Male, aged over 65, smoking patients have a greater risk of COVID-19

Male, aged over 65, smoking patients have a greater risk of COVID-19

Objectives:
What are the risk factors, clinical manifestations and laboratory examinations for the progression of COVID-19?

Study design:
This review article included 13 studies with a total number of 3,027 patients with SARS-CoV-2 infection (COVID-19 infection).

All of the selected studies were published in 2020 with different sample patient sizes that ranged from 27 to 1,099 patients.

The median ages ranged from 49 to 70.5 years old in the critical/mortal group across the enrolled studies.

Results and conclusions:
The investigators found male, older than 65 and smoking were risk factors for disease progression in patients with COVID-19 [male: OR = 1.76, 95% CI =1.41 to 2.18, p 0.00001, I2 = 0%, age over 65 years old: OR = 6.06, 95% CI = 3.98 to 9.22, p 0.00001, I2 = 0%,  current smoking: OR = 2.51, 95% CI = 1.39 to 3.32, p = 0.0006, I2 = 0%].

The investigators found the proportion of underlying diseases such as hypertension, diabetes, cardiovascular disease and respiratory disease were statistically significant higher in critical/mortal patients compared to the non-critical patients [diabetes: OR = 3.68, 95% CI = 2.68 to 5.03, p 0.00001, I2 = 45%, hypertension: OR = 2.72, 95% CI = 1.60, to 4.64, p = 0.0002, I2 = 72%, cardiovascular disease: OR = 5.19, 95% CI = 3.25 to 8.29, p 0.00001, I2 = 37%, respiratory disease: OR = 5.15, 95% CI = 2.51 to 10.57, p 0.00001, I2 = 50%].

The investigators found clinical manifestations such as fever (temperature ≥ 37.3°C), shortness of breath or dyspnea were associated with the progression of disease [fever: OR = 0.56, 95% CI = 0.38 to 0.82, p = 0.003, shortness of breath or dyspnea: OR = 4.16, 95% CI = 3.13 to 5.53, p 0.00001].

The investigators found laboratory examination such as aspartate amino transferase(AST) > 40U/L, creatinine(Cr) ≥ 133mol/L, hypersensitive cardiac troponin I(hs-cTnI) > 28pg/mL, procalcitonin(PCT) > 0.5ng/mL, lactatede hydrogenase(LDH) > 245U/L and D-dimer > 0.5mg/L predicted the deterioration of disease while white blood cells(WBC)4 × 109/L meant a better clinical status:
[AST > 40U/L: OR = 4.00, 95% CI = 2.46 to 6.52, p 0.00001]
[Cr ≥ 133μmol/L: OR = 5.30, 95% CI = 2.19, 12.83, p = 0.0002]
[hs-cTnI > 28 pg/mL: OR = 43.24, 95% CI = 9.92 to 188.49, p 0.00001]
[PCT > 0.5 ng/mL: OR = 43.24, 95% CI = 9.92 to 188.49, p 0.00001]
[LDH > 245U/L: OR = 43.24, 95% CI = 9.92 to 188.49, p 0.00001]
D-dimer > 0.5mg/L: OR = 43.24, 95% CI = 9.92 to 188.49, p 0.00001]
[WBC 4 × 109/L: OR = 0.30, 95% CI = 0.17 to 0.51, p 0.00001].

The investigators concluded male, aged over 65, smoking patients have a greater risk of developing into the critical or mortal condition and the comorbidities such as hypertension, diabetes, cardiovascular disease and respiratory diseases worsen the prognosis of the COVID-19.
Patients with shortness of breath/dyspnea are more likely to develop into critical illness or even die, but patients with fever (temperature ≥ 37.3°C) progressed better than those without fever. Laboratory examinations such as WBC, AST, Cr, hs-cTnI, PCT, LDH and D-dimer could imply the progression of COVID-19.

Original title:
Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis by Zheng Z, Peng F, […], Tang W.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7177098/

Additional information of El Mondo:
Find more information/studies on coronavirus and OR/95% CI/review article right here.