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Meta-Analysis
. 2020 Jun:127:104371.
doi: 10.1016/j.jcv.2020.104371. Epub 2020 Apr 14.

Prevalence and severity of corona virus disease 2019 (COVID-19): A systematic review and meta-analysis

Yong Hu  1 , Jiazhong Sun  1 , Zhe Dai  1 , Haohua Deng  1 , Xin Li  1 , Qi Huang  1 , Yuwen Wu  1 , Li Sun  1 , Yancheng Xu  2
Affiliations
Meta-Analysis

Prevalence and severity of corona virus disease 2019 (COVID-19): A systematic review and meta-analysis

Yong Hu et al. J Clin Virol. 2020 Jun.

Abstract

Background: Since being first reported in Wuhan, China, in December 8, 2019, the outbreak of the novel coronavirus, now known as COVID-19, has spread globally. Some case studies regarding the characteristics and outcome of patients with COVID-19 have been published recently. We conducted a meta-analysis to evaluate the risk factors of COVID-19.

Methods: Medline, SinoMed, EMBASE, and Cochrane Library were searched for clinical and epidemiological studies on confirmed cases of COVID-19.

Results: The incidence of fever, cough, fatigue, and dyspnea symptoms were 85.6 % (95CI 81.3-89.9 %), 65.7 % (95CI 60.1-71.4 %), 42.4 % (95CI 32.2-52.6 %) and 21.4 % (95CI 15.3-27.5 %). The prevalence of diabetes was 7.7 % (95CI 6.1-9.3 %), hypertension was 15.6 % (95CI 12.6-18.6 %), cardiovascular disease was 4.7 % (95CI 3.1-6.2 %), and malignancy was 1.2 % (95CI 0.5-1.8 %). The complications, including ARDS risk, ranged from 5.6-13.2 %, with the pooled estimate of ARDS risk at 9.4 %, ACI at 5.8 % (95CI 0.7-10.8 %), AKI at 2.1 % (95CI 0.6-3.7 %), and shock at 4.7 % (95CI 0.9-8.6 %). The risks of severity and mortality ranged from 12.6 to 23.5% and from 2.0 to 4.4 %, with pooled estimates at 18.0 and 3.2 %, respectively. The percentage of critical cases in diabetes and hypertension was 44.5 % (95CI 27.0-61.9 %) and 41.7 % (95CI 26.4-56.9 %), respectively.

Conclusion: Fever is the most common symptom in patients with COVID-19. The most prevalent comorbidities are hypertension and diabetes which are associated with the severity of COVID-19. ARDS and ACI may be the main obstacles for patients to treatment recovery. The case severe rate and mortality is lower than that of SARS and MERS.

Keywords: COVID-19; Comorbidities; Mortality; Severity; Symptom.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flow diagram for selection of studies for inclusion in this meta-analysis.
Fig. 2
Fig. 2
Forest plot of the prevalence of symptoms in patients with COVID-19. Weights were calculated from binary random-effects model analysis. (a. fever. b. cough. c. fatigue. d. dyspnea). CI = confidence interval, COVID-19=Corona Virus Disease 2019.
Fig. 3
Fig. 3
Meta-analysis of the proportion of comorbidities in COVID-19 cases. Weights were calculated from binary random-effects model analysis. Values represent proportions of diabetes (a), hypertension (b), CAD (c), and malignancy (d). CAD = coronary artery disease, COVID-19=Corona Virus Disease 2019.
Fig. 4
Fig. 4
Forest plot of the incidence of complications in patients with COVID-19. (a. ARDS. b. ACI. c. AKI. d. shock), CI = confidence interval. ARDS = acute respiratory distress syndrome, ACI = acute cardiac injury, AKI = acute kidney injury, COVID-19=Corona Virus Disease 2019.
Fig. 5
Fig. 5
Forest plot of the incidence of severity and mortality in patients with COVID-19. (a. severe rate. b. mortality), meta-analysis of the severe rate of COVID-19 patients with diabetes (c), or hypertension (d). CI = confidence interval, COVID-19=Corona Virus Disease 2019.
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