Interpreting Kaplan Meier’s survival curve in COVID-19 patients: a systematic review
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20205733Keywords:
COVID-19, Interpretation, Kaplan Meier’s survival curve, Significance, Study designAbstract
Covid 19 is the causative agent of coronavirus disease in 2019-2020; was declared a pandemic by the World Health Organization on 11th March 2020. The article aims to interpret the functionality of Kaplan Meier’s survival curve used in various study designs. The search strategy and selection of published works in the MEDLINE database from the National Library of Medicine (NLM) was used to identify original journal articles published in English from March 1, 2020 to September 11, 2020. The search strings in title/abstract were ‘COVID-19’ or ‘coronavirus’ or and ‘Kaplan Meier curve’ that yielded 225 articles. Finally only 28 articles were reviewed. These were clinical trials (N=1), and retrospective (N=10) and prospective (N=1) observational studies (N=2), case control study (N=1) retrospective cohort study (N=6), medical record based study (N=3), observational studies (N=2), not specified (N=1), diagnostic test (N=1). 88% of articles were from China. Kaplan Meier’s curve was depicted in all the studies and 17 were found to be highly significant for KM curve, 2 were found significant as 6 were found to be non significant and in 3 no mention of significance of p value was given. It was concluded that it is the first systematic review to date related to interpreting Kaplan Meier’s survival curve in patients with COVID-19. The graph has been used singularly, in multiples and cumulatively, thus giving visual assessment which enhances the interpretation of results for survival analysis, failure to time and time to event plots. It is not only used in RCT study designs but a range of observational and retrospective studies.References
Tobaiqy M, Qashqary M, Al-Dahery S, Mujallad A, Hershan AA, Kamal MA, et al. Therapeutic management of patients with COVID-19: a systematic review. Infect Prev Pract. 2020;2(3):100061.
Advice for the public on COVID-19. World Health Organization. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public. Accessed on 28 October 2020.
Mc Coy E. Kaplan Meier curve and hazard ratio tutorial (Kaplan Meier curve and hazard ratio made simple!). 2018 Available from: https://www.youtube.com/watch?v=pxRCpcRupgU. Accessed on 12 October 2020.
Paemel RV. Kaplan Meier curves. Medium. 2019. Available from: https://towardsdatascience.com/ kaplan-meier-curves-c5768e349479. Accessed on 24 September 2020.
Lewinson E. Introduction to survival analysis: the Kaplan-Meier estimator. Medium. 2020. Available from: https://towardsdatascience.com/introduction-to-survival-analysis-the-kaplan-meier-estimator-94ec5812a97a. Accessed on 12 October 2020.
Use and Interpret Cochran-Mantel-Haenszel in SPSS. Available from: https://www.scalelive.com/cochran-mantel-haenszel.html. Accessed on 28 October 2020.
Baycan OF, Barman HA, Atici A, Tatlisu A, Bolen F, Ergen P, et al. Evaluation of biventricular function in patients with COVID-19 using speckle tracking echocardiography. Int J Cardiovasc Imag. 2020;1-10.
Sanfilippo F, Corredor C, Fletcher N, Tritapepe L, Lorini FL, Arcadipane A, et al. Left ventricular systolic function evaluated by strain echocardiography and relationship with mortality in patients with severe sepsis or septic shock: a systematic review and meta-analysis. Crit Care. 2018;22(1):183.
Haimovich AD, Ravindra NG, Stoytchev S, Young HP, Wilson FP, van Dijk D, et al. Development and validation of the quick COVID-19 severity index: a prognostic tool for early clinical decompensation. Ann Emerg Med. 2020;76(4):442-53.
Bernabeu-Wittel M, Ternero-Vega JE, Díaz-Jiménez P, Conde-Guzmán C, Nieto-Martín MD, Moreno-Gaviño L, et al. Death risk stratification in elderly patients with covid-19. A comparative cohort study in nursing homes outbreaks. Arch Gerontol Geriatr. 2020;91:104240.
Cao J, Zheng Y, Luo Z, Mei Z, Yao Y, Liu Z, et al. Myocardial injury and COVID-19: Serum hs-cTnI level in risk stratification and the prediction of 30-day fatality in COVID-19 patients with no prior cardiovascular disease. Theranostics. 2020;10(21):9663-73.
Myhre PL, Claggett B, Ballantyne CM, Selvin E, Røsjø H, Omland T, et al. Association between circulating troponin concentrations, left ventricular systolic and diastolic functions, and incident heart failure in older adults. JAMA Cardiol. 2019;4(10):997-1006.
