The influence of comorbidity on the severity of COVID-19 disease: systematic review and analysis

AbstractA novel form of coronavirus disease (SARS-CoV-2) has spread rapidly across the world. This disease, originating in Wuhan, China, has become a global pandemic. What risk factors influence the severity of the disease is of considerable importance. This research is intended to offer a systematic review/meta-analysis for assessing how common clinical conditions and comorbidities correlate with COVID-19. The meta-analysis incorporated seven studies covering 4101 COVID-19 patients from Chinese hospitals who had their diagnosis confirmed through laboratory testing. The findings demonstrate that the most common comorbidities with the disease were COPD (2.53%, OR 3.24 [95% CI: 1.99-4.45], p< 0.0006), cardiovascular disease (10.76%, OR 2.89 [95% CI: 1.90-4.40], p <0.0001), coronary heart disease (5.52%, OR 2.97 [95% CI: 1.99-4.45], p <0.0001), diabetes (11.34%, OR 2.27, [95% CI: 1.46-3.53], p = 0.0003), and hypertension (22.07%, OR 2.43 [95% CI: 1.71-3.45], p <0.0001). No significant associations were found for disease severity with the comorbidities of kidney disease, liver disease, or cancer. The most frequently exhibited clinical symptoms were fever (74.52%, OR 1.37, 95% CI: 1.01-1.86, p = 0.04), cough (62.15%, OR 1.25, 95% CI: 0.97-1.60, p = 0.0823), myalgia/fatigue (38.77%, OR 1.31, 95% CI: 1.11-1.55, p = 0.0018), dyspnea (33.9%, OR 3.61, 95% CI: 2.57-5.06, p = <0.0001), respiratory failure/ARDS (20.6%, OR 11.46, 95% CI: 3.24-40.56, p = 0.0002), diarrhea (11.21%) and chest tightness/pain (16.82%, OR 2.17, 95% CI: 1.40-3.36, p = 0.0006). Meta-analysis also revealed that neither the duration of the incubation period nor current smoking status associated with disease severity.

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The influence of comorbidity on the severity of COVID-19 disease: systematic review and analysis

10.21203/rs.3.rs-37127/v1 ◽

2020 ◽

Author(s):

Nazar Zaki ◽

Elfadil Abdalla Mohamed ◽

Sahar Ibrahim ◽

Gulfaraz Khan

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Clinical Symptoms ◽

Smoking Status ◽

Meta Analysis ◽

Extraction Methods ◽

Global Pandemic ◽

Severity Of The Disease ◽

Clinical Conditions ◽

Random Effects Modeling

Abstract Background: A novel form of coronavirus disease (SARS-CoV-2) has spread rapidly across the world. This disease, originating in Wuhan, China, has become a global pandemic. What risk factors influence the severity of the disease is of considerable importance.Aim: This research is intended to offer a systematic review/meta-analysis for assessing how common clinical conditions and comorbidities correlate with COVID-19.Methodology: Two independent researchers undertook searches using Europe PMC, Google Scholar, and PubMed. In addition, a search engine was created for screening another 59,000 articles in COVID-19 Open Research Dataset (CORD-19). Screening was undertaken for any article related to comorbidity and their influence on the progress of the disease. Random-effects modeling was used to pool 95% confidence intervals (CIs) and odds ratios (ORs). The significance of all comorbidities and clinical conditions in relation to the severity of the disease were evaluated by employing feature extraction methods and machine-learning. Publication bias was assessed by employing funnel plots, and heterogeneity was tested in relation to I2.Results: The meta-analysis incorporated 12 studies covering 4101 confirmed COVID-19 patients from Chinese hospitals. The findings demonstrate that the most common comorbidities with the disease were hypertension (22.07%, OR 2.43 [95% CI: 1.71-3.45], p <0.0001), diabetes (11.34%, OR 2.27, [95% CI: 1.46-3.53], p = 0.0003), cardiovascular disease (10.76%, OR 2.89 [95% CI: 1.90-4.40], p <0.0001), and COPD (2.53%, OR 3.24 [95% CI: 1.99-4.45], p< 0.0006). No significant associations were found for disease severity with the comorbidities of kidney disease, liver disease, or cancer.The most frequently exhibited clinical symptoms were fever (74.52%, OR 1.37, 95% CI: 1.01-1.86, p = 0.04), cough (62.15%, OR 1.25, 95% CI: 0.97-1.60, p = 0.0823), myalgia/fatigue (38.77%, OR 1.31, 95% CI: 1.11-1.55, p = 0.0018), dyspnea (33.9%, OR 3.61, 95% CI: 2.57-5.06, p = <0.0001), and respiratory failure/ARDS (20.6%, OR 11.46, 95% CI: 3.24-40.56, p = 0.0002). Meta-analysis also revealed that neither the duration of the incubation period nor current smoking status associated with disease severity.Conclusion: Existing comorbidities, including COPD, cardiovascular disease, coronary heart disease, diabetes, and hypertension represent a risk of increasing the severity of the disease in COVID-19 patients.

