Clinical, Laboratory and Imaging Features of COVID-19: A Systematic Review and Meta-analysis

Abstract

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.

Clinical features of the first cases and a cluster of Coronavirus Disease 2019 (COVID-19) in Bolivia imported from Italy and Spain

“…The clinical manifestations of these patients were according to the expected as reported in the literature [50], presenting mainly fever, and cough, among other symptoms. Ten of the twelve cases were younger than 60 y-old, and with no risk factors, except in two cases with hypertension and a history of community-acquired pneumonia.…”

“…None of the cases in this study required intensive care unit (ICU). The hospitalized case evolved good and was only hospitalized due to risk factors (age and hypertension) [1][2][3][4]6,16,50].…”

“…For some risk factors, such as diabetes mellitus, Bolivia is amongst the country with the lowest prevalence, around 6.6% in 2016 [56]. However, is estimated that a third of the Bolivian population presents high blood pressure [57], which is considered among the most prevalent risk factors in patients with COVID-19, for worse clinical progression [50], then the case 2 in Santa Cruz, was hospitalized for close monitoring while having age and hypertension as risk factors.…”

Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study

“…CFR was also calculated to be 8.06% among hospitalized patients, it is not surprising that the CFR among hospitalized patients was high as patients with a better general condition who were not hospitalized and therefore not included in the denominator. A recently published systematic review and meta-J o u r n a l P r e -p r o o f analysis reports a CFR of over 13% in 7 studies describing 632 hospitalized patients [16]. Also, two studies from China, reported a CFR of 15% [8]and 11% [9], respectively.…”

Compassionate Use of Remdesivir for Patients with Severe Covid-19

“…3,4 The symptoms of SARS-CoV-2 infection vary widely, from asymptomatic disease to pneumonia and life-threatening complications, including acute respiratory distress syndrome, multisystem organ failure, and ultimately, death. [5][6][7] Older patients and those with preexisting respiratory or cardiovascular conditions appear to be at the greatest risk for severe complications. 6,7 In the absence of a proven effective therapy, current management consists of supportive care, including invasive and noninvasive oxygen support and treatment with antibiotics.…”