Comparison of Comorbidities in Relation to Critical Conditions among Coronavirus Disease 2019 Patients: A Network Meta-Analysis

Severe illness and poor outcome are mainly associated with aging or certain medical comorbidities, especially chronic diseases. However, factors for unfavorable prognosis have not been well described owing to relatively small sample sizes and single-center reports. Therefore, this study aimed to compare the contribution of comorbidities in the development of critical conditions in coronavirus disease 2019 (COVID-19) patients. Pooled estimates of relative risks (RRs) and their 95% confidence intervals (CIs) were calculated by conducting a meta-analysis and network meta-analysis of 18 studies. Chronic obstructive pulmonary disease (COPD) was most strongly associated with the overall critical condition (RR = 4.22, 95% CI = 3.12 - 5.69), followed by cardiovascular disease (CVD) (RR = 3.00, 95% CI = 2.41 - 3.73), malignancy (RR = 2.91, 95% CI = 2.16 - 3.91), cerebrovascular accident (CVA) (RR = 2.86, 95% CI = 1.95 - 4.19), diabetes (RR = 2.10, 95% CI = 2.16 - 3.91), hypertension (RR = 2.02, 95% CI = 1.82 - 2.23), and chronic kidney disease (RR = 2.00, 95% CI = 1.36 - 2.94). The presence of comorbidities except for chronic liver disease and chronic kidney disease significantly increased the risk of severe infection, intensive care unit (ICU) admission, and cardiac injury in the subgroup analysis by types of critical conditions. Preexisting hypertension and diabetes additionally increased the risk of acute respiratory distress syndrome (ARDS). Among comorbidities, COPD had the highest probability of leading to severe COVID-19, ICU admission, and liver injury, while malignancy was most likely to cause ARDS and cardiac injury. In summary, preexisting COPD, CVD, CVA, hypertension, diabetes, and malignancy are more likely to worsen the progression of COVID-19, with severe infection, ICU admission requirement, and cardiac injury development.