Ek Hastalıklar ile COVID-19 Kaynaklı Mortalite Arasındaki İlişki: Meta Analiz Çalışması

Öz

Amaç: Bu çalışmada, hayatta kalan ve ölen hastalardaki ek hastalık oranları incelenerek ek hastalık varlığı ile COVID-19 kaynaklı mortalite arasındaki ilişkinin ortaya konması amaçlandı. Yöntem: Bu meta-analiz çalışması için Scopus, PubMed ve Web of Science veri tabanları üzerinde, Ocak 2021'e kadar makale taraması yapıldı. Hastalara ilişkin sonuç değişkeni olarak ölüm seçildi. Ek hastalıklar; böbrek hastalığı, hipertansiyon, diyabet, kardiyovasküler hastalık, karaciğer hastalığı, otoimmün hastalık ve malignite olarak seçildi. Odds oranlarını (OR) belirlemek için sabit etkili ve rastgele etkili meta-analiz kullanıldı. Heterojenlik varlığı Ki-kare ve Higgins I2 testleri ile değerlendirildi. Yayın yanlılığı ise huni grafiği ve Hegger testi ile incelendi. Bulgular: Bu meta-analizde 16 çalışmadan elde edilen 11467 COVID-19 hastasına ilişkin sonuçlar kullanıldı. Böbrek hastalığı varlığı (OR=2,30; %95 GA: 1,96-2,70; p<0,001), hipertansiyon varlığı (OR=2,14; %95 GA: 1,67-2,76; p<0,001), diyabet varlığı (OR=1,85; %95 GA: 1,63-2,10; p<0,001), kardiyovasküler hastalık varlığı (OR=2,85; %95 GA: 2,00-4,06; p<0,001) ölen hastalarda daha yüksekti. Karaciğer hastalığı, malignite ve otoimmün hastalık bakımından ise anlamlı bir fark bulunamadı (p>0,05). Sonuç: Bu meta-analiz çalışması; böbrek hastalığı, hipertansiyon, diyabet ve kardiyovasküler hastalık gibi majör ek hastalıkların COVID-19 kaynaklı ölüm riskini artırdığını göstermektedir. Bu nedenle çalışmamızda, spesifik ek hastalığı olan hastaların ihtiyaçlarını karşılamak için uygun tedavi seçiminin ne kadar önemli olduğu vurgulanmaktadır.

Anahtar Kelimeler

• COVID-19
• mortalite
• meta-analiz
• ek hastalıklar

Association between Pre-Existing Comorbidities and COVID-19 Related Mortality: A Meta-Analysis Study

Öz

Objective: In our study, we aimed to examine the proportion of comorbidities in survivors and non-survivors and investigate the association between the comorbidities and COVID-19 related mortality. Methods: We searched Scopus, PubMed and Web of Science for articles up to January, 2021. Patients’ outcomes were selected as survived and non-survived. Comorbidities were selected as kidney disease, hypertension, diabetes mellitus, cardiovascular disease, liver disease, autoimmune disease and malignancy. Odds ratios (ORs) were reported using fixed-effect and random-effect meta-analysis. The heterogeneity was assessed by the Chi-square test and Higgins' I2 test. The publication bias was examined via funnel plot and Hegger’s test. Results Our meta-analysis was conducted based on 11467 COVID-19 cases from 16 studies. Compared to the survivors, the odds of kidney disease (OR=2.30; 95% CI: 1.96-2.70; p<0.001), odds of hypertension (OR=2.14; 95% CI: 1.67-2.76; p<0.001), odds of diabetes mellitus (OR=1.85; 95% CI: 1.63-2.10; p<0.001), odds of cardiovascular disease (OR=2.85; 95% CI: 2.00-4.06; p<0.001) were higher in non-survivors. There was no significant difference for the odds of liver disease, malignancy and autoimmune disease (p>0.05). Conclusion: Our meta-analysis suggests that the major comorbidities such kidney disease, hypertension, diabetes mellitus and cardiovascular disease increase the risk of death from COVID-19 disease. Our study also highlights the importance of appropriate treatment for the patients with these specific comorbidities to meet their need.

