Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis

Travel Med Infect Dis. Mar-Apr 2020;34:101623. doi: 10.1016/j.tmaid.2020.101623. Epub 2020 Mar 13.

Abstract

Introduction: An epidemic of Coronavirus Disease 2019 (COVID-19) began in December 2019 in China leading to a Public Health Emergency of International Concern (PHEIC). Clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews on COVID-19 have been published to date.

Methods: We performed a systematic literature review with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of COVID-19 confirmed cases. Observational studies and also case reports, were included, and analyzed separately. We performed a random-effects model meta-analysis to calculate pooled prevalences and 95% confidence intervals (95%CI).

Results: 660 articles were retrieved for the time frame (1/1/2020-2/23/2020). After screening, 27 articles were selected for full-text assessment, 19 being finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For 656 patients, fever (88.7%, 95%CI 84.5-92.9%), cough (57.6%, 95%CI 40.8-74.4%) and dyspnea (45.6%, 95%CI 10.9-80.4%) were the most prevalent manifestations. Among the patients, 20.3% (95%CI 10.0-30.6%) required intensive care unit (ICU), 32.8% presented with acute respiratory distress syndrome (ARDS) (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock. Some 13.9% (95%CI 6.2-21.5%) of hospitalized patients had fatal outcomes (case fatality rate, CFR).

Conclusion: COVID-19 brings a huge burden to healthcare facilities, especially in patients with comorbidities. ICU was required for approximately 20% of polymorbid, COVID-19 infected patients and hospitalization was associated with a CFR of >13%. As this virus spreads globally, countries need to urgently prepare human resources, infrastructure and facilities to treat severe COVID-19.

Keywords: Clinical features; Coronavirus disease 2019; Epidemic; Laboratory; Outcomes; SARS-CoV-2.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Betacoronavirus
  • Coronavirus Infections / diagnosis*
  • Coronavirus Infections / pathology
  • Cough / virology
  • Fever / virology
  • Hospitalization
  • Humans
  • Intensive Care Units
  • Pandemics
  • Pneumonia, Viral / diagnosis*
  • Pneumonia, Viral / pathology
  • Respiratory Distress Syndrome, Adult / virology

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2