Clinical Symptom Differences Between Mild and Severe COVID-19 Patients in China: A Meta-Analysis

Abstract

Objective: The prognosis of mild and severe patients has prominent differences during the prevalence of COVID-19, and it will be significant to identify patients' potential risk of progressing to severe cases according to their first clinical presentations. Therefore, we aim to review the clinical symptoms of the COVID-19 epidemic systematically. Methods:We searched PubMed, Embase, Web of Science, and CNKI (Chinese Database) for studies about the clinical features of COVID-19 in China from March 18 to April 18. Then we used REVMAN to conduct a meta-analysis. Results: After screening, 20 articles including 3,326 COVID-19 confirmed cases were selected from 142 articles we retrieved at the beginning of our research. We divided all the cases into a severe group (including severe and critically severe patients) and a mild group according to the "Diagnosis and Treatment Protocol for Novel Coronavirus Infection-Induced Pneumonia" version 4 (trial). Of all the initial symptoms (including fever, cough, abdominal pain, anorexia, chest tightness, diarrhea, dyspnea, expectoration, fatigue, headache, hemoptysis, myalgia, nausea or vomiting, and pharyngalgia) we studied, we found that cough (odds ratio [OR] = 1.4, 95% confidence interval [CI]: 1.2-1.7; p < 0.001), fever (OR = 1.5, 95% CI: 1.2-1.9; p < 0.001), dyspnea (OR = 6.2, 95% CI: 3.6-10.6; p < 0.001), diarrhea (OR = 2.6, 95% CI: 1.3-4.9; p < 0.001), fatigue (OR = 2.1, 95% CI: 1.3-3.3; p < 0.01), expectoration (OR = 1.7, 95% CI: 1.2-2.6; p < 0.01), myalgia (OR = 1.6, 95% CI: 0.8-3.1; p < 0.001), hemoptysis (OR = 4.0, 95% CI: 1.5-11.3; p < 0.001), abdominal pain (OR = 7.5, 95% CI: 2.4-23.4; p < 0.001), and anorexia (OR = 2.8, 95% CI: 1.5-5.1; p < 0.001) had a different distribution in two groups and were statistically significant (p < 0.05). Conclusion:COVID-19 patients whose initial manifestation is dyspnea, hemoptysis, anorexia, diarrhea, or fatigue, especially abdominal pain should be closely monitored to prevent disease deterioration.

Keywords: COVID-19; clinical features; differences; meta-analysis; risk factor.

Figure 1

Flow diagram of the study selection procedure of the meta-analysis.

Figure 2

Publication bias: Begg's (A) (p > 0.05) and Egger's (B) (p > 0.05) funnel plots for possible publication bias in the current study. No publication bias was found, indicating credible results.

Figure 3

The initial symptoms were divided into three types: respiratory symptoms (including fever, cough, dyspnea, expectoration, hemoptysis, chest tightness, and pharyngalgia), digestive symptoms (including abdominal pain, diarrhea, and nausea or vomiting), and neurological symptoms (including anorexia, fatigue, myalgia, and headache).

Figure 4

Forest plots of odds ratios (ORs) showed the associations between fever and disease progression of COVID-19 pneumonia.

Figure 5

Forest plots of odds ratios (ORs) showed the associations between respiratory symptoms, including cough (A) as well as dyspnea (B), and disease progression of COVID-19 pneumonia.

Figure 6

Forest plots of odds ratios (ORs) showed the associations between respiratory symptoms, including expectoration (A) as well as hemoptysis (B), and disease progression of COVID-19 pneumonia.

Figure 7

Forest plots of odds ratios (ORs) showed the associations between digestive symptoms, including abdominal pain (A) as well as diarrhea (B), and disease progression of COVID-19 pneumonia.

Figure 8

Forest plots of odds ratios (ORs) showed the associations between neurological symptoms, including anorexia (A) as well as fatigue (B), and disease progression of COVID-19 pneumonia.