Association of Demographic, Clinical, Laboratory, and Radiological Characteristics with Outcomes of COVID-19 Patients: An Updated Review and Meta-Analysis

Background: Risk factors for the adverse clinical outcomes of COVID-19 pneumonia have not yet been well delineated across different countries. The aim of this meta-analysis was to assess association between a composite clinical outcome (severe infection/ required ICU admission/ death) of COVID-19 pneumonia and demographic, clinical, laboratory and radiological findings of these patients.Methods: A literature search was conducted using the databases PubMed, Medline, Scopus and Web of Science through July 25, 2020. Relative risk (RRs), standardized mean difference (SMDs) and 95% confidence intervals (CIs) were pooled using random-effects models. We described overall estimates of relevant data of clinical importance (described in past literatures) from 1, 16,260 COVID-19 pneumonia patients including 19,628 with composite end points from 40 observational studies of 5 countries.Findings: The result showed that male gender (RR=1.24, CI=1.15-1.34, p <.001), older age (SMD= 3.19, CI=2.17 - 4.21, P 64 years (RR=2.52, CI=1.94-3.27, P <.001) followed aggravated course. Delayed hospitalization (SMD=.75, CI=.23-1.28, p= 0.005), presence of co-morbidity (RR= 1.76, 95% CI=1.50-2.07, p<.001) and multiple co-morbidities (RR=1.50, CI=1.27- 1.77, p<.001) were associated with higher risk of fatal course. Pooled data reported significantly high neutrophil-lymphocyte ratio (SMD=10.79, CI=8.89-12.68, p<.001), low lymphocyte-to-C-reactive protein ratio (SMD=-3.89, CI= -4.99 to -2.80, p<.001), low platelet count (SMD=-1.622, I=-2.64 to -.61, p<.001), prolonged prothrombin time (SMD=0.98, CI=.07- 1.90, p<.001), high lactate dehydrogenase (SMD=6.260, I= 4.50- 8.02, p<.001), D-dimer (SMD=1.92, CI=1.60- 2.24, p<.001) and creatine kinase level (SMD=1.68, CI=.73- 2.64, p= 0.001) in patients with fatal outcome. Funnel plots and Egger’s tests did not reveal any significant publication bias.Interpretation: Features like older age, male gender, presence of co-morbidities and delayed hospitalization along with the laboratory findings consistent with immune system activation, coagulation disorder and tissue damage could help clinicians to identify COVID-19 patients with poor prognosis at an early stage.Funding No funding received for this work from any of the organizations or so. All authors reported no biomedical financial interests or potential conflicts of interest.Funding Statement: None.Declaration of Interests: All authors reported no biomedical financial interests or potential conflicts of interest.Ethics Approval Statement: The study does not require ethical approval because the meta-analysis is based on published research and the original data are anonymous. We took a waiver for the ethical approval from the Institutional Ethical Committee of MAMC, New Delhi.