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Prognostic factors for mortality, intensive care unit and hospital admission due to SARS-CoV-2: a systematic review and meta-analysis of cohort studies in Europe

Vardavas, Constantine I.; Mathioudakis, Alexander G.; Nikitara, Katerina; Stamatelopoulos, Kimon; Georgiopoulos, Georgios; Phalkey, Revati; Leonardi-Bee, Jo; Fernandez, Esteve; Carnicer-Pont, Dolors; Vestbo, Jørgen; Semenza, Jan C.; Deogan, Charlotte; Suk, Jonathan E.; Kramarz, Piotr; Lamb, Favelle; Penttinen, Pasi


Constantine I. Vardavas

Alexander G. Mathioudakis

Katerina Nikitara

Kimon Stamatelopoulos

Georgios Georgiopoulos

Revati Phalkey

Professor of Medical Statistics and Epidemiology

Esteve Fernandez

Dolors Carnicer-Pont

Jørgen Vestbo

Jan C. Semenza

Charlotte Deogan

Jonathan E. Suk

Piotr Kramarz

Favelle Lamb

Pasi Penttinen


Background As mortality from coronavirus disease 2019 (COVID-19) is strongly age-dependent, we aimed to identify population subgroups at an elevated risk for adverse outcomes from COVID-19 using age-/gender-adjusted data from European cohort studies with the aim to identify populations that could potentially benefit from booster vaccinations. Methods We performed a systematic literature review and meta-analysis to investigate the role of underlying medical conditions as prognostic factors for adverse outcomes due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including death, hospitalisation, intensive care unit (ICU) admission and mechanical ventilation within three separate settings (community, hospital and ICU). Cohort studies that reported at least age and gender-adjusted data from Europe were identified through a search of peer-reviewed articles published until 11 June 2021 in Ovid Medline and Embase. Results are presented as odds ratios with 95% confidence intervals and absolute risk differences in deaths per 1000 COVID-19 patients. Findings We included 88 cohort studies with age-/gender-adjusted data from 6 653 207 SARS-CoV-2 patients from Europe. Hospital-based mortality was associated with high and moderate certainty evidence for solid organ tumours, diabetes mellitus, renal disease, arrhythmia, ischemic heart disease, liver disease and obesity, while a higher risk, albeit with low certainty, was noted for chronic obstructive pulmonary disease and heart failure. Community-based mortality was associated with a history of heart failure, stroke, diabetes and end-stage renal disease. Evidence of high/moderate certainty revealed a strong association between hospitalisation for COVID-19 and solid organ transplant recipients, sleep apnoea, diabetes, stroke and liver disease. Interpretation The results confirmed the strong association between specific prognostic factors and mortality and hospital admission. Prioritisation of booster vaccinations and the implementation of nonpharmaceutical protective measures for these populations may contribute to a reduction in COVID-19 mortality, ICU and hospital admissions.


Vardavas, C. I., Mathioudakis, A. G., Nikitara, K., Stamatelopoulos, K., Georgiopoulos, G., Phalkey, R., …Penttinen, P. (2022). Prognostic factors for mortality, intensive care unit and hospital admission due to SARS-CoV-2: a systematic review and meta-analysis of cohort studies in Europe. European Respiratory Review, 31(166), Article 220098.

Journal Article Type Review
Acceptance Date Aug 3, 2022
Online Publication Date Nov 2, 2022
Publication Date Dec 31, 2022
Deposit Date Sep 9, 2022
Publicly Available Date Nov 2, 2022
Journal European Respiratory Review
Print ISSN 0905-9180
Electronic ISSN 1600-0617
Publisher European Respiratory Society
Peer Reviewed Peer Reviewed
Volume 31
Issue 166
Article Number 220098
Keywords Pulmonary and Respiratory Medicine
Public URL
Publisher URL


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