Cardiovascular, cerebrovascular, and renal co-morbidities in COVID-19 patients: A systematic-review and meta-analysis

Abby C Lee; Wei Tse Li; Lauren Apostol; Jiayan Ma; Pam R Taub; Eric Y Chang; Mahadevan Rajasekaran; Weg M Ongkeko

doi:10.1016/j.csbj.2021.06.038

Cardiovascular, cerebrovascular, and renal co-morbidities in COVID-19 patients: A systematic-review and meta-analysis

Comput Struct Biotechnol J. 2021:19:3755-3764. doi: 10.1016/j.csbj.2021.06.038. Epub 2021 Jun 29.

Authors

Abby C Lee^{1

2}, Wei Tse Li^{1

2}, Lauren Apostol^{1

2}, Jiayan Ma^{1

2}, Pam R Taub³, Eric Y Chang^{4

5}, Mahadevan Rajasekaran^{6

7}, Weg M Ongkeko^{1

2}

Affiliations

¹ Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, UC San Diego School of Medicine, San Diego, CA 92093, USA.
² Research Service, VA San Diego Healthcare System, San Diego, La Jolla, CA 92093, USA.
³ Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego, CA, USA.
⁴ Department of Radiology, University of California, San Diego, CA 92093, USA.
⁵ Radiology Service, VA San Diego Healthcare System, San Diego 92161, USA.
⁶ Department of Urology, University of California San Diego, La Jolla, CA 92093, USA.
⁷ Urology Service, VA San Diego Healthcare System, San Diego, CA 92161, USA.

Abstract

Background: COVID-19 has infected over 35 million people worldwide and led to over 1 million deaths. Several risk factors that increase COVID-19 severity have emerged, including age and a history of cardiovascular disease, hypertension, or kidney disease. However, a number of outstanding questions persist, including whether the above comorbidities correlate with increased mortality from COVID-19 or whether age is a significant confounding variable that accounts for the observed relationship between COVID-19 severity and other comorbidities.

Methods and findings: We conducted a systematic review and meta-analysis of studies documenting COVID-19 patients with hypertension, cardiovascular disease, cerebrovascular disease, or chronic kidney disease. We classified COVID-19 cases into severe/non-severe or deceased/surviving and calculated the odds ratio (OR) for each of the four comorbidities in these cohorts. 36 studies, comprising 22,573 patients, are included in our meta-analysis. We found that hypertension is the most prevalent comorbidity in deceased COVID-19 patients (55.4%; CI: 49.4-61.3%), followed by cardiovascular disease (30.7%; CI: 22.6-38.8%), cerebrovascular disease (13.4%; CI: 9.12-19.2%), then chronic kidney disease (9.05%; CI: 5.57-15.0%). The risk of death is also significantly higher for patients with these comorbidities, with the greatest risk factor being chronic kidney disease (OR: 8.86; CI: 5.27-14.89), followed by cardiovascular disease (OR: 6.87; CI: 5.56-8.50), hypertension (OR: 4.87; CI: 4.19-5.66), and cerebrovascular disease (OR: 4.28; CI: 2.86-6.41). These risks are significantly higher than previously reported, while correlations between comorbidities and COVID-19 severity are similar to previously reported figures. Using meta-regression analysis with age as a moderating variable, we observed that age contributes to the observed risks but does not explain them fully.

Conclusions: In this meta-analysis, we observed that cardiovascular, cerebrovascular, and kidney-related comorbidities in COVID-19 significantly contributes to greater risk of mortality and increased disease severity. We also demonstrated that age may not be a confounder to these associations.

Keywords: COVID-19; Comorbidity; Meta-analysis.