• Stefano Figliozzi, Pier Giorgio Masci, Navid Ahmadi, Lara Tondi, Evangelia Koutli, Alberto Aimo, Kimon Stamatelopoulos, Meletios-Athanasios Dimopoulos, Caforio Alida L P ALP Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua Medical School, Padova, Italy., and Georgios Georgiopoulos.
• School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK.
• Eur. J. Clin. Invest. 2020 Oct 1; 50 (10): e13362.

BackgroundIdentification of reliable outcome predictors in coronavirus disease 2019 (COVID-19) is of paramount importance for improving patient's management.MethodsA systematic review of literature was conducted until 24 April 2020. From 6843 articles, 49 studies were selected for a pooled assessment; cumulative statistics for age and sex were retrieved in 587 790 and 602 234 cases. Two endpoints were defined: (a) a composite outcome including death, severe presentation, hospitalization in the intensive care unit (ICU) and/or mechanical ventilation; and (b) in-hospital mortality. We extracted numeric data on patients' characteristics and cases with adverse outcomes and employed inverse variance random-effects models to derive pooled estimates.ResultsWe identified 18 and 12 factors associated with the composite endpoint and death, respectively. Among those, a history of CVD (odds ratio (OR) = 3.15, 95% confidence intervals (CIs) 2.26-4.41), acute cardiac (OR = 10.58, 5.00-22.40) or kidney (OR = 5.13, 1.78-14.83) injury, increased procalcitonin (OR = 4.8, 2.034-11.31) or D-dimer (OR = 3.7, 1.74-7.89), and thrombocytopenia (OR = 6.23, 1.031-37.67) conveyed the highest odds for the adverse composite endpoint. Advanced age, male sex, cardiovascular comorbidities, acute cardiac or kidney injury, lymphocytopenia and D-dimer conferred an increased risk of in-hospital death. With respect to the treatment of the acute phase, therapy with steroids was associated with the adverse composite endpoint (OR = 3.61, 95% CI 1.934-6.73), but not with mortality.ConclusionsAdvanced age, comorbidities, abnormal inflammatory and organ injury circulating biomarkers captured patients with an adverse clinical outcome. Clinical history and laboratory profile may then help identify patients with a higher risk of in-hospital mortality.© 2020 Stichting European Society for Clinical Investigation Journal Foundation.

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