(s):

Sensitivity Analysis ◽

Mortality Risk ◽

Meta Analysis ◽

Prognostic Role ◽

Chinese Studies ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

D Dimer ◽

Overall Mortality

Abstract D-dimer level on admission is a promising biomarker to predict mortality in patients with COVID-19. In this study, we reviewed the association between on-admission D-dimer levels and all-cause mortality risk in COVID-19 patients. Peer-reviewed studies and preprints reporting categorised D-dimer levels on admission and all-cause mortality until 24 May 2020 were searched for using the following keywords: ‘COVID-19’, ‘D-dimer’ and ‘Mortality’. A meta-analysis was performed to determine the pooled risk ratio (RR) for all-cause mortality. In total, 2911 COVID-19 patients from nine studies were included in this meta-analysis. Regardless of the different D-dimer cut-off values used, the pooled RR for all-cause mortality in patients with elevated vs. normal on-admission D-dimer level was 4.77 (95% confidence interval (CI) 3.02–7.54). Sensitivity analysis did not significantly affect the overall mortality risk. Analysis restricted to studies with 0.5 μg/ml as the cut-off value resulted in a pooled RR for mortality of 4.60 (95% CI 2.72–7.79). Subgroup analysis showed that the pooled all-cause mortality risk was higher in Chinese vs. non-Chinese studies (RR 5.87; 95% CI 2.67–12.89 and RR 3.35; 95% CI 1.66–6.73; P = 0.29). On-admission D-dimer levels showed a promising prognostic role in predicting all-cause mortality in COVID-19 patients, elevated D-dimer levels were associated with increased risk of mortality.

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Association of Sex, Age, and Comorbidities with Mortality in COVID-19 Patients: A Systematic Review and Meta-Analysis

Intervirology ◽

10.1159/000512592 ◽

2020 ◽

pp. 1-12

Author(s):

Mohitosh Biswas ◽

Shawonur Rahaman ◽

Tapash Kumar Biswas ◽

Zahirul Haque ◽

Baharudin Ibrahim

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Meta Analysis ◽

Statistical Significance ◽

Considerable Proportion ◽

Relative Risks ◽

Risk Of Mortality ◽

Increased Risk ◽

Male Patients ◽

Reduce Risk

Introduction: Although severe acute respiratory syndrome coronavirus-2 infection is causing mortality in considerable proportion of coronavirus disease-2019 (COVID-19) patients, however, evidence for the association of sex, age, and comorbidities on the risk of mortality is not well-aggregated yet. It was aimed to assess the association of sex, age, and comorbidities with mortality in COVID-2019 patients. Methods: Literatures were searched using different keywords in various databases. Relative risks (RRs) were calculated by RevMan software where statistical significance was set as p < 0.05. Results: COVID-19 male patients were associated with significantly increased risk of mortality compared to females (RR 1.86: 95% confidence interval [CI] 1.67–2.07; p < 0.00001). Patients with age ≥50 years were associated with 15.4-folds significantly increased risk of mortality compared to patients with age <50 years (RR 15.44: 95% CI 13.02–18.31; p < 0.00001). Comorbidities were also associated with significantly increased risk of mortality; kidney disease (RR 4.90: 95% CI 3.04–7.88; p < 0.00001), cereborovascular disease (RR 4.78; 95% CI 3.39–6.76; p < 0.00001), cardiovascular disease (RR 3.05: 95% CI 2.20–4.25; p < 0.00001), respiratory disease (RR 2.74: 95% CI 2.04–3.67; p < 0.00001), diabetes (RR 1.97: 95% CI 1.48–2.64; p < 0.00001), hypertension (RR 1.95: 95% CI 1.58–2.40; p < 0.00001), and cancer (RR 1.89; 95% CI 1.25–2.84; p = 0.002) but not liver disease (RR 1.64: 95% CI 0.82–3.28; p= 0.16). Conclusion: Implementation of adequate protection and interventions for COVID-19 patients in general and in particular male patients with age ≥50 years having comorbidities may significantly reduce risk of mortality associated with COVID-19.

