Prognostic Factors of COVID-19: An Umbrella Review Endorsed by the International Society for Pharmacoepidemiology

Grammati Sarri, Wei Liu, Luke Zabotka, Andreas Freitag, Ravinder Claire, Grace Wangge, Jamie Elvidge, Dalia Dawoud, Dimitri Bennett, Xuerong Wen, Xiaojuan Li, Christopher T. Rentsch, Md Jamal Uddin, M. Sanni Ali, Mugdha Gokhale, Anouk Déruaz-Luyet, Daniela C. Moga, Jeff Jianfei Guo, Andrew R. Zullo, Elisabetta PatornoKueiyu Joshua Lin

Research output: Contribution to journalReview articlepeer-review


During the coronavirus disease 2019 (COVID-19) pandemic, the urgency for updated evidence to inform public health and clinical care placed systematic literature reviews (SLRs) at the cornerstone of research. We aimed to summarize evidence on prognostic factors for COVID-19 outcomes through published SLRs and to critically assess quality elements in the findings' interpretation. An umbrella review was conducted via electronic databases from January 2020 to April 2022. All SLRs (and meta-analyses) in English were considered. Data screening and extraction were conducted by two independent reviewers. AMSTAR 2 tool was used to assess SLR quality. The study was registered with PROSPERO (CRD4202232576). Out of 4,564 publications, 171 SLRs were included of which 3 were umbrella reviews. Our primary analysis included 35 SLRs published in 2022, which incorporated studies since the beginning of the pandemic. Consistent findings showed that, for adults, older age, obesity, heart disease, diabetes, and cancer were more strongly predictive of risk of hospitalization, intensive care unit admission, and mortality due to COVID-19. Male sex was associated with higher risk of short-term adverse outcomes, but female sex was associated with higher risk of long COVID. For children, socioeconomic determinants that may unravel COVID-19 disparities were rarely reported. This review highlights key prognostic factors of COVID-19, which can help clinicians and health officers identify high-risk groups for optimal care. Findings can also help optimize confounding adjustment and patient phenotyping in comparative effectiveness research. A living SLR approach may facilitate dissemination of new findings. This paper is endorsed by the International Society for Pharmacoepidemiology.

Original languageEnglish
Pages (from-to)604-613
Number of pages10
JournalClinical Pharmacology and Therapeutics
Issue number3
StatePublished - Sep 2023

Bibliographical note

Funding Information:
This work was partly funded by ISPE and also received support from the European Health Data and Evidence Network (EHDEN) project. EHDEN received funding from the Innovative Medicines Initiative 2 Joint Undertaking (JU) under grant agreement No. 806968. The JU receives support from the European Union's Horizon 2020 research and innovation program and the European Federation of Pharmaceutical Industries and Associations (EFPIA).

Funding Information:
G.S. and A.F. are employed by Cytel, Inc. D.B. is an employee of Takeda. L.Z. and M.S.A. report no declarations. X.L. receives research support from the NIH (R03AG070661 and K01AG073651). A.R.Z. receives grant funding paid directly to Brown University by Sanofi for collaborative research on the epidemiology of infections and vaccinations in nursing home residents and infants. A.R.Z. also receives grant funding from the U.S. National Institute on Aging (R01AG077620 and R01AG065722). E.P. is investigator of a research grant to the Brigham and Women's Hospital from Boehringer‐Ingelheim, not related to the topic of this work. E.P. receives research grants from the Patient Centered Outcomes Research Institute (DB‐2020C2‐20326) and the US Food and Drug Administration (5U01FD007213), not related to the topic of this work. All other authors declared no competing interests for this work.

Publisher Copyright:
© 2023 The Authors. Clinical Pharmacology & Therapeutics © 2023 American Society for Clinical Pharmacology and Therapeutics.

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)


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