Gao Y, Li T, Han M, Li X, Wu D, Xu Y, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID‐19. J Med Virol. 2020.
Cheng A, Hu L, Wang Y, Huang L, Zhao L, Zhang C, et al. Diagnostic performance of initial blood urea nitrogen combined with D-dimer levels for predicting in-hospital mortality in COVID-19 patients. Int J Antimicrob Agents. 2020;56(3):106110.
Francone M, Iafrate F, Masci GM, Coco S, Cilia F, Manganaro L, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol. 2020;1-10.
Akpınar EE, Hoşgün D, Akpınar S, Ateş C, Baha A, Gülensoy ES, et al. Do N-terminal pro-brain natriuretic peptide levels determine the prognosis of community acquired pneumonia? J Bras Pneumol. 2019;45(4).
Gao L, Jiang D, Wen X, Cheng X, Sun M, He B, et al. Prognostic value of NT-proBNP in patients with severe COVID-19. Respir Res. 2020;21.
Jang JG, Hur J, Hong KS, Lee W, Ahn JH. Prognostic Accuracy of the SIRS, qSOFA, and NEWS for early detection of clinical deterioration in SARS-CoV-2 infected patients. J Korean Med Sci. 2020;35(25).
Liu J, Zhang S, Wu Z, Shang Y, Dong X, Li G, et al. Clinical outcomes of COVID-19 in Wuhan, China: a large cohort study. Ann Intens Care. 2020;10.
Chhiba KD, Patel GB, Vu THT, Chen MM, Guo A, Kudlaty E, et al. Prevalence and characterization of asthma in hospitalized and nonhospitalized patients with COVID-19. J Allerg Clin Immunol. 2020;146(2):307-314.e4.
Lovinsky-Desir S, Deshpande DR, De A, Murray L, Stingone JA, Chan A, et al. Asthma among hospitalized patients with COVID-19 and related outcomes. J Allerg Clin Immunol. 2020;146(5):1027-34.
Yan Y, Yang Y, Wang F, Ren H, Zhang S, Shi X, et al. Clinical characteristics and outcomes of patients with severe covid-19 with diabetes. BMJ Open Diabetes Res Care. 2020;8(1).
Shang J, Wang Q, Zhang H, Wang X, Wan J, Yan Y, et al. The relationship between diabetes mellitus and COVID-19 prognosis: a retrospective cohort study in Wuhan, China. Am J Med. 2020;
Uribarri A, Núñez-Gil IJ, Aparisi A, Becerra-Muñoz VM, Feltes G, Trabattoni D, et al. Impact of renal function on admission in COVID-19 patients: an analysis of the international HOPE COVID-19 (Health Outcome Predictive Evaluation for COVID 19) Registry. J Nephrol. 2020;1-9.
Chen H, Hou J, Jiang X, Ma S, Meng M, Wang B, Zhang M, Zhang M, Tang X, Zhang F, Wan T. Response of memory CD8+ T cells to severe acute respiratory syndrome (SARS) coronavirus in recovered SARS patients and healthy individuals. J Immunol. 2005;175(1):591-8.
Wan S, Yi Q, Fan S, Lv J, Zhang X, Guo L, et al. Relationships among lymphocyte subsets, cytokines, and the pulmonary inflammation index in coronavirus (COVID‐19) infected patients. Br J Haematol. 2020;189(3):428-37.
Wei X, Zeng W, Su J, Wan H, Yu X, Cao X, et al. Hypolipidemia is associated with the severity of COVID-19. J Clin Lipidol. 2020;14(3):297-304.
Wang G, Zhang Q, Zhao X, Dong H, Wu C, Wu F, et al. Low high-density lipoprotein level is correlated with the severity of COVID-19 patients: an observational study. Lipids Health Dis. 2020;19.
Russell CD, Millar JE, Baillie JK. Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury. Lancet Lond Engl. 2020;395(10223):473-5.
Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):1-11.
Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335-7.
Zhang L, Zhu F, Xie L, Wang C, Wang J, Chen R, et al. Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China. Ann Oncol. 2020 ;31(7):894-901.
Zhang XJ, Qin JJ, Cheng X, Shen L, Zhao YC, Yuan Y, et al. In-hospital use of statins is associated with a reduced risk of mortality among individuals with COVID-19. Cell Metab. 2020;32(2):176-87.e4.
De Rossi N, Scarpazza C, Filippini C, Cordioli C, Rasia S, Mancinelli CR, et al. Early use of low dose tocilizumab in patients with COVID-19: a retrospective cohort study with a complete follow-up. E Clin Med. 2020;25:100459.
