The Case Fatality Rate of Alpha Covid-۱۹ Variant in Patients with Concurrent Diabetes or Chronic Kidney Disease: A Systematic Review and Meta-analysis

Background: People with diabetes or chronic kidney diseases (CKD) are vulnerable to Covid-۱۹. Our aim in this study was to estimate the fatality rate among people with diabetes or CKD infected by Alpha Covid-۱۹ variant.Methods: The authors searched PubMed, Scopus, and Embase from ۱/۱۲/۲۰۱۹ to ۱۳/۵/۲۰۲۰ to find studies that reported the fatality rate of Alpha Covid-۱۹ variant among patients with diabetes/renal disease. A Random effects model meta-analysis was used to calculate the pooled case fatality rate (CFR). Then, a subgroup analysis was performed according to the sample size to find possible sources of heterogeneity.Results: In total, ۲۲ papers were studied for diabetes and ۱۰ papers for CKD. The pooled CFR was estimated at ۲۳% (۹۵% CI: ۰.۱۸, ۰.۲۸) among diabetes patients and ۳۱% (۹۵% CI: ۰.۱۶, ۰.۴۸) among renal patients. High heterogeneity was observed among the studies (Diabetes: I^۲=۹۴%, t^۲=۰.۰۱۷۳, P<۰.۰۱), (CKD: I^۲=۶۹%, t^۲=۰.۰۴۵۷, P<۰.۰۱). The subgroup analysis indicated that the sample size had a significant effect on fatality rate estimation. In the diabetes patients, the pooled CFR of Alpha Covid-۱۹ variant was ۴۰% (۹۵% CI: ۲۲%-۵۸%; I^۲=۹۱%, t^۲=۰.۰۷۹۷, P<۰.۰۱) among the studies with the sample size of less than ۵۲ hospitalized patients. In the studies with equal or more than ۵۲ patients, the pooled CFR was ۱۴% (۹۵% CI: ۱۱%-۱۷%; I^۲=۸۸%, t^۲=۰.۰۰۴۸, P<۰.۰۱). In addition, in renal patients, the pooled CFR was ۶۲% (۹۵% CI: ۰.۰۶%-۱۰۰%; I^۲=۸۵%, t^۲=۰.۳۷۴۵, P<۰.۰۱) in the studies with less than six hospitalized patients, and the pooled CFR was ۲۳% (۹۵% CI: ۱۶%-۳۱%; I^۲=۰%, t^۲=۰.۰۰, P=۰.۵۸) among studies with more than ۶ patients.Conclusions: People with either diabetes or CKD and infected with Alpha Covid-۱۹ variant had a higher fatality rate in the general population. More care and vaccination is recommended for these patients. It is recommended that we calculate pooled estimation of the case fatality rate of the other variant of COVID-۱۹ such as Beta, Delta, and Omicron in patients with chronic disease.

Keywords:

COVID-۱۹ , Diabetes mellitus , Kidney diseases , Meta-analysis , mortality