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The influence of comorbidity on the severity of COVID-19 disease: A systematic review and analysis

10.21203/rs.3.rs-37127/v2 ◽

2020 ◽

Author(s):

Nazar Zaki ◽

Elfadil Abdalla Mohamed ◽

Sahar Ibrahim ◽

Gulfaraz Khan

Keyword(s):

Systematic Review ◽

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Disease Severity ◽

Clinical Symptoms ◽

Meta Analysis ◽

Machine Learning Techniques ◽

Severity Of The Disease ◽

Clinical Conditions

Abstract Background: A novel form of coronavirus disease (SARS-CoV-2) has spread rapidly across the world. What risk factors influence the severity of the disease is of considerable importance.Aim: This research offers a systematic review and meta-analysis of the correlation between common clinical conditions and comorbidities and the severity of COVID-19.Methodology: Two independent researchers searched Europe PMC, Google Scholar, and PubMed databases for articles related to influence comorbidities have on the progress of the disease. A search engine was also created to screen a further 59,000 articles in COVID-19 Open Research Dataset (CORD-19). Random-effects modeling was used to pool 95% confidence intervals (CIs) and odds ratios (ORs). The significance of all comorbidities and clinical conditions to the severity of the disease was evaluated by employing machine-learning techniques. Publication bias was assessed by using funnel-plots and Egger’s test. Heterogeneity was tested using I2.Results: The meta-analysis incorporated 12 studies spanning 4,101 confirmed COVID-19 patients who were admitted to Chinese hospitals. The prevalence of the most commonly associated co-morbidities and their corresponding odds ratio for disease severity were as follows: coronary heart disease (OR 2.97 [CI: 1.99-4.45], p < 0.0001), cancer (OR 2.65 [CI: 1.12-6.29], p < 0.03), cardiovascular disease (OR 2.89 [CI: 1.90-4.40], p < 0.0001), COPD (OR 3.24 [CI: 1.66-6.32], p = 0.0), and kidney disease (OR 2.2.4 [CI: 1.01-4.99], p = 0.05) with low or moderate level of heterogeneity. The most frequently exhibited clinical symptoms were fever (OR 1.37 [CI: 1.01-1.86], p = 0.04), myalgia/fatigue (OR 1.31 [CI: 1.11-1.55], p = 0.0018), and dyspnea (OR 3.61, [CI: 2.57-5.06], p = <0.0001). No significant associations between disease severity and liver disease, smoking habits, and other clinical conditions, such as a cough, respiratory/ARDS, diarrhea or chest tightness/pain were found. The meta-analysis also revealed that the incubation period was positively associated with disease severity. Conclusion: Existing comorbidities, including COPD, cardiovascular disease, and coronary heart disease, increase the severity of COVID-19. Some studies found a statistically significant association between comorbidities such as diabetes and hypertension and disease severity. However, these studies may be biased due to substantial heterogeneity.

