Effects of Cancer, Coronary Artery Disease and other Comorbidities on COVID-19 Related Mortality: A Meta-analysis and Meta-regression

Author(s): Shon Shmushkevich, Massimo Baudo, Nagla Abdel Karim, Mahmoud Morsi, Mariam Khobsa, Hala Aziz, Maha Yahia, Mohamed Emam, Omnia Mohamed, Hossameldin Abdallah, Ahmed Abouarab, Dina Mofed, Mohamed Isma

Objective: To investigate Coronavirus Disease 2019 (COVID-19) associated mortality, the prevalence of different symptoms, and the prevalence and association between comorbidities and their effects on outcomes.

Methods: We performed a systematic literature search and meta-analysis on studies that assess COVID-19 patients' symptoms, comorbidities, and outcomes using pooled event rate (PER) and pooled event means (PEM). The primary outcome was the pooled all- cause short-term mortality. The secondary outcomes were length of hospital stay and symptom presentation. Meta-regression and leave-one-out analysis were conducted for mortality.

Results: 56 articles met our inclusion criteria with a total of 9074 patients. The PEM for age was 49.6 years. The PER for female gender was 46.79%. The PER for smoking, hypertension, cardiac comorbidities, diabetes was 10.96%, 24.47%, 20.30%; 12.34% respectively. The PER for CAD, COPD, history of cancer and chronic liver disease was 5.44%, 3.96%, 3.75% and 3.08%. The PER for fever, cough, sore throat and headache was 79.29%, 56.48%, 11.10%, 8.16%, respectively. The PER for diarrhea, chest pain, fatigue and vomiting was 11.32%, 13.43%, 27.72% and 11.98%, respectively. PEM for hospital stay was 10.9 days (95% CI 7.3- 16.1 days). The PER for hospital mortality was 11.17% (95% CI, 6.67% - 17.89%). Hospital mortality was significantly and positively associated with cardiac comorbidity and COPD. Age and cancer were not associated with higher hospital mortality.

Conclusion: Fever and cough are the most common presenting symptoms with estimated PER of 79.29% and 56.48% respectively. Hospital mortality is significantly and positively associated with cardiac comorbidities, CAD, and COPD, while not being significantly associated with patient age or cancer.