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      Severity and mortality of COVID 19 in patients with diabetes, hypertension and cardiovascular disease: a meta-analysis

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          Abstract

          Background

          The aim of this study is to evaluate the impact of diabetes, hypertension, cardiovascular disease and the use of angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) with severity (invasive mechanical ventilation or intensive care unit admission or O2 saturation < 90%) and mortality of COVID-19 cases.

          Methods

          Systematic review of the PubMed, Cochrane Library and SciELO databases was performed to identify relevant articles published from December 2019 to 6th May 2020. Forty articles were included involving 18.012 COVID-19 patients.

          Results

          The random-effect meta-analysis showed that diabetes mellitus and hypertension were moderately associated respectively with severity and mortality for COVID-19: Diabetes [OR 2.35 95% CI 1.80–3.06 and OR 2.50 95% CI 1.74–3.59] Hypertension: [OR 2.98 95% CI 2.37–3.75 and OR 2.88 (2.22–3.74)]. Cardiovascular disease was strongly associated with both severity and mortality, respectively [OR 4.02 (2.76–5.86) and OR 6.34 (3.71–10.84)]. On the contrary, the use of ACEI/ARB, was not associate with severity of COVID-19.

          Conclusion

          In conclusion, diabetes, hypertension and especially cardiovascular disease, are important risk factors for severity and mortality in COVID-19 infected people and are targets that must be intensively addressed in the management of this infection.

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Chaolin Huang, Yeming Wang, Xingwang Li … (2020)
          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Clinical Characteristics of Coronavirus Disease 2019 in China

            Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)
            Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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              Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

              Fei Zhou, Ting Yu, Ronghui Du … (2020)
              Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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                Author and article information

                Contributors
                Bianca de Almeida-Pititto: bapititto@unifesp.br
                Patrícia M. Dualib: patricia.dualib@uol.com.br
                Lenita Zajdenverg: lenitazaj@gmail.com
                Joana Rodrigues Dantas: joanardantasp@gmail.com
                Filipe Dias de Souza: filipesouza.endocrino@outlook.com
                Melanie Rodacki: melanierodacki@gmail.com
                Marcello Casaccia Bertoluci: mcbertoluci@hcpa.edu.br
                Journal
                Journal ID (nlm-ta): Diabetol Metab Syndr
                Journal ID (iso-abbrev): Diabetol Metab Syndr
                Title: Diabetology & Metabolic Syndrome
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1758-5996
                Publication date (Electronic): 31 August 2020
                Publication date PMC-release: 31 August 2020
                Publication date Collection: 2020
                Volume: 12
                Electronic Location Identifier: 75
                Affiliations
                [1 ]GRID grid.411249.b, ISNI 0000 0001 0514 7202, Departamento de Medicina Preventiva, , Escola Paulista de Medicina, Universidade Federal de São Paulo, ; Rua Botucatu, n° 740, Vila Clementino, São Paulo, SP CEP 04023-062 Brazil
                [2 ]Sociedade Brasileira de Diabetes–SBD, Rua Afonso Braz, 579, Salas 72/74, Vila Nova Conceição, São Paulo, SP CEP 04511-011 Brazil
                [3 ]GRID grid.411249.b, ISNI 0000 0001 0514 7202, Programa de Pós-Graduação Em Endocrinologia E Metabologia, , Escola Paulista de Medicina, Universidade Federal de São Paulo, ; Rua Estado de Israel, n° 639, Vila Clementino, São Paulo, SP CEP 04022-001 Brazil
                [4 ]GRID grid.411249.b, ISNI 0000 0001 0514 7202, Departamento de Medicina, , Escola Paulista de Medicina, Universidade Federal de São Paulo, ; Rua Sena Madureira, 1500, Vila Clementino, São Paulo, SP CEP 04021-001 Brazil
                [5 ]GRID grid.8536.8, ISNI 0000 0001 2294 473X, Departamento de Clínica Médica, Serviço de Nutrologia, , Hospital Universitário Clementino Fraga Filho, Universidade Federal Do Rio de Janeiro, ; Rua Professor Rodolpho Paulo Rocco, 255/sala 9E14, Cidade Universitária, Rio de Janeiro, RJ CEP 21941-590 Brazil
                [6 ]GRID grid.8532.c, ISNI 0000 0001 2200 7498, Departamento de Medicina Interna, Faculdade de Medicina, , Universidade Federal Do Rio Grande Do Sul (UFRGS), ; Rua Ramiro Barcelos, 2350, 4º Andar, Porto Alegre, RS CEP 90035‑007 Brazil
                [7 ]GRID grid.414449.8, ISNI 0000 0001 0125 3761, Unidade de Endocrinologia, Hospital de Clínicas de Porto Alegre (HCPA-UFRGS), ; Rua Ramiro Barcelos, 2350, 4º Andar, Porto Alegre, RS CEP 90035‑007 Brazil
                Article
                Publisher ID: 586
                DOI: 10.1186/s13098-020-00586-4
                PMC ID: 7456786
                PubMed ID: 32874207
                SO-VID: 1e12f60c-e2be-4b0e-b407-3fbae94300dc
                Copyright © © The Author(s) 2020
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 15 July 2020
                Date accepted : 21 August 2020
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2020

                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: diabetes,hypertension,cardiovascular disease,covid-19,sars-cov-2,severity,mortality
                Data availability:
                ScienceOpen disciplines: Nutrition & Dietetics
                Keywords: diabetes, hypertension, cardiovascular disease, covid-19, sars-cov-2, severity, mortality

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