Epidemiological and clinical characteristics of non-severe and severe pediatric and adult COVID-19 patients across different geographical regions in the early phase of pandemic: a systematic review and meta-analysis of observational studies

Abstract

This systematic and meta-review aimed to compare clinical presentation, outcomes, and care management among patients with COVID-19 during the early phase of the pandemic. A total of 77 peer-reviewed publications were identified between January 1, 2020 and April 9, 2020 from PubMed, Google Scholar, and Chinese Medical Journal databases. Subsequently, meta-analysis of 40 non-overlapping studies, comprising of 4844 patients from seven countries, was conducted to see differences in clinical characteristics and laboratory outcomes across patients from different geographical regions (Wuhan, other parts of China and outside China), severity (non-severe, severe and fatal) and age groups (adults and children). Patients from Wuhan had a higher mean age (54.3 years) and rates of dyspnea (39.5%) compared with patients from other parts of China and outside China. Myalgia, fatigue, acute respiratory distress syndrome (ARDS) and fatalities were also significantly more prevalent among Wuhan patients. A significant dose-response increase in prevalence of diabetes, D-dimer, white blood cells, neutrophil levels and ARDS was seen from non-severe to severe and fatal outcomes. A significant increase in mean duration of symptom onset to admission was seen between non-severe cases (4.2 days) and severe and fatal cases (6.3 days and 8.8 days, respectively). Proportion of asymptomatic cases was higher in children (20%) compared with adults (2.4%). In conclusion, patients with COVID-19 from Wuhan displayed more severe clinical disease during the early phase of the pandemic, while disease severity was significantly lesser among pediatric cases. This review suggests that biomarkers at admission may be useful for prognosis among patients with COVID-19.

Keywords: COVID-19.

Figure 1

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.

Figure 2

Patients’ characteristics with dose–response relationship across increasing clinical severity: (A) mean age; (B) diabetes; (C) mean white blood cells (WBC); (D) mean total lymphocytes; (E) mean neutrophil; (F) mean D-dimer; (G) acute respiratory distress syndrome (ARDS).

Figure 3

Forest plots of patient characteristics that differed across all geographical subgroups. (A) Mean age in general adult patients. (B) Hypertension in severe patients. (C) Diabetes in severe patients. (D) Cough in severe patients. (E) Dyspnea in severe patients. (F) Mean neutrophils in general adult patients. (G) Abnormal CT/CXR in severe patients. (H) Acute respiratory distress syndrome (ARDS) in in general adult patients.

Figure 4

Forest plots of patients’ characteristics of adult and children patient groups. (A) Mean age in years. (B) Asymptomatic cases. (C) Cases with family cluster exposure. (D) Fever. (E) Dyspnea. (F) Mean white blood cells (WBC). (G) Mean total lymphocytes. (H) Abnormal CT/CXR.

Figure 5

Bubble plot for meta-regression of (A) age and (B) follow-up duration with case-fatality rate.