Severity and case fatality rates of COVID-19: a systematic review, meta-analysis and an exploratory meta-regression of risk factors

  • Chathurika Samudani Dhanasekara Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA. https://orcid.org/0000-0002-2661-062X
  • Shao-Hua Chin Department of Medical Science, Protech Pharmaservices Corporation, Taipei City, Taiwan.
  • Chanaka N. Kahathuduwa Department of Laboratory Science and Primary Care (PA Program), School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, USA. Department of Psychiatry, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA. https://orcid.org/0000-0003-2049-4901

Abstract

Background: We aimed to estimate prevalence of severe or critical illness and case fatality of COVID-19 in a systematic review and meta-analysis and to examine 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 examined. 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 related with the studies. Meta-regression analyses revealed that increasing age and elevated LDH consistently predicted severe / critical disease and case fatality. Moreover, hypertension; fever and dyspnea at presentation; and elevated CRP predicted increased severity.

Conclusions: Emerged predictors of severity and case fatality should inform clinicians to define at-risk endophenotypes. Differences in un-adjusted vs. adjusted pooled estimates indicates limited utility of small-scale studies and underscores the importance of multi-national studies to establish the morbidity and mortality rates in pandemics.

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Author Biographies

Chathurika Samudani Dhanasekara, Department of Surgery, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.

HSC Research Associate,

Department of Surgery,

School of Medicine,

Texas Tech University Health Sciences Center,

Lubbock, Texas, USA.

Chanaka N. Kahathuduwa, Department of Laboratory Science and Primary Care (PA Program), School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, Texas, USA. Department of Psychiatry, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.

Assistant Professor – Department of Laboratory Sciences and Primary Care, School of Health Professions

Clinical Assistant Professor – Department of Psychiatry, School of Medicine

Texas Tech University Health Sciences Center

Affiliate Faculty – Department of Human Development and Family Studies, College of Human Sciences

Texas Tech University

Published
2021-10-22
How to Cite
Dhanasekara, C. S., Chin, S.-H., & Kahathuduwa, C. N. (2021). 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, 9(41), 8-19. https://doi.org/10.12746/swrccc.v9i41.921