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The influence of comorbidity on the severity of COVID-19 disease: A scoping review and meta-analysis

10.21203/rs.3.rs-37127/v3 ◽

2020 ◽

Author(s):

Nazar Zaki ◽

Elfadil Abdalla Mohamed ◽

Sahar Ibrahim ◽

Gulfaraz Khan

Keyword(s):

Cardiovascular Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Disease Severity ◽

Clinical Symptoms ◽

Meta Analysis ◽

Machine Learning Techniques ◽

Severity Of The Disease ◽

Clinical Conditions ◽

Random Effects Modeling

Abstract Background: A novel form of coronavirus disease (SARS-CoV-2) has spread rapidly across the world. What risk factors influence the severity of the disease is of considerable importance. Objectives: This research offers a systematic review and meta-analysis of the correlation between common clinical conditions and comorbidities and the severity of COVID-19. Methodology: Two independent researchers searched Europe PMC, Google Scholar, and PubMed databases for articles related to influence comorbidities have on the progress of the disease. A search engine was also created to screen a further 59,000 articles in COVID-19 Open Research Dataset (CORD-19). Random-effects modeling was used to pool 95% confidence intervals (CIs) and odds ratios (ORs). The significance of all comorbidities and clinical conditions to the severity of the disease was evaluated by employing machine-learning techniques. Publication bias was assessed by using funnel-plots and Egger’s-test. Heterogeneity was tested using I2. Results: The meta-analysis incorporated 12 studies spanning 4,101 confirmed COVID-19 patients who were admitted to Chinese hospitals. The prevalence of the most commonly associated co-morbidities and their corresponding odds ratio for disease severity were as follows: coronary heart disease (OR 2.97 [CI: 1.99-4.45], p < 0.0001), cancer (OR 2.65 [CI: 1.12-6.29], p < 0.03), cardiovascular disease (OR 2.89 [CI: 1.90-4.40], p < 0.0001), COPD (OR 3.24 [CI: 1.66-6.32], p = 0.0), and kidney disease (OR 2.2.4 [CI: 1.01-4.99], p = 0.05) with low or moderate level of heterogeneity. The most frequently exhibited clinical symptoms recorded during the course of admission were fever (OR 1.37 [CI: 1.01-1.86], p = 0.04), myalgia/fatigue (OR 1.31 [CI: 1.11-1.55], p = 0.0018), and dyspnea (OR 3.61, [CI: 2.57-5.06], p = <0.0001). No significant associations between disease severity and liver disease, smoking habits, and other clinical conditions, such as a cough, respiratory/ARDS, diarrhea or chest tightness/pain were found. The meta-analysis also revealed that the incubation period was positively associated with disease severity. Conclusion: Existing comorbidities, including COPD, cardiovascular disease, and coronary heart disease, increase the severity of COVID-19. Some studies found a statistically significant association between comorbidities such as diabetes and hypertension and disease severity. However, these studies may be biased due to substantial heterogeneity.

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Impact of Smoking Status on Disease Severity and Mortality of Hospitalized Patients With COVID-19 Infection: A Systematic Review and Meta-analysis

Nicotine & Tobacco Research ◽

10.1093/ntr/ntaa107 ◽

2020 ◽

Vol 22 (9) ◽

pp. 1657-1659 ◽

Cited By ~ 8

Author(s):

Antonios Karanasos ◽

Konstantinos Aznaouridis ◽

George Latsios ◽

Andreas Synetos ◽

Stella Plitaria ◽

...

Keyword(s):

Systematic Review ◽

Disease Severity ◽

Smoking Status ◽

Meta Analysis ◽

Hospitalized Patients

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The Effect of Smoking on COVID-19 Symptom Severity: Systematic Review and Meta-Analysis

Pulmonary Medicine ◽

10.1155/2020/7590207 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11 ◽

Cited By ~ 6

Author(s):

Askin Gülsen ◽

Burcu Arpinar Yigitbas ◽

Berat Uslu ◽

Daniel Drömann ◽

Oguz Kilinc

Keyword(s):

