A comparison of mortality-related risk factors of COVID-19, SARS, and MERS: A systematic review and meta-analysis

J Infect. 2020 Oct;81(4):e18-e25. doi: 10.1016/j.jinf.2020.07.002. Epub 2020 Jul 4.

Abstract

Objective: Coronavirus Disease 2019 (COVID-19) is a pandemic. This systematic review compares mortality risk factors including clinical, demographic and laboratory features of COVID-19, Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). The aim is to provide new strategies for COVID-19 prevention and treatment.

Methods: We performed a systematic review with meta-analysis, using five databases to compare the predictors of death for COVID-19, SARS and MERS. A random-effects model meta-analysis calculated odds ratios (OR) and 95% confidence intervals (95% CI).

Results: 845 articles up through 11/4/2020 were retrieved, but only 28 studies were included in this meta-analysis. The results showed that males had a higher likelihood of death than females (OR = 1.82, 95% CI 1.56-2.13). Age (OR = 7.86, 95% CI 5.46-11.29), diabetes comorbidity (OR = 3.73, 95% CI 2.35-5.90), chronic lung disease (OR = 3.43, 95% CI 1.80-6.52) and hypertension (OR = 3.38, 95% CI 2.45-4.67) were the mortality risk factors. The laboratory indicators lactic dehydrogenase (OR = 37.52, 95% CI 24.68-57.03), C-reactive protein (OR = 12.11, 95% CI 5.24-27.98), and neutrophils (OR = 17.56, 95% CI 10.67-28.90) had stronger correlations with COVID-19 mortality than with SARS or MERS mortality. Consolidation and ground-glass opacity imaging features were similar among COVID-19, SARS, and MERS patients.

Conclusions: COVID-19's mortality factors are similar to those of SARS and MERS. Age and laboratory indicators could be effective predictors of COVID-19 mortality outcomes.

Keywords: COVID-19; MERS; Meta-analysis; Mortality; Risk factors; SARS.

Publication types

  • Comparative Study
  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Betacoronavirus
  • C-Reactive Protein / analysis
  • COVID-19
  • Coronavirus Infections / epidemiology*
  • Coronavirus Infections / mortality*
  • Diabetes Mellitus / pathology
  • Female
  • Humans
  • Hypertension / pathology
  • L-Lactate Dehydrogenase / blood
  • Lung Diseases / pathology
  • Male
  • Middle East Respiratory Syndrome Coronavirus
  • Neutrophils / cytology
  • Pandemics
  • Pneumonia, Viral / epidemiology*
  • Pneumonia, Viral / mortality*
  • Risk Factors*
  • SARS-CoV-2
  • Severe Acute Respiratory Syndrome / epidemiology*
  • Severe Acute Respiratory Syndrome / mortality*
  • Severe acute respiratory syndrome-related coronavirus
  • Sex Factors

Substances

  • C-Reactive Protein
  • L-Lactate Dehydrogenase