A systematic review and meta-analysis of cardiovascular risk with increased of

severity or mortality in adult patients with COVID-19

Acevedo Maldonado Kleider, Chun Torres Julia, Rojas Florian Nineth, Caballero Alvarado Jose

Citation
Acevedo Maldonado Kleider, Chun Torres Julia, Rojas Florian Nineth, Caballero Alvarado Jose. A
systematic review and meta-analysis of cardiovascular disease with increased risk of severity or
mortality in adult patients with COVID-19.

Review question
Does cardiovascular risk in adult patients with COVID-19 increase the risk of severity or mortality?

Searches
PubMed, Ovid, EBSCO, Scielo and Cochrane will be searched for relevant studies published since January
2015 to june 2020, without limits.

Studies published in English and Spanish will be included.

Types of study to be included

Case series, cohort, cross-cuts, case control studies

Condition or domain being studied

the review is about patients with COVID-19 and outcomes with greater severity or mortality

Participants/population
Adult patients with COVID-19.

Intervention(s), exposure(s)

Exposure is cardiovascular disease

Comparator(s)/control

Confirmed COVID-19 positive patients without cardiovascular disease.

Main outcome(s)
Death and / or severity related to COVID-19

* Measures of effect
Relative risks

Odds ratios

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 PROSPERO
International prospective register of systematic reviews

Additional outcome(s)
Artificial Respiration
Hospitalization

* Measures of effect
Not applicable

Data extraction (selection and coding)

We are going to apply initial exclusion criteria (looking only at abstracts or titles) and delete:

- Reviews

- Editorials

- Letters

- Case reports

- Animal studies

- Drug experiments

- Duplicate studies

Then with the filtered list we are going to start searching for full articles; the ones which are accessible we
are going to review manually and distribute to pairs of reviewers.

Looking at the tables we are going to search for outcomes: death and/or ICU admission and/or need for
mechanical ventilation.

The studies with at least 1 available outcome and some variable of interest (diabetes mellitus, obesity or
cardiovascular disease) will be downloaded.

Then we are going to make manual review, article by article and set up the data extraction study form.

Risk of bias (quality) assessment

The titles, abstracts and full text articles will be reviewed by three independent researchers according to the
inclusion and exclusion criteria, and at the same time they will evaluate the risk of bias using the valid tool
ROBINS-I ("Risk of bias in non-randomized studies - of interventions "), as recommended by the Cochrane
Collaboration.

ROBINS-I covers seven risk of bias domains:

D1 Bias due to confusion;
D2 Bias due to participant selection;
D3 Bias in the classification of interventions;
D4 Bias due to deviations from planned interventions;
D5 Bias due to missing data;
D6 Bias in the measurement of results;
D7 Bias in the selection of the reported result.

Assessments will be done at the study and outcome level.

Any disagreements between reviewers' judgements will be resolved by consensus following adjudication with a
third reviewer.
Strategy for data synthesis
We did the literature search with the PubMed, Ovid, EBSCO, Scielo and Cochrane database and our
resulting in 1762 articles to be analyzed. We are going to include case series, cohort, cross-cuts and case
control studies. The data will be synthesised using OR for severity (ICU admission and/or need for
mechanical ventilation) or death according to the previous presence of diabetes mellitus, obesity or
cardiovascular disease. Risk ratios for individual studies will be combined using a random-effects meta-
analysis.

Analysis of subgroups or subsets

We will divide participants by: diabetes mellitus and cardiovascular risk factors (such as high blood pressure)

Contact details for further information

Acevedo Maldonado Kleider
k.acevedo.m@upao.edu.pe
Rojas Florian Nineth
nrojasf@upao.edu.pe
Chun Torres Julia
Tchun_@upao.edu.pe
Caballero Alvarado Jose

Organisational affiliation of the review

UPAO

Review team members and their organisational affiliations

Acevedo Maldonado Kleider
Chun Torres Julia
Rojas Florian Nineth
Caballero Alvarado Jose

Type and method of review

Epidemiologic, Meta-analysis, Systematic review

Anticipated or actual start date

1 June 2020

Anticipated completion date

21 June 2020

Funding sources/sponsors
UPAO

Conflicts of interest
Language
English

Country
Peru

Stage of review
Review Ongoing

Subject index terms status

Subject indexing assigned by CRD

Subject index terms

Cardiovascular; Cardiovascular Diseases; Cardiovascular risk*; Hypertension; Diabetes; Comorbidity; Covid-
19; Coronavirus Disease 2019; Coronavirus infection*; SARS-CoV-2”; Mortality; severity.

Date of registration in PROSPERO

06 May 2020

Date of first submission

05 May 2020
Stage of review at time of this submission

Stage Started Completed

Preliminary searches Yes No

Piloting of the study selection process Yes No

Formal screening of search results against eligibility criteria Yes No

Data extraction No No

Risk of bias (quality) assessment No No

Data analysis No No

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 PROSPERO
International prospective register of systematic reviews

The record owner confirms that the information they have supplied for this submission is accurate and
complete and they understand that deliberate provision of inaccurate information or omission of data may
be construed as scientific misconduct.

The record owner confirms that they will update the status of the review when it is completed and will
add publication details in due course.

Versions
06 May 2020

PROSPERO
This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review
in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or
liability for the content of this registration record, any associated files or external websites.

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