Clinical question
Introduction
Methods
Relevant outcome measures
Search and select
Study (first author name, reference) | Population | N | Age in years; median (IQR) | Inclusion period | Follow-up | Method | Outcome |
---|---|---|---|---|---|---|---|
Chen [3] | Hospitalised COVID-19 patients, 575 hospitals, China | 1590 | Not reported | Admission to hospital until 31 Jan 2020 (time of admission to hospital not reported) | Not reported | Multivariate Cox regression model; included prognostic factors selected based on univariable analyses; nomogram developed based on backward step-down selection | Mortality |
Cummings [6] | Hospitalised COVID-19 patients (≥18 years), critically ill with acute hypoxaemic respiratory failure, 2 hospitals, USA | 257 | 62 (51–72) | Admission to hospital between 2 Mar–1 Apr 2020; candidate factors measured during hospital stay (collected from medical records) | 28 Apr 2020 | Multivariate Cox regression model; included prognostic factors considered relevant to in-hospital mortality by the authors | In-hospital mortality |
Gao [7] | Hospitalised COVID-19 patients, 1 hospital, China | 2877 | Not reported for total group | Admission to hospital between 5 Feb–15 Mar 2020; candidate factors measured during hospital stay (collected from medical records) | 1 Apr 2020 | Multivariable Cox proportional hazards model; reason of selection of included prognostic factors in multivariable model not described | In-hospital mortality |
Giacomelli [4] | Hospitalised COVID-19 patients (≥18 years), 1 hospital, Italy | 233 | 61 (50–72) | Admission to hospital between 21 Feb–19 Mar 2020; candidate factors measured during hospital stay (collected from medical records) | 20 Apr 2020 | Multivariable Cox proportional hazards model; included prognostic factors selected based on univariable analyses | Mortality |
Klang [8] | Hospitalised COVID-19 patients (≥18 years), 5 hospitals, USA | 3406 | Not reported for total group | Admission to hospital between 1 Mar–17 May 2020; candidate factors measured during hospital stay (collected from medical records) | Not reported | Multivariable logistic regression model, adjusted for age decile, male sex, CAD, CHF, hypertension, DM, hyperlipidaemia, CKD, history of cancer, smoking (past or present), BMI 30–40 kg/m2, BMI ≥40 kg/m2 and race; included prognostic factors selected based on univariable analyses; no validation reported | In-hospital mortality |
Palaiodimos [9] | Hospitalised COVID-19 patients, 1 hospital, USA | 200 | 64 (50–73.5) | Admission to hospital between 9–22 Mar 2020; candidate factors measured during hospital stay (collected from medical records) | 3‑weeks follow-up: 12 Apr 2020 | Multivariate logistic regression model; 3 models used (model 1: BMI and age; model 2: all variables with significant univariate associations; model 3: variables of model 2 plus clinically significant variables that did not show a significant univariate association); no validation reported | In-hospital mortality |
Petrilli [10] | Admitted to hospital and non-admitted COVID-19 patients, >260 outpatient office sites and 4 acute care hospitals, USA | 5279 (2441 admitted to hospital) | Tested population: 54 (38–66); admitted population: 63 (51–74) | Patients tested between 1 Mar–8 Apr 2020; candidate factors measured during hospital stay (collected from medical records) | 5 May 2020 | Multivariable logistic regression model; predictors selected based on published literature and authors’ clinical experience with COVID-19 patients | Inpatient hospital admission, discharge to hospice or death among those admitted to hospital |
Wang [5] | Hospitalised COVID-19 patients (>60 years), 1 hospital, China | 339 | 69 (65–76) | Admission to hospital between 1 Jan–6 Feb 2020; candidate factors measured during hospital stay (collected from medical records) | 4 weeks from last admission | Multivariate Cox regression model; included prognostic factors selected based on univariable analyses; no validation reported | Mortality |
Description of studies
Results
Study (first author name, reference) | Mortality (n/N (%)) | Outcome | Included prognostic factors |
---|---|---|---|
Chen [3] | 50/1590 (3.1%) | Mortality | Age, coronary heart disease, cerebrovascular disease, dyspnoea, procalcitonin, aspartate aminotransferase, total bilirubin, creatinine |
Cummings [6] | 101/257 (39.0%) | Time from hospital admission to in-hospital mortality | Age, sex, symptom duration before hospital presentation, hypertension, chronic cardiac disease, COPD, DM, IL‑6 concentrations, D‑dimer concentrations |