Canziani LM, Trovati S, Brunetta E, Testa A, De Santis M, Bombardieri E, et al. Interleukin-6 receptor blocking with intravenous tocilizumab in COVID-19 severe acute respiratory distress syndrome: A retrospective case-control survival analysis of 128 patients. J Autoimmun. 2020.
Davido B, Boussaid G, Vaugier I, Lansaman T, Bouchand F, Lawrence C, et al. Impact of medical care, including use of anti-infective agents, on prognosis of COVID-19 hospitalized patients over time. Int J Antimicrob Agents. 2020.
Geleris J, Sun Y, Platt J, Zucker J, Baldwin M, Hripcsak G, et al. Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19. N Engl J Med. 2020;382(25):2411-8.
Rosenberg ES, Dufort EM, Udo T, Wilberschied LA, Kumar J, Tesoriero J, et al. Association of treatment with hydroxychloroquine or azithromycin with in-hospital mortality in patients with COVID-19 in New York state. JAMA. 2020.
Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19. N Engl J Med. 2020;382(19):1787-99.
Choi MH, Ahn H, Ryu HS, Kim BJ, Jang J, Jung M, et al. Clinical characteristics and disease progression in early-stage COVID-19 patients in South Korea. J Clin Med. 2020;9(6).
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet Lond Engl. 2020;395(10229):1054-62.
Campioli CC, Cano Cevallos E, Assi M, Patel R, Binnicker MJ, O’Horo JC. Clinical predictors and timing of cessation of viral RNA shedding in patients with COVID-19. J Clin Virol. 2020;130:104577.
Xiao AT, Tong YX, Zhang S. Profile of RT-PCR for SARS-CoV-2: a preliminary study from 56 COVID-19 patients. Clin Infect Dis. 2020.
Green DA, Zucker J, Westblade LF, Whittier S, Rennert H, Velu P, et al. Clinical performance of SARS-CoV-2 molecular tests. J Clin Microbiol. 2020;58(8).
Hou T, Zeng W, Yang M, Chen W, Ren L, Ai J, et al. Development and evaluation of a rapid CRISPR-based diagnostic for COVID-19. PLoS Pathog. 2020;16(8).
Tselios K, Skendros P. Hydroxychloroquine against COVID-19: a critical appraisal of the existing evidence. Eur J Rheumatol. 2020;7(2):S110-6.
Lagier JC, Million M, Gautret P, Colson P, Cortaredona S, Giraud-Gatineau A, et al. Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: a retrospective analysis. Travel Med Infect Dis. 2020;36:101791.
Rees EM, Nightingale ES, Jafari Y, Waterlow NR, Clifford S, B. Pearson CA, et al. COVID-19 length of hospital stay: a systematic review and data synthesis. BMC Med. 2020;18(1):270.
Wang Z, Ji JS, Liu Y, Liu R, Zha Y, Chang X, et al. Survival analysis of hospital length of stay of novel coronavirus (COVID-19) pneumonia patients in Sichuan, China. MedRxiv. 2020;20057299.
Meng Y, Lu W, Guo E, Liu J, Yang B, Wu P, et al. Cancer history is an independent risk factor for mortality in hospitalized COVID-19 patients: a propensity score-matched analysis. J Hematol Oncol J Hematol Oncol. 2020;13.
Hou W, Zhang W, Jin R, Liang L, Xu B, Hu Z. Risk factors for disease progression in hospitalized patients with COVID-19: a retrospective cohort study. Infect Dis Lond Engl. 2020;1-8.
Yang AP, Liu J, Tao W, Li H. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020;84:106504.
Kamijo H, Mochizuki K, Nakamura Y, Mori K, Ichikawa M, Nitta K, et al. Nafamostat Mesylate Improved Survival Outcomes of Sepsis Patients Who Underwent Blood Purification: A Nationwide Registry Study in Japan. J Clin Med [Internet]. 2020 Aug 13 [cited 2020 Sep 10];9(8). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7464767.
Lim J-H, Park S-H, Jeon Y, Cho J-H, Jung H-Y, Choi J-Y, et al. Fatal Outcomes of COVID-19 in Patients with Severe Acute Kidney Injury. J Clin Med [Internet]. 2020 Jun 3 [cited 2020 Sep 10];9(6). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7355571.
Joseph A, Zafrani L, Mabrouki A, Azoulay E, Darmon M. Acute kidney injury in patients with SARS-CoV-2 infection. Ann Intensive Care [Internet]. 2020 Sep 3 [cited 2020 Sep 10];10. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7471244.