The prognostic properties of thyroid disorders, hypothyroidism, and hyperthyroidism in predicting COVID-19 poor outcomes: A systematic review and diagnostic meta-analysis

Abstract

Purpose: The relationship between thyroid metabolism and coronavirus disease 2019 (COVID-19) inflammation has been extensively investigated. This meta-analysis aimed to evaluate the prognostic properties of unspecified thyroid disorders, hypothyroidism and hyperthyroidism for predicting poor COVID-19 outcomes. Methods: We conducted systematic literature searching through multiple databases–PubMed, EBSCO and CENTRAL up until 27 September 2021. The main exposure was unspecified thyroid disorders, hypothyroidism or hypothyroidism on-admission status. The outcome of interest was the COVID-19 composite poor outcome that comprises severity, mortality, ICU admission and hospitalisation. Results: There were 24517 patients from 20 studies. Meta-analysis showed that thyroid disorder, regardless of its type, was associated with COVID-19 poor outcome (OR 2.92 (95% CI 2.09 – 4.08), P < 0.001; I2 = 71%, P < 0.001). Unspecified thyroid disorder has a sensitivity of 0.17 (0.08–0.33), specificity of 0.94 (0.88–0.97) and Area Under Curve (AUC) of 0.66. Hypothyroidism has a sensitivity of 0.24 (0.12–0.42), specificity of 0.92 (0.87–0.96) and AUC of 0.77. Hyperthyroidism has a sensitivity of 0.05 (0.02–0.11), specificity of 0.98 (0.88–1.00) and AUC of 0.36. In this pooled analysis, the posttest probability of unspecified thyroid disease, hypothyroidism and hyperthyroidism were 42%, 27% and 8% for poor outcomes, respectively. Conclusion: Thyroid disorders are associated with poor COVID-19 prognosis.

Keywords

• covid-19
• hyperthyroidism
• hypothyroidism
• prognosis
• thyroid disorder