COVID-19 clinical characteristics, and sex-specific risk of mortality: Systematic Review and Meta-analysis

Abstract

Objectives: The rapidly evolving coronavirus disease 2019 (COVID-19), was declared a pandemic by the World Health Organization on March 11, 2020. It was first detected in the city of Wuhan in China and has spread globally resulting in substantial health and economic crisis in many countries. Observational studies have partially identified the different aspects of this disease. Up to this date, no comprehensive systematic review for the clinical, laboratory, epidemiologic and mortality findings has been published. We conducted this systematic review and meta-analysis for a better understanding of COVID-19. Methods: We reviewed the scientific literature published from January 1, 2019 to March 3, 2020. Statistical analyses were performed with STATA (version 14, IC; Stata Corporation, College Station, TX, USA). The pooled frequency with 95% confidence intervals (CI) was assessed using random effect model. Publication bias was assessed and p <0.05 was considered a statistically significant publication bias. Results: Out of 1102 studies, 32 satisfied the inclusion criteria. A total of 4789 patients with a mean age of 49 years were evaluated. Fever (83.0%, CI 77.5 to 87.6), cough (65.2%, CI 58.6 to 71.2) and myalgia/fatigue (34.7, CI 26.0 to 44.4) were the most common symptoms. The most prevalent comorbidities were hypertension (18.5 %, CI 12.7 to 24.4) and Cardiovascular disease (14.9 %, CI 6.0 to 23.8). Among the laboratory abnormalities, elevated C-Reactive Protein (CRP) (72.0% (CI 54.3 to 84.6) and lymphopenia (50.1%, CI 38.0 to 62.4) were the most common findings. Bilateral ground-glass opacities (66.0%, CI 51.1 to 78.0) was the most common CT-Scan presentation. Pooled mortality rate was 6.6%, with males having significantly higher mortality compared to females (OR 3.4; 95% CI 1.2 to 9.1, P = 0.01). Conclusion: COVID-19 commonly presented with a progressive course of cough and fever with more than half of hospitalized patients showing leukopenia or a high CRP on their laboratory findings. Mortality associated with COVID19 was higher than that reported in studies in China with Males having a 3-fold higher risk of mortality in COVID19 compared to females.

Case Fatality Rates for Patients with COVID-19 Requiring Invasive Mechanical Ventilation. A Meta-analysis

“…Despite stratifying studies based on location and NOS score, high heterogeneity continued to exist across our meta-analysis. This has been reported in other meta-analyzes studying COVID-19 mortality (109)(110)(111)(112)(113). Heterogeneity was the lowest at 83.4% among definitive outcomes from Wuhan (Supplementary figure 6).…”

Spectrum of Headaches Associated With SARS‐CoV‐2 Infection: Study of Healthcare Professionals

“…Numerous hospital case series and observational studies have described the clinical characteristics of patients in symptomatic phases; headache is recorded among these symptoms. Meta‐analysis of these studies shows that headache is reported in 6%‐15% of patients 1‐8 . All these data are from studies conducted in China; however, preliminary data from our setting suggest that approximately 60% of patients with COVID‐19 presented with headache 8 …”

ACE 2 Coding Variants: A Potential X-linked Risk Factor for COVID-19 Disease

“…6 Age and preexisting comorbidities have been described as risk factors for more serious disease, 7, 8 and environmental factors such as initial dose of virions and availability of critical care are also believed important. Early data from the pandemic has suggested that males might account for a greater proportion of cases 5 and/or suffer from higher COVID-19 morbidity and mortality, 9 though if this is ultimately shown to be true, the reasons behind it are unclear.…”