Data_Sheet_1_Comorbidities and complications of COVID-19 associated with disease severity, progression, and mortality in China with centralized isolation and hospitalization: A systematic review and meta-analysis.DOCX

BackgroundCoronavirus disease 2019 (COVID-19) causes life-threatening with the high-fatality rates and spreads with high-infectious disease worldwide. We aimed to systematically review the comorbidities and complications of COVID-19 that are associated with various disease severity, progression, and mortality in China, to provide contemporary and reliable estimates in settings with centralized isolation and hospitalization.MethodsIn this systematic review and meta-analysis, we searched four main English language databases, and four main Chinese language databases for observational studies published from inception to January 2022, to identify all the related comorbidities and complications of COVID-19, in the China region with centralized isolation and hospitalization, with disease severity, progression, and mortality. Literature search, data extraction, and quality assessment were independently conducted by two reviewers. We used the generalized linear mixed model to estimate pooled effect sizes for any comorbidities and complications, and subgroup in gender ratio was done to further address the potential heterogeneity.ResultsOverall, 187 studies describing 77,013 patients, namely, 54 different comorbidities and 46 various complications of COVID-19, were identified who met our inclusion criteria. The most prevalent comorbidities were hypertension [20.37% 95% CI (15.28–26.63), 19.29% (16.17–22.85), 34.72% (31.48–38.10), and 43.94% (38.94–49.06)] and diabetes [7.84% (5.78–10.54), 8.59% (7.25–10.16), 17.99% (16.29–19.84), and 22.68% (19.93–25.69)] in mild, moderate, severe, and critical cases. The most prevalent complications were liver injury [10.00% (1.39–46.72), 23.04% (14.20–35.13), and 43.48% (39.88–47.15)] in mild, moderate, and severe cases, and acute respiratory distress syndrome [ARDS; 94.17% (20.78–99.90)] and respiratory failure [90.69% (28.08–99.59)] in critical cases. Renal insufficiency [odds ratio (OR) 17.43 (6.69–45.43)] in comorbidities and respiratory failure [OR 105.12 (49.48–223.33)] in complications were strongly associated in severe/critical than in mild/moderate cases. The highest estimated risk in intensive care unit (ICU) admission, progression, and mortality was an autoimmune disease, nervous system disease, and stroke in comorbidities, shock, and ARDS in complications.ConclusionComorbidities and complications in inpatients with COVID-19 were positively associated with increased risk in severe and critical cases, ICU admission, exacerbation, and death during centralized isolation and hospitalization. Prompt identification of comorbidities and complications in inpatients with COVID-19 can enhance the prevention of disease progression and death and improve the precision of risk predictions.

背景：新型冠状病毒疾病2019（COVID-19）具有高致死率，并具有高度传染性，在全球范围内传播。本研究旨在系统性地回顾中国在集中隔离和住院条件下，与COVID-19严重程度、进展和死亡率相关的合并症和并发症，以提供具有时效性和可靠性的估计。方法：在本系统性综述和荟萃分析中，我们检索了截至2022年1月发表的四种主要英语数据库和四种主要中文数据库中的观察性研究，以识别中国地区集中隔离和住院条件下所有与COVID-19相关的合并症和并发症。文献检索、数据提取和质量评估由两名审稿人独立完成。我们使用广义线性混合模型来估计任何合并症和并发症的汇总效应量，并按性别比例进行亚组分析，以进一步解决潜在的异质性。结果：总体而言，我们发现符合我们纳入标准的有187项研究，涉及77,013名患者，即54种不同的合并症和46种不同的COVID-19并发症。最常见的合并症为高血压和糖尿病，分别在轻度、中度、重度和危重病例中占20.37%、19.29%、34.72%和43.94%，以及7.84%、8.59%、17.99%和22.68%。最常见的并发症为肝损伤，在轻度、中度和重度病例中分别占10.00%、23.04%和43.48%，而在危重病例中为急性呼吸窘迫综合征（ARDS）和呼吸衰竭，分别占94.17%和90.69%。在合并症中，肾衰竭与呼吸衰竭在重症/危重病例中的关联性比在轻度/中度病例中更强。在合并症中，最高估计风险为自身免疫性疾病、神经系统疾病和中风，而在并发症中为休克和ARDS。结论：COVID-19住院患者的合并症和并发症与重症和危重病例的风险增加、ICU入院、病情恶化及死亡风险呈正相关。及时识别COVID-19住院患者的合并症和并发症，可以增强对疾病进展和死亡的预防，并提高风险预测的精确度。