Web Of Science ◽

Smoking Status ◽

Meta Analysis ◽

Good Health ◽

Common Type ◽

Current Smoking Status ◽

Current Smoking ◽

The World ◽

History Of ◽

The Relationship

Background. Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SAR2-COV-2) and was first identified in Wuhan, China, in December of 2019, but quickly spread to the rest of the world, causing a pandemic. While some studies have found no link between smoking status and severe COVID-19, others demonstrated a significant one. The present study aimed to determine the relationship between smoking and clinical COVID-19 severity via a systematic meta-analysis approach. Methods. We searched the Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to identify clinical studies suitable for inclusion in this meta-analysis. Studies reporting smoking status and comparing nonsevere and severe patients were included. Nonsevere cases were described as mild, common type, nonintensive care unit (ICU) treatment, survivors, and severe cases as critical, need for ICU, refractory, and nonsurvivors. Results. A total of 16 articles detailing 11322 COVID-19 patients were included. Our meta-analysis revealed a relationship between a history of smoking and severe COVID-19 cases (OR=2.17; 95% CI: 1.37–3.46; P<.001). Additionally, we found an association between the current smoking status and severe COVID-19 (OR=1.51; 95% CI: 1.12–2.05; P<.008). In 10.7% (978/9067) of nonsmokers, COVID-19 was severe, while in active smokers, severe COVID-19 occurred in 21.2% (65/305) of cases. Conclusion. Active smoking and a history of smoking are clearly associated with severe COVID-19. The SARS-COV-2 epidemic should serve as an impetus for patients and those at risk to maintain good health practices and discontinue smoking. The trial is registered with the International Prospective Register of Systematic Reviews (PROSPERO) CRD42020180173.

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Prevalence of Current Smoking and Association with Adverse Outcome in Hospitalized COVID-19 Patients: A Systematic Review and Meta-Analysis

10.20944/preprints202005.0113.v1 ◽

2020 ◽

Author(s):

Konstantinos Farsalinos ◽

Konstantinos Poulas ◽

Riccardo Polosa ◽

Anastasia Barbouni ◽

Pasquale Caponnetto ◽

...

Keyword(s):

Systematic Review ◽

Odds Ratio ◽

Adverse Outcome ◽

Smoking Status ◽

Meta Analysis ◽

Hospitalized Patients ◽

Adverse Outcomes ◽

Prevalence Odds Ratio ◽

Current Smoking ◽

Former Smokers

Background: The purpose of this study was to examine the prevalence and effects of current smoking on adverse outcomes among hospitalized COVID-19 patients. Methods: We performed a systematic review of the literature (PubMed) for studies published until April 25. Studies were included into the analysis if they satisfied all of the following criteria: 1. To present hospitalized patients with COVID-19. 2. To classify patients into less and more severe disease, irrespective of the severity definition (defined as “adverse ourtcome”). 3. To present data on the smoking status, separately for each severity classification. We identified 18 (from a total of 1398) relevant studies. Pooled current smoking prevalence was compared with the gender-adjusted, population-based expected prevalence by calculating Prevalence Odds Ratio (POR). The association between current, compared to non-current and former, smoking and adverse outcome was examined by calculating Odds Ratio (OR). All analyses were performed using random-effects meta-analysis. Results: Among 6515 patients, 440 of whom were current smokers, the pooled prevalence of current smoking was 6.8% (95%CI: 4.8-9.1%) and the POR was 0.21 (95%CI: 0.16-0.26, P < 0.001). In Chinese studies only, the POR was 0.22 (95%CI: 0.17-0.27, P < 0.001). Current smokers were more likely to have an adverse outcome compared to non-current smokers (OR: 1.53, 95%CI: 1.06-2.20, P = 0.022). However, they were less likely to have an adverse outcome compared to former smokers (OR: 0.42, 95%CI: 0.27-0.74, P = 0.003). Conclusion: An unexpectedly low prevalence of current smoking was observed among hospitalized patients with COVID-19. Hospitalized current smokers had higher odds compared to non-current smokers but lower odds compared to former smokers for an adverse outcome. The possibility that nicotine may have a protective effect in COVID-19 which may be masked by smoking-related toxicity and by the abrupt cessation of nicotine intake when smokers are hospitalized should be explored.

