Predictors of COVID-19 severity: A systematic review and meta-analysis

Mudatsir Mudatsir, Laksmi Wulandari, Jonny Karunia Fajar, Gatot Soegiarto, Muhammad Ilmawan, Yeni Purnamasari, Bagus Aulia Mahdi, Galih Dwi Jayanto, Suhendra Suhendra, Yennie Ayu Setianingsih, Romi Hamdani, Daniel Alexander Suseno, Kartika Agustina, Hamdan Yuwafi Naim, Muchamad Muchlas, Hamid Hunaif Dhofi Alluza, Nikma Alfi Rosida, Mayasari Mayasari, Mustofa Mustofa, Adam HartonoRichi Aditya, Firman Prastiwi, Fransiskus Xaverius Meku, Monika Sitio, Abdullah Azmy, Anita Surya Santoso, Radhitio Adi Nugroho, Camoya Gersom, Ali A. Rabaan, Sri Masyeni, Firzan Nainu, Abram L. Wagner, Kuldeep Dhama, Harapan Harapan

Research output: Contribution to journalArticlepeer-review

110 Citations (Scopus)


Background: The unpredictability of the progression of coronavirus disease 2019 (COVID-19) may be attributed to the low precision of the tools used to predict the prognosis of this disease. Objective: To identify the predictors associated with poor clinical outcomes in patients with COVID-19. Methods: Relevant articles from PubMed, Embase, Cochrane, and Web of Science were searched and extracted as of April 5, 2020. Data of interest were collected and evaluated for their compatibility for the meta-analysis. Cumulative calculations to determine the correlation and effect estimates were performed using the Z test. Results: In total, 19 papers recording 1,934 mild and 1,644 severe cases of COVID-19 were included. Based on the initial evaluation, 62 potential risk factors were identified for the meta-analysis. Several comorbidities, including chronic respiratory disease, cardiovascular disease, diabetes mellitus, and hypertension were observed more frequent among patients with severe COVID-19 than with the mild ones. Compared to the mild form, severe COVID-19 was associated with symptoms such as dyspnea, anorexia, fatigue, increased respiratory rate, and high systolic blood pressure. Lower levels of lymphocytes and hemoglobin; elevated levels of leukocytes, aspartate aminotransferase, alanine aminotransferase, blood creatinine, blood urea nitrogen, high-sensitivity troponin, creatine kinase, high-sensitivity C-reactive protein, interleukin 6, D-dimer, ferritin, lactate dehydrogenase, and procalcitonin; and a high erythrocyte sedimentation rate were also associated with severe COVID-19. Conclusion: More than 30 risk factors are associated with a higher risk of severe COVID-19. These may serve as useful baseline parameters in the development of prediction tools for COVID-19 prognosis.

Original languageEnglish
Article number1107
Publication statusPublished - 2020


  • COVID-19
  • Clinical outcome
  • Prognosis
  • SARS-CoV-2
  • Severity


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