Imaging and clinical features of patients with 2019 novel coronavirus SARS-CoV-2: A systematic review and meta-analysis

Abstract

Background: Currently, the epidemic of coronavirus disease 2019 (COVID-19) has begun to spread worldwide. We aim to explore reliable evidence for the diagnosis and treatment of the COVID-19 by analyzing all the published studies by Chinese scholars on the clinical and imaging features in novel coronavirus pneumonia caused by SARS-CoV-2.

Methods: We searched five medical databases including two Chinese and three English databases for all published articles on COVID-19 since the outbreak. A random-effects model was designed, and the imaging and clinical data from all studies were collected for meta-analysis.

Results: Overall, 31 articles and 46 959 patients were included, including 10 English articles and 21 Chinese articles. The results of meta-analysis showed that the most common clinical manifestations were fever (87.3%; 0.838-0.909), cough (58.1%; 0.502-0.660), dyspnea (38.3%; 0.246-0.520), muscle soreness or fatigue (35.5%; 0.253-0.456), and chest distress (31.2%; -0.024 to 0.648). The main imaging findings were bilateral pneumonia (75.7%; 0.639-0.871) and ground-glass opacification (69.9%; 0.602-0.796). Among the patients, the incidence that required intensive care unit (ICU) was (29.3%; 0.190-0.395), the incidence with acute respiratory distress syndrome was (28.8%; 0.147-0.429), the incidence with multiple organ dysfunction syndrome was (8.5%; -0.008 to 0.179), and the case fatality rate of patients with COVID-19 was (6.8%; 0.044-0.093).

Conclusion: COVID-19 is a new clinical infectious disease that mainly causes bilateral pneumonia and lung function deteriorates rapidly. Nearly a third of patients need to be admitted to the ICU, and patients are likely to present respiratory failure or even death.

Keywords: 2019 novel coronavirus pneumonia; SARS-CoV-2; clinical features; imaging finding.

Figure 1

Diagram of documents retrieval

Figure 2

The forest plots of age and sex. A, age and (B) sex

Figure 3

The forest plots of the incidence of comorbidities and intensive care unit (ICU). A, Comorbidities; (B) tumor; (C) diabetes; (D) hypertension; (E) cardiovascular disease; (F) phthisis; (G) chronic obstructive pulmonary disease; (H) chronic hepatonephropathy; (I) ICU

Figure 4

The forest plots of the incidence of clinical features. A, Fever; (B) cough; (C) sore throat; (D) expectoration; (E) chest distress; (F) muscle soreness or fatigue; (G) headache; (H) diarrhea; (I) dyspnea

Figure 5

The forest plots of the incidence of laboratory test features. A, Leukocytosis; (B) leukopenia; (C) lymphocytopenia; (D) high C‐reactive protein; (E) high lactate dehydrogenase; (F) high erythrocyte sedimentation rate

Figure 6

The forest plots of the incidence of imaging features. A, Unilateral; (B) bilateral; (C) lung consolidation; (D) ground‐glass; (E) air bronchogram; (F) grid‐form shadow; (G) bronchovascular bundles thickening; (H) hydrothorax; (I) irregular or halo sign

Figure 7

The forest plots of the incidence of complication. A, acute respiratory distress syndrome; (B) acute cardiac injury; (C) acute renal injury; (D) shock; (E) multiple organ dysfunction syndrome; (F) mortality