Systematic Reviews
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Infect Dis. Jun 18, 2020; 10(2): 24-32
Published online Jun 18, 2020. doi: 10.5495/wjcid.v10.i2.24
Predictors of severe and critical COVID-19: A systematic review
Sameh Hany Emile, Sualeh Muslim Khan
Sameh Hany Emile, General Surgery Department, Mansoura University Hospitals, Mansoura University, Mansoura City 35516, Egypt
Sualeh Muslim Khan, Dow Medical College, Dow University of Health Sciences, Karachi 74200, Pakistan
Author contributions: Emile SH designed and wrote the manuscript; Khan SM contributed to data collection and analysis and revision of the manuscript.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
PRISMA 2009 Checklist statement: The manuscript has been revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sameh Hany Emile, MD, Associate Professor, Surgeon, General Surgery Department, Mansoura University Hospitals, Mansoura University, Dakahlia Governorate, Mansoura City 35516, Egypt. dr_sameh81@mans.edu.eg
Received: April 23, 2020
Peer-review started: April 23, 2020
First decision: May 5, 2020
Revised: May 6, 2020
Accepted: May 21, 2020
Article in press: May 21, 2020
Published online: June 18, 2020
Processing time: 55 Days and 15.9 Hours
Abstract
BACKGROUND

Coronavirus disease 2019 (COVID-19) has emerged as a public health crisis that was declared as a global pandemic by the World Health Organization. Although most cases have no or mild symptoms, around 10% of patients develop severe or critical illness that necessitates hospitalization and intensive care unit admission.

AIM

To assess the literature for the predictive factors that can identify patients having severe/critical COVID-19 disease.

METHODS

A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic search of the literature was conducted. Electronic databases including PubMed/MEDLINE, Scopus, and Cochrane Library were queried. The main outcome measures were the predictors of severe/critical COVID-19 and mortality.

RESULTS

Five studies including 583 patients of a median age of 50.5 years were reviewed. Patients were 346 (59.4%) male and 237 (40.6%) female. Of 583 hospitalized patients, 242 (41.5%) had critical illness. Acute respiratory distress disease occurred in 291 patients, accounting for 46.7% of total complications. One-hundred (17.1%) mortalities were recorded. The most commonly reported predictors of severe COVID-19 were older age, medical comorbidities, lymphopenia, elevated C-reactive protein, increased D-dimer, and increased neutrophil ratio. Findings on computed tomography (CT) scanning predictive of severe disease were bronchial wall thickening, CT score > 7, linear opacities, consolidation, right upper lobe affection, and crazy paving pattern.

CONCLUSION

Several demographic, clinical, laboratory, and radiologic factors can help predict severe and critical COVID-19 along with the potential need for mechanical ventilation. Factors that were more commonly reported were older age, medical comorbidities, lymphopenia, increased neutrophil ratio, elevated C-reactive protein, and increased D-dimer.

Keywords: COVID-19; SARS-CoV-2; Predictors; Severe; Critical; Systematic review

Core tip: After systematic literature search, several demographic, clinical, laboratory, and radiologic factors were found to be predictive of severe and critical coronavirus disease 2019 along with the potential need for mechanical ventilation. Factors that were more commonly reported were older age, medical comorbidities, lymphopenia, increased neutrophil ratio, elevated C-reactive protein, and increased D-dimer. Findings on computed tomography (CT) scanning predictive of severe disease were bronchial wall thickening, CT score > 7, linear opacities, consolidation, right upper lobe affection, and crazy paving pattern.