Clinical features and outcomes of adults with coronavirus disease 2019: A systematic review and pooled analysis of the literature

Abstract

Background: The 2019 coronavirus disease (COVID-19) has become a global pandemic and the published literature describing the virus has grown exponentially.

Methods: We conducted a systematic review of the literature to identify the symptoms, comorbidities present, radiological features and outcomes for adults testing positive for COVID-19 admitted to hospital. The results across multiple studies were numerically pooled to yield total estimated.

Results: A total of 45 studies were included in this review with 14 358 adult participants (average age 51 years, male 51%). The pooled findings suggest that the most common symptom among patients was fever (81.2%) followed by cough (62.9%), fatigue (38.0%) and anorexia/loss of appetite (33.7%). The comorbidities that were most prevalent among patients with the virus were hypertension (19.1%), cardiovascular disease (17.9%), endocrine disorder (9.3%) and diabetes (9.2%). Abnormal chest X-ray findings were present in 27.7% of patients and ground-glass opacity was demonstrated on chest computerized tomography in 63.0% of patients. The most frequent adverse outcomes were acute respiratory distress syndrome (27.4%), acute cardiac injury (16.2%) and acute kidney injury (12.6%). Death occurred in 8.2% of patients and 16.3% required intensive care admission and 11.7% had mechanical ventilation. Bacterial or secondary infections affected 8.5% of patients and 6.9% developed shock.

Conclusions: COVID-19 most commonly presents with fever, cough, fatigue and anorexia and among patients with existing hypertension and cardiovascular disease. It is important as serious adverse outcomes can develop such as acute respiratory distress syndrome, acute cardiac injury, acute kidney injury and death.

FIGURE 1

Flow diagram of study selection

FIGURE 2

Symptoms reported from multiple studies of adults hospitalized with COVID‐19

FIGURE 3

Symptoms reported from single studies of adults hospitalized with COVID‐19

FIGURE 4

Comorbidities reported from multiple studies of adults hospitalized with COVID‐19

FIGURE 5

Changes on imaging reported from multiple studies of adults hospitalized with COVID‐19

FIGURE 6

Adverse outcomes reported from multiple studies of adults hospitalized with COVID‐19