Chathurika Dhanasekara MBBS, PhD, Shao-Hua Chin PhD, Chanaka N. Kahathuduwa MBBS, PhD
Background: We estimated the prevalence of severe or critical illness and case fatality of COVID-19 in a systematic review and meta-analysis and examined clinical, biochemical, and radiological risk factors in a meta-regression.
Methods: PRISMA guidelines were followed. PubMed, Scopus and Web of Science were searched using pre-specified keywords. Peer-reviewed empirical studies examining rates of severe illness, critical illness and case fatality among COVID-19 patients were analyzed. Random-effects meta-analyses were performed and adjusted for publication bias. Meta-regression analyses examined the moderator effects of risk factors.
Results: The meta-analysis included 29 studies representing 2,090 individuals. Pooled prevalence rates of severe illness, critical illness and case fatality among COVID-19 patients were 15%, 5%, and 0.8%, respectively. There were significant heterogeneity and publication bias in these studies. Meta-regression analyses revealed that increasing age and elevated LDH consistently predicted severe / critical disease and case fatality. In addition, hypertension, fever and dyspnea at presentation, and elevated CRP predicted increased severity.
Conclusions: These predictors of severity and case fatality should allow clinicians to define at-risk endophenotypes. Differences in unadjusted vs. adjusted pooled estimates indicates limited utility of small-scale studies and underscores the importance of multinational studies to establish the morbidity and mortality rates in pandemics.
Keywords: SARS-CoV-2, COVID-19, case fatality, meta-analysis, meta-regression
Article citation: Dhanasekara C, Chin S-H, Kahathuduwa CN. Severity and case fatality rates of COVID-19: a systematic review, meta-analysis and an exploratory meta-regression of risk factors. The Southwest Respiratory and Critical Care Chronicles 2021;9(41):8–19
From: Department of Psychiatry (CNK), Department of Laboratory Science and Primary Care (CNK), Department of Surgery (CSD), Texas Tech University Health Sciences Center, Lubbock, Texas; Medical Science Department (SHC), Protech Pharmaservices Corporation, Taipei City, Taiwan
Submitted: 8/6/2021
Accepted: 10/9/2021
Reviewer: Jeff Dennis PhD
Conflicts of interest: none
This work is licensed under a Creative Commons
Attribution-ShareAlike 4.0 International License.