Methods:We performed a systematic literature review with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of COVID-19 confirmed cases. Observational studies and also case reports, were included, and analyzed separately. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95%CI).Results: 660 articles were retrieved for the time frame (1/1/2020-2/23/2020). After screening, 27 articles were selected for full-text assessment, 19 being finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For 656 patients, fever (88.7%, 95%CI 84.5-92.9%), cough (57.6%, 40.8-74.4%) and dyspnea (45.6%, 10.9-80.4%) were the most prevalent manifestations. Among the patients, 20.3% (95%CI 10.0-30.6%) required intensive care unit (ICU), 32.8% presented with acute respiratory distress syndrome (ARDS) (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock. Some 13.9% (95%CI 6.2-21.5%) of hospitalized patients had fatal outcomes (case fatality rate, CFR).Conclusion: COVID-19 brings a huge burden to healthcare facilities, especially in patients with comorbidities. ICU was required for approximately 20% of polymorbid, COVID-19 infected patients and hospitalization was associated with a CFR of over 13%. As this virus spreads globally, countries need to urgently prepare human resources, infrastructure and facilities to treat severe COVID-19.

Introduction: An epidemic of Coronavirus Disease 2019 (COVID-19) begun in December 2019 in China, causing a Public Health Emergency of International Concern. Among raised questions, clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews have been published on this matter. Methods: We performed a systematic literature review with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of COVID-19 confirmed cases. Observational studies, and also case reports, were included and analyzed separately. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95%CI). Results: 660 articles were retrieved (1/1/2020-2/23/2020). After screening by abstract/title, 27 articles were selected for full-text assessment. Of them, 19 were finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For 656 patients, fever (88.7%, 95%CI 84.5-92.9%), cough (57.6%, 40.8-74.4%) and dyspnea (45.6%, 10.9-80.4%) were the most prevalent manifestations. Among the patients, 20.3% (95%CI 10.0-30.6%) required intensive care unit (ICU), with 32.8% presenting acute respiratory distress syndrome (ARDS) (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock and 13.9% (95%CI 6.2-21.5%) of hospitalized patients with fatal outcomes (case fatality rate, CFR).Conclusion: COVID-19 brings a huge burden to healthcare facilities, especially in patients with comorbidities. ICU was required for approximately 20% of polymorbid, COVID-19 infected patients and this group was associated with a CFR of over 13%. As this virus spreads globally, countries need to urgently prepare human resources, infrastructure, and facilities to treat severe COVID-19.

Introduction: An epidemic of Coronavirus Disease 2019 (COVID-19) begun in December 2019 in China, causing primary concern. Among raised questions, clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews have been published on this matter. Methods: We performed a systematic review of the literature with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of confirmed cases of COVID-19. All the observational studies, and also case reports, were included. The case reports were analyzed separately. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95%CI. Measures of heterogeneity, including Cochran’s Q statistic, the I2 index, and the τ2 test, were estimated and reported.Results: 660 articles were retrieved. After screening by abstract and title, 27 articles were selected for full-text assessment. Of them, 19 were finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For >656 patients, fever (88.7%, 95%CI 84.5-92.9%), cough (57.6%, 40.8-74.4%) and dyspnea (45.6%, 10.9-80.4%) were the most prevalent clinical manifestations. Among the patients, 20.3% (95%CI 10.0-30.6%) required ICU, with 32.8% presenting ARDS (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock and 13.9% (95%CI 6.2-21.5%) with a fatal outcome.Discussion: COVID-19 is a new clinical infectious disease, causing considerable compromise, especially in patients with comorbidities, requiring ICU in at least a fifth of them and sometimes with fatal outcomes. Additional research is needed to elucidate factors that may mediate the pathogenesis of the severe and fatal associated disease.