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Obesity and Mortality Among Patients Diagnosed With COVID-19: A Systematic Review and Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2021.620044 ◽

2021 ◽

Vol 8 ◽

Cited By ~ 1

Author(s):

Tahmina Nasrin Poly ◽

Md. Mohaimenul Islam ◽

Hsuan Chia Yang ◽

Ming Chin Lin ◽

Wen-Shan Jian ◽

...

Keyword(s):

Systematic Review ◽

Risk Ratio ◽

Web Of Science ◽

Meta Analysis ◽

Epidemiological Studies ◽

Class Iii ◽

Risk Of Death ◽

Risk Of Mortality ◽

Increased Risk ◽

Class Iii Obesity

Coronavirus disease 2019 (COVID-19) has already raised serious concern globally as the number of confirmed or suspected cases have increased rapidly. Epidemiological studies reported that obesity is associated with a higher rate of mortality in patients with COVID-19. Yet, to our knowledge, there is no comprehensive systematic review and meta-analysis to assess the effects of obesity and mortality among patients with COVID-19. We, therefore, aimed to evaluate the effect of obesity, associated comorbidities, and other factors on the risk of death due to COVID-19. We did a systematic search on PubMed, EMBASE, Google Scholar, Web of Science, and Scopus between January 1, 2020, and August 30, 2020. We followed Cochrane Guidelines to find relevant articles, and two reviewers extracted data from retrieved articles. Disagreement during those stages was resolved by discussion with the main investigator. The random-effects model was used to calculate effect sizes. We included 17 articles with a total of 543,399 patients. Obesity was significantly associated with an increased risk of mortality among patients with COVID-19 (RRadjust: 1.42 (95%CI: 1.24–1.63, p < 0.001). The pooled risk ratio for class I, class II, and class III obesity were 1.27 (95%CI: 1.05–1.54, p = 0.01), 1.56 (95%CI: 1.11–2.19, p < 0.01), and 1.92 (95%CI: 1.50–2.47, p < 0.001), respectively). In subgroup analysis, the pooled risk ratio for the patients with stroke, CPOD, CKD, and diabetes were 1.80 (95%CI: 0.89–3.64, p = 0.10), 1.57 (95%CI: 1.57–1.91, p < 0.001), 1.34 (95%CI: 1.18–1.52, p < 0.001), and 1.19 (1.07–1.32, p = 0.001), respectively. However, patients with obesity who were more than 65 years had a higher risk of mortality (RR: 2.54; 95%CI: 1.62–3.67, p < 0.001). Our study showed that obesity was associated with an increased risk of death from COVID-19, particularly in patients aged more than 65 years. Physicians should aware of these risk factors when dealing with patients with COVID-19 and take early treatment intervention to reduce the mortality of COVID-19 patients.

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Migraine and mortality: A systematic review and meta-analysis

Cephalalgia ◽

10.1177/0333102411415879 ◽

2011 ◽

Vol 31 (12) ◽

pp. 1301-1314 ◽

Cited By ~ 48

Author(s):

Markus Schürks ◽

Pamela M Rist ◽

Robert E Shapiro ◽

Tobias Kurth

Keyword(s):

