Meta-analysis Of Risk Factors For Fatality Of COVID-19,MERS,H1N1 And SARS

Objective:In recent years,four large scale epidemics of RNA viruses including Coronavirus Disease 2019(COVID-19),Middle East Respiratory Syndrome(MERS),Influenza A(H1N1)and Severe Acute Respiratory Syndromes(SARS)have caused a large number of death in the world and had a great impact on the limited medical resources.The four have certain commonalities and each has its own characteristics.The identification of risk factors for fatality through Meta-analysis will help to screen people at high risk for fatality of RNA virus epidemics which including currently ravaging COVID-19,and promoting the rational and efficient allocation of limited medical resources.Methods:Meta-analysis was conducted according to PRISMA guidelines,and four databases including Pub Med,Web of Science,Embase and Cochrane Library were searched by computer.The deadline of literature retrieval was February 17th,2021.Keywords include“COVID-19”,“MERS”,“H1N1”,“SARS”,“prognosis”and their free words.Screening was conducted according to inclusion and exclusion criteria,and quality evaluation was carried out.The OR value and 95%confidence interval of each risk factor were calculated,Q test and I~2test were used to evaluate heterogeneity,and sensitivity analysis was used to find out the causes of heterogeneity.Subgroup analysis was performed for COVID-19,MERS,H1N1 and SARS,and combined effect sizes.Publication bias was examined by funnel plot and evaluated by Egger’s test and Begg’s test.Results:A total of 55 articles in this study met the inclusion criteria.Meta-analysis results showed that age(OR=12.43,95%CI 9.99-14.86,p<0.00001),chronic heart disease(OR=3.20,95%CI 2.68-3.82,p<0.00001),diabetes(OR=2.51,95%CI 2.05-3.07,p<0.00001)and chronic lung disease(OR=1.54,95%CI 1.28-1.87,p<0.00001)were common risk factors for fatality of COVID-19,MERS,H1N1 and SARS.Cerebrovascular disease(OR=3.66,95%CI 2.84-4.70,p<0.00001)and male sex(OR=1.43,95%CI 1.24-1.64,p<0.00001)were common risk factors for fatality of COVID-19 and SARS.Hypertension was a risk factor for fatality of COVID-19 and H1N1(OR=2.30,95%CI 2.01-2.63,p<0.00001).Dementia was a risk factor for fatality of COVID-19(OR=3.96,95%CI 2.31-6.78,p<0.00001).Obesity was not significantly associated with fatality of COVID-19 and H1N1(OR=1.13,95%CI0.88-1.44,p=0.35).Conclusions:Dementia is the most important risk factor for fatality of COVID-19.Other risk factors include advanced age,male,cerebrovascular disease,chronic heart disease,diabetes,hypertension and chronic lung disease.There are some common risk factors for fatality of the epidemic caused by RNA virus,which include advanced age,chronic heart disease,diabetes and chronic lung disease,etc.Obesity may not be significantly associated with fatality of epidemics caused by RNA virus.