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. 2020 May;8(9):576.
doi: 10.21037/atm-20-2124.

Clinical features of severe patients infected with 2019 novel coronavirus: a systematic review and meta-analysis

Daozheng Huang  1 , Xingji Lian  2 , Feier Song  3 , Huan Ma  4 , Zhiwen Lian  5 , Yuanfeng Liang  6 , Tiehe Qin  1 , Wei Chen  2 , Shouhong Wang  1
Affiliations

Clinical features of severe patients infected with 2019 novel coronavirus: a systematic review and meta-analysis

Daozheng Huang et al. Ann Transl Med. 2020 May.

Abstract

Background: 2019 novel coronavirus disease (COVID-19) has posed significant threats to public health. To identify and treat the severe and critical patients with COVID-19 is the key clinical problem to be solved. The present study aimed to evaluate the clinical characteristics of severe and non-severe patients with COVID-19.

Methods: We searched independently studies and retrieved the data that involved the clinical characteristics of severe and non-severe patients with COVID-19 through database searching. Two authors independently retrieved the data from the individual studies, assessed the study quality with Newcastle-Ottawa Scale and analyzed publication bias by Begg's test. We calculated the odds ratio (OR) of groups using fixed or random-effect models.

Results: Five studies with 5,328 patients confirmed with COVID-19 met the inclusion criteria. Severe patents were older and more common in dyspnea, vomiting or diarrhea, creatinine >104 µmol/L, procalcitonin ≥0.05 ng/mL, lymphocyte count <1.5×109/L and bilateral involvement of chest CT. Severe patents had higher risk on complications including acute cardiac injury (OR 13.48; 95% CI, 3.60 to 50.47, P<0.001) or acute kidney injury (AKI) (OR 11.55; 95% CI, 3.44 to 38.77, P<0.001), acute respiratory distress syndrome (ARDS) (OR 26.12; 95% CI, 11.14 to 61.25, P<0.001), shock (OR 53.17; 95% CI, 12.54 to 225.4, P<0.001) and in-hospital death (OR 45.24; 95% CI, 19.43 to 105.35, P<0.001). Severe group required more main interventions such as received antiviral therapy (OR 1.69; 95% CI, 1.23 to 2.32, P=0.001), corticosteroids (OR 5.07; 95% CI, 3.69 to 6.98, P<0.001), CRRT (OR 37.95; 95% CI, 7.26 to 198.41, P<0.001) and invasive mechanical ventilation (OR 129.35; 95% CI, 25.83 to 647.68, P<0.001).

Conclusions: Severe patients with COVID-19 had more risk of clinical characteristics and multiple system organ complications. Even received more main interventions, severe patients had higher risk of mortality.

Keywords: 2019 novel coronavirus; acute respiratory disease; clinical features; disease severity; meta-analysis.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-2124). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart for the selection of studies.
Figure 2
Figure 2
Forest plots of comparison severe versus non-severe cases for complications.
Figure 3
Figure 3
Forest plots of comparison severe versus non-severe cases for main interventions.
Figure 4
Figure 4
Funnel plot with 95% confidence interval (CI) to assess publication bias.
Figure S1
Figure S1
Forest plots of comparison severe versus non-severe cases for age.
Figure S2
Figure S2
Forest plots of comparison severe versus non-severe cases for gender.
Figure S3
Figure S3
Forest plots of comparison severe versus non-severe cases for fever.
Figure S4
Figure S4
Forest plots of comparison severe versus non-severe cases for headache.
Figure S5
Figure S5
Forest plots of comparison severe versus non-severe cases for dyspnea.
Figure S6
Figure S6
Forest plots of comparison severe versus non-severe cases for vomiting and diarrhea.
Figure S7
Figure S7
Forest plots of comparison severe versus non-severe cases for myalgia or arthralgia.
Figure S8
Figure S8
Forest plots of comparison severe versus non-severe cases for lymphocyte count <1.5*10^9/L.
Figure S9
Figure S9
Forest plots of comparison severe versus non-severe cases for white blood cell count <4*10^9/L.
Figure S10
Figure S10
Forest plots of comparison severe versus non-severe cases for procalcitonin ≥0.05 ng/mL.
Figure S11
Figure S11
Forest plots of comparison severe versus non-severe cases for serum creatinine >104 μmol/L.
Figure S12
Figure S12
Forest plots of comparison severe versus non-severe cases for bilateral involvement of chest CT.
See this image and copyright information in PMC

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