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The effect of smoking on COVID-19 symptom severity: Systematic review and meta-analysis

10.1101/2020.08.15.20102699 ◽

2020 ◽

Author(s):

Askin Gulsen ◽

Burcu Arpinar Yigitbas ◽

Berat Uslu ◽

Daniel Droemann ◽

Oguz Kilinc

Keyword(s):

Web Of Science ◽

Smoking Status ◽

Meta Analysis ◽

Good Health ◽

Common Type ◽

Current Smoking Status ◽

Current Smoking ◽

The World ◽

History Of ◽

The Relationship

Background: Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SAR2-COV-2), and was first identified in Wuhan, China in December of 2019, but quickly spread to the rest of the world, causing a pandemic. While some studies have found no link between smoking status and severe COVID-19, others demonstrated a significant one. The present study aimed to determine the relationship between smoking and clinical COVID-19 severity via a systematic meta-analysis approach. Methods: We searched the Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to identify clinical studies suitable for inclusion in this meta-analysis. Studies reporting smoking status and comparing non-severe and severe patients were included. Non-severe cases were described as mild, common type, non-intensive care unit (ICU) treatment, survivors, and severe cases as critical, need for ICU, refractory, and non-survivors. Results: A total of 16 articles detailing 11322 COVID-19 patients were included. Our meta-analysis revealed a relationship between a history of smoking and severe COVID-19 cases (OR=2.17; 95% CI: 1.37-3.46; P <.001). Additionally, we found an association between the current smoking status and severe COVID-19 (OR=1.51; 95% CI: 1.12-2.05; P <.008). In 10.7% (978/9067) of non-smokers, COVID-19 was severe, while in active smokers, severe COVID-19 occurred in 21.2% (65/305) of cases. Conclusion: Active smoking and a history of smoking are clearly associated with severe COVID-19. The SARS-COV-2 epidemic should serve as an impetus for patients and those at risk to maintain good health practices and discontinue smoking.

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Susceptibility of β-Thalassemia Heterozygotes to COVID-19

Journal of Clinical Medicine ◽

10.3390/jcm10163645 ◽

2021 ◽

Vol 10 (16) ◽

pp. 3645

Author(s):

Sotirios Sotiriou ◽

Athina A. Samara ◽

Dimitra Vamvakopoulou ◽

Konstantinos-Odysseas Vamvakopoulos ◽

Andreas Sidiropoulos ◽

...

Keyword(s):

Multivariate Analysis ◽

Clinical Symptoms ◽

Smoking Status ◽

Single Gene ◽

Patient Characteristics ◽

Current Smoking Status ◽

Current Smoking ◽

Icu Admission ◽

Blood Disorder ◽

Male Sex

Background: β-Thalassemia is the most prevalent single gene blood disorder, while the assessment of its susceptibility to coronavirus disease 2019 (COVID-19) warrants it a pressing biomedical priority. Methods: We studied 255 positive COVID-19 participants unvaccinated against severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2), consecutively recruited during the last trimester of 2020. Patient characteristics including age, sex, current smoking status, atrial fibrillation, chronic respiratory disease, coronary disease, diabetes, neoplasia, hyperlipidemia, hypertension, and β-thalassemia heterozygosity were assessed for COVID-19 severity, length of hospitalization, intensive care unit (ICU) admission and mortality from COVID-19. Results: We assessed patient characteristics associated with clinical symptoms, ICU admission, and mortality from COVID-19. In multivariate analysis, severe-critical COVID-19 was strongly associated with male sex (p = 0.023), increased age (p < 0.001), and β-thalassemia heterozygosity (p = 0.002, OR = 2.89). Regarding the requirement for ICU care, in multivariate analysis there was a statistically significant association with hypertension (p = 0.001, OR = 5.12), while β-thalassemia heterozygosity had no effect (p = 0.508, OR = 1.33). Mortality was linked to male sex (p = 0.036, OR = 2.09), increased age (p < 0.001) and β-thalassemia heterozygosity (p = 0.010, OR = 2.79) in multivariate analysis. It is worth noting that hyperlipidemia reduced mortality from COVID-19 (p = 0.008, OR = 0.38). No statistically significant association of current smoking status with patient characteristics studied was observed. Conclusions: Our pilot observations indicate enhanced mortality of β-thalassemia heterozygotes from COVID-19.

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