Clinical characteristics, laboratory abnormalities and CT findings of COVID-19 patients and risk factors of severe disease: a systematic review and meta-analysis

Abstract

Background: The coronavirus disease 2019 (COVID-19) is an emerging pandemic of global public health concern. We aimed to summarize the characteristics of COVID-19 patients in the early stage of the pandemic and explore the risk factors of disease progression.Methods: We conducted a systematic review with meta-analysis, searching three databases for studies published between January 1, 2020, and March 18, 2020. We used random-effects models to calculate the 95% confidence intervals of pooled estimated prevalence and the odds ratio between the severe and nonsevere cases.Results: Ninety studies involving 16,526 COVID-19 patients were included. Hypertension (19.1%) and diabetes (9.5%) were the most common comorbidities. The most prevalent clinical symptoms were fever (78.4%), cough (58.5%), and fatigue (26.4%). Increased serum ferritin (74.2%), high C-reactive protein (73.3%), and high erythrocyte sedimentation rate (ESR) (72.2%) were the most frequently reported laboratory abnormalities. Most patients had bilateral lung involvement (82.2%) and showed peripheral (66.9%) and subpleural (62.1%) distribution, with multifocal involvement (73.1%). And the most common CT features were vascular enlargement (64.3%), ground-glass opacity (GGO) (60.7%), and thickened interlobular septa (55.1%). Respiratory failure was the most common complication (30.7%) and the overall case-fatality rate (CFR) was 4.2%. Moreover, male, history of smoking, and comorbidities might influence the prognosis. Most clinical symptoms such as fever, high fever, cough, sputum production, fatigue, shortness of breath, dyspnoea, and abdominal pain were linked to the severity of disease. Some specific laboratory indicators implied the deterioration of disease, such as leucocytosis, lymphopenia, platelet, alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin, creatinine, creatine kinase (CK), lactic dehydrogenase (LDH), C-reactive protein, procalcitonin (PCT), and D-dimer. Besides, the risk of bilateral pneumonia, consolidation, pleural effusion, and enlarged mediastinal nodes was higher in severe cases.Conclusions: Most COVID-19 patients have fever and cough with lymphopenia and increased inflammatory indices, and the main CT feature is GGO involved bilateral lung. Patients with comorbidities and worse clinical symptoms, laboratory characteristics, and CT findings tend to have poor disease progression. respectively. According to the prior studies, the SARS-CoV-2, a betacoronavirus, is both similar and different to the SARS-CoV and MERS-CoV (3). As reported, the mortality of SARS-CoV and MERS-CoV is higher than that of SARS-CoV-2. But the pandemic caused by COVID-19 has exceeded the previous two diseases (4).It is important to find out the epidemiological, clinical, laboratory and image features of patients with SARS-CoV-2 infection and risk factors of severe illness for better prevention and treatment of this disease. Large quantities of researches have made effort to understand this subject, but most were case series, cross-sectional ...

Predicting Severe/Critical Outcomes in Patients With SARS-CoV2 Pneumonia: Development of the prediCtion seveRe/crItical ouTcome in COVID-19 (CRITIC) Model

“…Previous works have documented that CRP might play a role in predicting a higher severity of COVID-19 in the early stages, before the development of CT findings (55). A recent systematic review and meta-analysis confirmed that elevated CRP levels are predictors of a worse prognosis in COVID-19 patients (56). Interestingly, a role on CRP values would also be determined by oral cavity health, these two variables being inversely correlated (57).…”

Outcome of SARS CoV-2 inpatients treated with convalescent plasma: One-year of data from the Veneto region (Italy) Registry

“…Moreover, severity of lung involvement had a negative impact on recovery, in particular a chest X-ray showing consolidation areas, PaO2/FiO2 ≤200 and high flow oxygen therapy or mechanical ventilation [26] .…”

Hematological changes associated with COVID‐19 infection

“…Serum ferritin level is elevated in 74.2% complicated viral infection. 63 COVID‐19 patients with elevated serum ferritin were at higher risk of developing ARDS (HR = 3.53, 95%CI: 1.52–8.16, p = 0.003). A meta‐analysis of 18 studies concluded that the ferritin level was significantly higher in severely ill patients [WMD 397.77 (95% CI 306.51–489.02)] and non‐survivors [WMD 677.17 (95% CI 391.01–963.33)].…”