Gao [7] | 56/2877 (1.9%) | All-cause mortality during hospitalization | Hypertension, age, sex, DM, myocardial infarction, treatment with PCI or CABG, renal failure, chronic heart failure, asthma, COPD, stroke |
Giacomelli [4] | 48/233 (20.6%) | Mortality (censoring date: 20 Apr 2020) | Age, sex, obesity, being treated with ≥1 antihypertensive agent, disease severity, presence of anaemia, lymphocyte count, D‑dimer, C‑reactive protein, creatinine, creatine kinase |
Klang [8] | 1136/3406 (33.4%) | In-hospital mortality | Age, sex, comorbidities (CAD, CHF, hypertension, DM, hyperlipidaemia, CKD, cancer), obesity, smoking status |
Palaiodimos [9] | 48/200 (24%) | In-hospital mortality | Age, BMI, heart failure, CAD, DM, CKD or end-stage renal disease, COPD, current or former smoker |
Petrilli [10] | 665/2741 (24.3%) | (1) Admission to hospital (2) Mortality (only admitted patients in analysis) | Age, BMI, sex, ethnicity, smoking status, CAD, heart failure, hypertension, DM, asthma or COPD, CKD, cancer |
Wang [5] | 65/339 (19.2%) | Mortality | Age, CVD, cerebrovascular disease, COPD |
Mortality predicted by prognostic factors measured during hospital stay
Statistically significant for mortality in respective study (Yes/No) | |||||||||
---|---|---|---|---|---|---|---|---|---|
Chen [3] | Cummings [6] | Gao [7] | Giacomelli [4] | Klang [8] (age ≤50 years) | Klang [8] (age >50 years) | Palaiodimos [9] | Petrilli [10] | Wang [5] | |
Predictor | HR (95% CI) | HR (95% CI) | HR (95% CI) | HR (95% CI) | OR (95% CI) | OR (95% CI) | OR (95% CI) | HR (95% CI) | HR (95% CI) |
Age, years | Yes <65 y: ref 65–74 y: 3.43 (1.24–9.5) ≥75 y: 7.86 (2.44–25.35) | Yes Per 10 y: 1.39 (1.29–1.57) | Yes Per year: 1.06 (1.04–1.09) | Yes Per 10 y: 2.08 (1.48–2.92) | Yes Per 10 y: 3.0 (1.9–4.8) | Yes Decile: 1.7 (1.6–1.8) | Yes Quartiles: 1.73 (1.13–2.63) | Yes 19–44 y: ref 45–54 y: 1.12 (0.80–1.60) 55–64 y: 2.04 (1.50–2.80) 65–74 y: 2.88 (2.46–4.80) ≥75 y: 3.46 (2.46–4.80) | Yes 1.86 (1.06–3.26) |
BMI, kg/m2 | – | No <40: ref ≥40: 0.76 (0.4–1.47) | – | Yes <30: ref ≥30: 3.04 (1.42–6.49) | Yes <30: ref 30–40: 1.1 (0.5–2.3) ≥40: 5.1 (2.3–11.1) | Yes >30: ref 30–40: 1.1 (0.9–1.3) ≥40: 1.6 (1.2–2.3) | Yes 25–34: ref <25: 1.37 (0.52–3.64) ≥35: 3.78 (1.45–9.83) | Yes <25: ref 25–30: 0.91 (0.74–1.11) 30–40: 1.02 (0.82–1.27) ≥40: 1.41 (0.98–3.02) Unknown: 1.85 (1.13–3.02) | – |
Smoking | – | – | – | – | No 1.7 (0.8–3.8) | No 1.0 (0.8–1.2) | No 0.83 (0.37–1.87) | Yes Never: ref Former: 1.13 (0.93–1.37) Current: 0.90 (0.61–1.31) Unknown: 1.56 (1.26–1.93) | – |
Hypertension (yes/no) | – | No 1.58 (0.89–2.81) | Yes 2.00 (1.13–3.54) | – | No 0.5 (0.2–1.1) | No 1.1 (0.9–1.3) | No 0.94 (0.76–1.16) | – | |
Diabetes mellitus (yes/no) | – | No 1.31 (0.81–2.10) | – | – | No 1.3 (0.7–2.6) | Yes 1.4 (1.2–1.7) | No 1.16 (0.55–2.44) | No 1.10 (0.93–1.31) | – |
Coronary artery disease or congestive heart failure (yes/no) | – | Yes 1.76 (1.08–2.86) | – | – | – | – | – | – | – |
Coronary artery disease (yes/no) | Yes 4.28 (1.14–16.13) | – | – | – | No 0.6 (0.2–2.1) | Yes 1.3 (1.1–1.6) | No 1.53 (0.54–4.34) | No 1.12 (0.92–1.36) | – |
Cerebrovascular disease (yes/no) | Yes 3.1 (1.07–8.94) | – | – | – | – | – | – | – | No 1.38 (0.65–2.93) |
Heart failure (yes/no) | – | – | Yes 3.3 (1.33–8.19) | – | Yes 4.0 (1.6–10.4) | No 1.0 (0.8–1.3) | No 1.43 (0.50–4.06) | Yes 1.77 (1.43–2.20) | – |
Body mass index
Smoking
Hypertension
Diabetes mellitus
Coronary artery disease or congestive heart failure
Cerebrovascular disease
Heart failure
Conclusion
Mortality predicted by prognostic factors measured during hospital stay
Body mass index
Smoking
Hypertension
Diabetes mellitus
Coronary artery disease
Cerebrovascular disease
Heart failure
Other cardiovascular risk factors, cardiovascular disease or cardiovascular history
Discussion
CAPACITY registry
Recommendations
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Regard patients with CVD and cardiovascular risk factors as vulnerable to COVID-19 and at risk of poor outcome.
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Be aware that patients with heart failure may have a greater risk of poor outcome and mortality.
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Healthcare professionals delivering care to patients with CVD should follow COVID-19 guidelines for vulnerable groups.
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Patients with CVD and cardiovascular risk factors should comply with the governmental and public health COVID-19 recommendations and advice for vulnerable groups. Implementation is expected to be high and should bear no extra costs since it is embedded in the current governmental policies.