Anahtar Kelimeler

• Comorbidities
• COVID-19
• mortality
• meta-analysis

Kaynakça

1. Bai T, Tu S, Wei Y, et al. Clinical and laboratory factors predicting the prognosis of patients with COVID-19: an analysis 127 patients in Wuhan, China. Lancet Respir. Med. doi:10.2139/ssrn.3546118
2. Chen T, Wu D, Chen H, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;31:368-380. doi:10.1136/BMJ.M1295
3. Fu L, Fei J, Xiang HX, et al. Influence factors of death risk among COVID-19 patients in Wuhan, China: a hospital-based case-cohort study. medRxiv. doi:10.1101/2020.03.13.20035329
4. Graselli G, Greco M, Zanella A, et al. Risk factors associated with mortality among patients with COVID-19 in intensive care units in Lombardy, Italy. JAMA Intern Med. 2020;180:1345-1355. doi:10.1001/jamainternmed.2020.3539
5. Gupta R, Agrawal R, Bukhari Z, et al. Higher comorbidities and early death in hospitalized African-American patients with Covid-19. BMC Infect Dis. 2021;21:78-89. doi:10.1186/S12879-021-05782-9
6. Luo X, Xia H, Yang W, et al. Characteristics of patients with COVID-19 during epidemic ongoing outbreak in Wuhan, China. medRxiv. doi:10.11001/2020.03.19.20033175
7. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020;395:1054-1062. doi:10.1016/s0140-6736(20)30566-3
8. Wang L, He W, Yu X, et al. Coronovirus disease 2019 in elderly patients: Characteristics and prognostic factors based on 4-week follow-up. J Infect. 2020;80:639-645. doi:10.1016/j.jinf.2020.03.019

9. Du RH, Liang LR, Yang CQ, et al. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur Respir J. 2020;55(5):2000524. doi:10.1183/13993003.00524-2020
10. Cao J, Tu WJ, Cheng W, et al. Clinical features short-term outcomes of 102 patients with corona virus disease 2019 in Wuhan, China. Clin Infect Dis. 2020;71:748-755. doi:10.1093/cid/ciaa243
11. Gu T, Chu Q, Yu Z, et al. History of coronary heart disease increases the mortality rate of COVID-19 patients: a nested case-control study. BMJ Open. 2020;10(9):e038976. doi:10.1136/bmjopen-2020-038976
12. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8:475-481. doi:10.1016/S2213-2600(20)30079
13. Deng Y, Liu W, Liu K, et al. Clinical characteristics of fatal and recovered cases of coronavirus disease 2019 in Wuhan, China: a retrospective study. Chin Med J. 2020;133:1261-1267. doi:10.1097/CM9.0000000000000824
14. Lee LYW, Cazier JB, Angelis V, et al. COVID-19 mortality in patients with cancer on chemotherapy or other anticancer treatments: a prospective cohort study. Lancet. 2020;395:1919-1926. doi:10.1016(S0140-6736(20)31173-9
15. Klang E, Kassim G, Soffer S, Freeman R, Levin MA, Reich DL. Morbid obesity as an independent risk factor for COVID-19 mortality in hospitalized patients younger than 50. Obesity. 2020;28:1595-1599. doi:10.1002/oby.22913
16. Abbatista M, Ciavarella A, Capecchi M, et al. Risk factors for mortality in hospitalized patients with COVID-19: a study in Milan, Italy. Infect Dis. 2021;53:226-229. doi:10.1080/23744235.2020.18559131
17. Ssentongo P, Ssentongo AE, Heilbrunn ES, Ba DM, Chinchilli VM. Association of cardiovascular disease and 10 other pre-existing comorbidities with COVID-19 mortality: A systematic review and meta-analysis. PloS One. 2020;15(8):e0238215. doi:10.1371/journal.pone.0238215
18. Pranata R, Huang I, Lim MA, Wahjoepramono EJ, July J. Impact of cerebrovascular and cardiovascular diseases on mortality and severity of COVID-19- systematic review, meta-analysis and meta-regression. J Stroke Cerebrovasc Dis. 2020; 29(8):104949. doi:10.1016/j.jsrokecerebrovasdis.2020.104949
19. Qiu P, Zhou Y, Wang F, et al. Clinical characteristics, laboratory outcome characteristics, comorbidities, and complications of related COVID-19 deceased: a systematic review and meta-analysis. Aging Clin Exp Res. 2020;32:1869-1878. doi:10.1007/s40520-020-01664-3