Impact of age, sex, comorbidities and clinical symptoms on the severity of COVID-19 cases: A meta-analysis with 55 studies and 10014 cases

04, December 2020 |

Authors:

Abstract

Purpose: Severe acute respiratory coronavirus 2 (SARS-CoV-2) cases are overgrowing globally and now become a pandemic. A meta-analysis was conducted to evaluate the impact of age, sex, comorbidities, and clinical char- acteristics on the severity of COVID-19 to help diagnose and evaluate the current outbreak in clinical decision- making. Methods: PubMed, ScienceDirect, and BMC were searched to collect data about demographic, clinical charac- teristics, and comorbidities of COVID-19 patients. Meta-analysis was conducted with Review Manager 5.3. Publication bias was assessed using Egger's test and Begg-Mazumdar's rank correlation. Results: Fifty-five studies were included in this meta-analysis, including 10014 patients with SARS-CoV-2 infec- tion. Male cases and cases with an age of !50 years (OR 1⁄4 2.41, p < 0.00001; RR 1⁄4 3.36, p 1⁄4 0.0002, respectively) were severely affected by SARS-CoV-2. Patients having age!65 years are not associated (p 1⁄4 0.110) with the severity of COVID-19. Presence of at least one comorbidity or hypertension, diabetes, cerebrovascular disease, cardiovascular diseases, respiratory disease, malignancy, chronic kidney disease and chronic liver dis- eases individually increased the severity of COVID-19 cases significantly (OR 1⁄4 3.13, p < 0.00001; OR 1⁄4 2.35, p < 0.00001; OR 1⁄4 2.42, p < 0.00001; OR 1⁄4 3.78, p < 0.00001; OR 1⁄4 3.33, p < 0.00001; OR 1⁄4 2.58, p < 0.00001; OR 1⁄4 2.32, p < 0.00001; OR 1⁄4 2.27, p 1⁄4 0.0007; OR 1⁄4 1.70, p 1⁄4 0.003, respectively). Clinical manifestation such as fever, cough, fatigue, anorexia, dyspnea, chest tightness, hemoptysis, diarrhea and abdominal pain (OR 1⁄4 1.68, p 1⁄4 0.0001; OR 1⁄4 1.41, p 1⁄4 0.004; OR 1⁄4 1.26, p 1⁄4 0.03; OR 1⁄4 2.38, p < 0.0001; OR 1⁄4 4.30, p < 0.00001; OR 1⁄4 2.11, p 1⁄4 0.002; OR 1⁄4 4.93, p < 0.0001; OR 1⁄4 1.35, p 1⁄4 0.03; OR 1⁄4 2.38, p 1⁄4 0.008, respectively) were significantly associated with the severity of cases. No association of severity was found with myalgia, phar- yngalgia, nausea, vomiting, headache, dizziness and sore throat (p > 0.05). No publication bias was found in case of age (!50 years, age!65 years), comorbidities and clinical manifestations. Conclusions: Males patients and elderly or older patients (age !50 years) are at higher risk of developing severity, whereas comorbidities and clinical manifestations could significantly affect the prognosis and severity of COVID- 19.