Systematic Review ◽

Migraine With Aura ◽

Meta Analysis ◽

Coronary Heart Disease Mortality ◽

Public Health Importance ◽

Definitive Answer ◽

Disease Mortality ◽

Risk Of Mortality ◽

Increased Risk ◽

High Prevalence

Objective: To evaluate the evidence on the association between migraine and mortality. Methods: Systematic review and meta-analysis of studies investigating the association between any migraine (all forms of migraine collectively) or migraine subtypes (e.g. migraine with aura) and mortality published until March 2011. Results: We identified ten cohort studies. Studies differed regarding the types of mortality investigated and only four presented aura-stratified results, limiting pooled analyses with regard to migraine subtypes and with regard to cause-specific mortality. For any migraine pooled analyses do not suggest an association with all-cause mortality (five studies; pooled relative risk (RR) = 0.90, 95% confidence interval (CI) 0.71–1.16), cardiovascular disease mortality (CVD; six studies; pooled RR = 1.09, 95% CI 0.89–1.32), or coronary heart disease mortality (CHD; three studies; pooled RR = 0.95, 95% CI 0.57–1.60). Heterogeneity among studies is moderate to high. Two studies suggest that migraine with aura increases risk for CVD and CHD mortality. Conclusion: This meta-analysis does not suggest that any migraine is associated with increased risk of mortality from all causes, CVD, or CHD. However, there is heterogeneity among studies and suggestion that migraine with aura increases CVD and CHD mortality. Given the high prevalence of migraine in the general population a definitive answer to the question of whether migraine or a subtype alters risk for mortality is of high public health importance and further targeted research implicated.

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DIGOXIN USE IN ATRIAL FIBRILLATION IS ASSOCIATED WITH INCREASED RISK OF MORTALITY: A SYSTEMATIC REVIEW AND META-ANALYSIS OF MORE THAN 200,000 PATIENTS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(15)60289-3 ◽

2015 ◽

Vol 65 (10) ◽

pp. A289

Author(s):

Waqas Qureshi ◽

Zaid Alirhayim ◽

Amjad Ahmed ◽

Mouaz Al-Mallah ◽

King AbdulAziz

Keyword(s):

Atrial Fibrillation ◽

Systematic Review ◽

Meta Analysis ◽

Risk Of Mortality ◽

Increased Risk

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Sarcopenia as a predictor of mortality among the critically ill in an intensive care unit: a systematic review and meta-analysis

BMC Geriatrics ◽

10.1186/s12877-021-02276-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Xiao-Ming Zhang ◽

Denghong Chen ◽

Xiao-Hua Xie ◽

Jun-E Zhang ◽

Yingchun Zeng ◽

...

Keyword(s):

Systematic Review ◽

Skeletal Muscle ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Meta Analysis ◽

Muscle Area ◽

Risk Of Mortality ◽

Increased Risk

Abstract Background The evidence of sarcopenia based on CT-scan as an important prognostic factor for critically ill patients has not seen consistent results. To determine the impact of sarcopenia on mortality in critically ill patients, we performed a systematic review and meta-analysis to quantify the association between sarcopenia and mortality. Methods We searched studies from the literature of PubMed, EMBASE, and Cochrane Library from database inception to June 15, 2020. All observational studies exploring the relationship between sarcopenia based on CT-scan and mortality in critically ill patients were included. The search and data analysis were independently conducted by two investigators. A meta-analysis was performed using STATA Version 14.0 software using a fixed-effects model. Results Fourteen studies with a total of 3,249 participants were included in our meta-analysis. The pooled prevalence of sarcopenia among critically ill patients was 41 % (95 % CI:33-49 %). Critically ill patients with sarcopenia in the intensive care unit have an increased risk of mortality compared to critically ill patients without sarcopenia (OR = 2.28, 95 %CI: 1.83–2.83; P < 0.001; I2 = 22.1 %). In addition, a subgroup analysis found that sarcopenia was associated with high risk of mortality when defining sarcopenia by total psoas muscle area (TPA, OR = 3.12,95 %CI:1.71–5.70), skeletal muscle index (SMI, OR = 2.16,95 %CI:1.60–2.90), skeletal muscle area (SMA, OR = 2.29, 95 %CI:1.37–3.83), and masseter muscle(OR = 2.08, 95 %CI:1.15–3.77). Furthermore, critically ill patients with sarcopenia have an increased risk of mortality regardless of mortality types such as in-hospital mortality (OR = 1.99, 95 %CI:1.45–2.73), 30-day mortality(OR = 2.08, 95 %CI:1.36–3.19), and 1-year mortality (OR = 3.23, 95 %CI:2.08 -5.00). Conclusions Sarcopenia increases the risk of mortality in critical illness. Identifying the risk factors of sarcopenia should be routine in clinical assessments and offering corresponding interventions may help medical staff achieve good patient outcomes in ICU departments.

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