People with chronic obstructive pulmonary disease (COPD) are among the most vulnerable to COVID-19 infections, being even more likely to develop severe disease or to be admitted to intensive care units (ICU) than those with diseases like high blood pressure or diabetes, an analysis of several published studies found.
The research also shows that shortness of breath (dyspnea) is the only COVID-19 symptom significantly associated with disease severity and ICU admission, a finding that may help group patients according to risk and allocate healthcare resources more efficiently.
The study, “Systematic review and meta-analysis of predictive symptoms and comorbidities for severe COVID-19 infection,” has been published in MedRxiv in advance of its printing and prior to peer review.
The coronavirus (SARS-2-CoV) pandemic has become a public health emergency, and cases worldwide are rapidly rising.
Defining the risk factors for severe COVID-19 infections is of utmost priority to maximize the use of available resources. This can help to create tools that predict a patient’s risk of having severe disease, allowing for early intervention in high-risk patients.
Recent studies suggest that fever and cough are the most common symptoms, and that older people and those with specific chronic medical conditions may be at higher risk for severe disease.
Researchers at the University College London (UCL) conducted a meta-analysis of seven published studies from China, looking at the symptoms and conditions associated with severe COVID-19 infections.
The analysis included a total of 1,813 patients who were admitted to the hospital with laboratory-confirmed COVID-19. Among them, 116 were admitted to the ICU, and 315 were classified as having severe disease.
ICU patients were older than those not requiring intensive care — a median age of 62.4 versus 46 — and a significantly higher proportion were male (67.2% vs. 57.1%).
The most common symptoms were cough and fever in all groups: severe, non-severe, ICU, and non-ICU.
However, shortness of breath (dyspnea) was the only symptom significantly more common to severe patients than non-severe ones (37.2% vs. 14.7%), and in ICU patients compared to those not needing this level of care (61.2% vs. 10.2%).
Dyspnea was seen to be a significant predictor of both severe illness and ICU admission. In fact, patients experiencing shortness of breath were 3.7 times more likely to have severe disease, and 6.6 times more likely to be admitted to the ICU, compared to those without this symptom.
“Our analysis finds that dyspnea is the only symptom strongly predictive for both severe disease and ICU admission, and could be a useful symptom to help guide clinical management decisions,” Vageesh Jain, the study’s lead author with the UCL Institute for Global Health, said in a press release.
“Whilst dyspnea was not a particularly common symptom in COVID-19 patients (the most common symptoms for non-severe cases being fever and cough), its significant association with both severe disease and ICU admission may help clinicians discriminate between severe and non-severe COVID-19 cases,” Jain added.
The team then investigated which chronic conditions were predictive of severe disease and ICU admission. While COPD, cardiovascular disease, and high blood pressure (hypertension) were all predictive of both these outcomes, COPD was found to be the stronger predictive factor.
COPD was not the most common disease — being present in only 4.5% of those with severe COVID-19, and in 9.7% of all in the ICU — but it increased by 17.8 times the likelihood of being admitted to an ICU. People with COPD were also 6.4 times more likely to develop severe disease.
For those with cardiovascular disease, the likelihood for severe disease was 2.7 times higher, and for ICU admissions 4.4 times more likely. High blood pressure increased these chances by two-fold (for severe disease) and 3.7 fold (for ICU admission).
Diabetes had no association with either severe disease or admission to an ICU, but researchers say that the studies examining diabetes were highly heterogeneous, which may hinder a significant association.
“Our analysis similarly suggests that comorbidities are not uniform in terms of the risk of severe COVID-19 disease,” the researchers wrote. “Despite being uncommon in our study population, COPD was by far the strongest risk factor for COVID-19 severity, followed by [cardiovascular disease] and hypertension.”
“As the outbreak develops, future research must aim to substantiate these findings by investigating factors related to disease severity. This will aid clinical assessment, risk stratification, and resource allocation, and allow public health interventions to be targeted at the most vulnerable,” they concluded.
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