Introduction: An epidemic of Coronavirus Disease 2019 (COVID-19) begun in December 2019 in China, causing a PublicHealth Emergency of International Concern. Among raised questions, clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews have been published on this matter. Methods:We performed a systematic literature review with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of confirmed cases of COVID-19. All the observational studies, and also case reports, were included, and analyzed separately. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95%CI). Measures of heterogeneity were estimated and reported.Results: 660 articles were retrieved. After screening by abstract and title, 27 articles were selected for full-text assessment.Of them, 19 were finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For 656 patients, fever (88.7%, 95%CI 84.5-92.9%), cough (57.6%, 40.8-74.4%) and dyspnea (45.6%, 10.9-80.4%) were the most prevalent clinical manifestations. Among the patients, 20.3% (95%CI 10.0-30.6%) required intensive care unit (ICU), with 32.8% presenting acute respiratory distress syndrome (ARDS) (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock and 13.9% (95%CI 6.2-21.5%) with a fatal outcome.Discussion: COVID-19 is a new clinical infectious disease, causing considerable compromise, especially in patients with comorbidities, requiring ICU in at least a fifth of them and sometimes with fatal outcomes. Additional research is needed to elucidate factors that may mediate the pathogenesis of the severe and fatal associated disease.

aminotransferase were associated with antibiotic and antifungal use but not with antivirals. Without learning more from liver biopsy data or associations with hemodynamics, muscle injury, and inflammatory markers, it is impossible to conclude from this work why patients with COVID-19 develop elevated liver biochemistries.As hepatology consultants, even if we cannot provide a precise etiology of elevated liver biochemistries, we are able to add value through prognostication about potential future liver failure or mortality risk. In 2 large Chinese cohorts, 6.2% 4 and 11.6% 5 of patients with COVID-19 developed liver biochemistries over 3 times the upper limit of normal, suggesting that a minority of patients experience significant biochemistry elevations. We suspect that the mild liver biochemistry elevations experienced by most patients with COVID-19 are unlikely to lead to short-or long-term clinical significance. Fan et al reported 1 death in their cohort of patients with COVID-19, which is a lower mortality rate than other studies. It is possible that this cohort was healthier than others, suggested also by the inclusion of some asymptomatic patients. Admission liver biochemistries in this study did not predict severe disease or death; however, Lei et al 5 found that peak liver biochemistries predicted mortality. There have been 2 published cases of severe liver injury in patients with COVID 6,7 ; one patient recovered and we do not know the fate of the other. Despite a signal that elevated liver biochemistries are linked to severe disease and mortality, it remains unlikely, yet unproven, that liver failure or dysfunction is driving mortality.Fan et al and other observational studies inform hepatologists about the relatively high prevalence of liver biochemistry elevations in COVID-19, but we can be reassured by the apparent rarity of severe liver injury. Instead, COVID-19 likely represents an opportunity for hepatologists to provide consultation on "bread and butter" matters of inpatient hepatology, including druginduced liver injury and ischemic hepatitis. In this pandemic, we can provide guidance around removing potentially hepatotoxic medications. Perhaps our most important role in hepatology consultation for hospitalized patients with COVID-19 will be to provide the appropriate context for these liver enzyme abnormalities and reassurance that many times supportive care alone is sufficient to achieve liver recovery.

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To the Editor, We have recently read the article by Chaung et al 1 describing a case of SARS-CoV-2 and HCoV-HKU1 coinfection. The HCoV-HKU1 is also a member of the Betacoronavirus. In addition to other coronaviruses in different regions of the world, there is an increasing number of reports of coinfections in SARS-CoV-2/COVID-19. Then, we would like to take the opportunity to discuss some of them, 1-10 as there are not yet reviews on this emerging issue of COVID-19. Currently, the evidence suggests that the coinfection rates between SARS-CoV-2 and other respiratory pathogens would be higher than initially expected, which represents a challenge for the diagnosis and treatment. 1-4 Kim et al 2 described 1217 specimens of patients with respiratory symptoms; 116 of the 1217 samples (9.5%) were positive for SARS-CoV-2, and 318 (26.1%) were positive for a different microorganism.

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