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Review
. 2021 Jan;49(1):82-89.
doi: 10.1016/j.ajic.2020.06.008. Epub 2020 Jun 12.

Meta-analysis investigating the relationship between clinical features, outcomes, and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia

Jia Li  1 , Xue He  1 , Yuan Yuan  1 , Wei Zhang  1 , Xue Li  1 , Yuhua Zhang  1 , Shaoxiang Li  1 , Chunyan Guan  1 , Zifen Gao  1 , Gehong Dong  2
Affiliations
Review

Meta-analysis investigating the relationship between clinical features, outcomes, and severity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia

Jia Li et al. Am J Infect Control. 2021 Jan.

Abstract

Objective: We aimed to investigate the relationship between clinical characteristics, outcomes and the severity of severe acute respiratory syndrome coronavirus 2 pneumonia.

Methods: We performed a systematic review and meta-analysis using PubMed, Embase, and Cochrane Library databases to assess the clinical characteristics and outcomes of confirmed COVID-19 cases and compared severe (ICU) and nonsevere (non-ICU) groups.

Results: We included 12 cohort studies including 2,445 patients with COVID-19. Compared with nonsevere (non-ICU) patients, severe (ICU) disease was associated with a smoking history (P = .003) and comorbidities including chronic obstructive pulmonary disease (OR = 5.08, P < .001), diabetes (OR = 3.17, P < .001), hypertension (OR = 2.40, P < .001), coronary heart disease (OR = 2.66, P < .001), cerebrovascular diseases (OR = 2.68, P = .008), and malignancy (OR=2.21, P = .040). We found significant differences between the 2 groups for fever, dyspnea, decreased lymphocyte and platelet counts, and increased leukocyte count, C-creative protein, procalcitonin, lactose dehydrogenase, aspartate aminotransferase, alanine aminotransferase, creatinine kinase, and creatinine levels (P < .05). Significant differences were also observed for multiple treatments (P < .05). Patients in the severe (ICU) group were more likely to have complications and had a much higher mortality rate and lower discharge rate than those with nonsevere (non-ICU) disease (P < .05).

Conclusions: Investigation of clinical characteristics and outcomes of severe cases of COVID-19 will contribute to early prediction, accurate diagnosis, and treatment to improve the prognosis of patients with severe illness.

Keywords: COVID-19; Clinical characteristics; ICU cases; Prognosis; Severe illness.

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Figures

Fig 1
Fig 1
Flow chart of the study selection process.
Fig 2
Fig 2
Pooled prevalence of severe (ICU) cases.
Fig 3
Fig 3
Forest plots for the ORs for comparing demographical characteristics between severe (ICU) cases and nonsevere (non-ICU) cases in SARS-CoV-2 infected patients. (A) Sex. (B) Wuhan exposure history. (C) Smoking history.
Fig 4
Fig 4
Forest plots for the ORs for comparing fever and dyspnea between severe (ICU) cases and nonsevere (non-ICU) cases in SARS-CoV-2 infected patients. (A) Fever. (B) Dyspnea.
Fig 5
Fig 5
Forest plots for the ORs for comparing the complications between severe (ICU) cases and nonsevere (non-ICU) cases in SARS-CoV-2 infected patients. (A) Acute respiratory distress syndrome (ARDS). (B) Shock. (C) Acute kidney injury. (D) Acute cardiac injury.
Fig 6
Fig 6
Forest plots for the ORs for comparing the outcomes between severe (ICU) cases and nonsevere (non-ICU) cases in SARS-CoV-2 infected patients. (A) Discharge. (B) Deaths. (C) Hospitalized.
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