Clinical, Laboratory and Imaging Features of COVID-19: A Systematic Review and Meta-analysis

Introduction: An epidemic of Coronavirus Disease 2019 (COVID-19) begun in December 2019 in China, causing primary concern. Among raised questions, clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews have been published on this matter. Methods: We performed a systematic review of the literature with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of confirmed cases of COVID-19. All the observational studies, and also case reports, were included. The case reports were analyzed separately. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95%CI. Measures of heterogeneity, including Cochran’s Q statistic, the I2 index, and the τ2 test, were estimated and reported.Results: 660 articles were retrieved. After screening by abstract and title, 27 articles were selected for full-text assessment. Of them, 19 were 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%, 40.8-74.4%) and dyspnea (45.6%, 10.9-80.4%) were the most prevalent clinical manifestations. Among the patients, 20.3% (95%CI 10.0-30.6%) required ICU, with 32.8% presenting ARDS (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock and 13.9% (95%CI 6.2-21.5%) with a fatal outcome.Discussion: COVID-19 is a new clinical infectious disease, causing considerable compromise, especially in patients with comorbidities, requiring ICU in at least a fifth of them and sometimes with fatal outcomes. Additional research is needed to elucidate factors that may mediate the pathogenesis of the severe and fatal associated disease.

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Clinical, Laboratory and Imaging Features of COVID-19: A Systematic Review and Meta-analysis

10.20944/preprints202002.0378.v2 ◽

2020 ◽

Author(s):

Alfonso J. Rodriguez-Morales ◽

Jaime A. Cardona-Ospina ◽

Estefanía Gutiérrez-Ocampo ◽

Rhuvi Villamizar-Peña ◽

Yeimer Holguin-Rivera ◽

...

Keyword(s):

Observational Studies ◽

Clinical Laboratory ◽

Case Reports ◽

Meta Analysis ◽

Fatal Outcome ◽

Clinical Manifestations ◽

Clinical Infectious Disease ◽

Imaging Features ◽

Pooled Prevalence ◽

Quantitative Analyses

Introduction: An epidemic of Coronavirus Disease 2019 (COVID-19) begun in December 2019 in China, causing a Public Health Emergency of International Concern. Among raised questions, clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews have been published on this matter. Methods: We performed a systematic literature review with meta-analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of confirmed cases of COVID-19. All the observational studies, and also case reports, were included and analyzed separately. We performed a random-effects model meta-analysis to calculate the pooled prevalence and 95% confidence interval (95%CI). Measures of heterogeneity were estimated and reported. Results: 660 articles were retrieved. After screening by abstract and title, 27 articles were selected for full-text assessment. Of them, 19 were 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%, 40.8-74.4%) and dyspnea (45.6%, 10.9-80.4%) were the most prevalent clinical manifestations. Among the patients, 20.3% (95%CI 10.0-30.6%) required intensive care unit (ICU), with 32.8% presenting acute respiratory distress syndrome (ARDS) (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock and 13.9% (95%CI 6.2-21.5%) with a fatal outcome. Discussion: COVID-19 is a new clinical infectious disease, causing considerable compromise, especially in patients with comorbidities, requiring ICU in at least a fifth of them and sometimes with fatal outcomes. Additional research is needed to elucidate factors that may mediate the pathogenesis of the severe and fatal associated disease.

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Clinical, Laboratory and Imaging Features of COVID-19: A Systematic Review and Meta-analysis

10.20944/preprints202002.0378.v3 ◽

2020 ◽

Cited By ~ 1

Author(s):

Alfonso J. Rodriguez-Morales ◽

Jaime A. Cardona-Ospina ◽

Estefanía Gutiérrez-Ocampo ◽

Rhuvi Villamizar-Peña ◽

Yeimer Holguin-Rivera ◽

...

Keyword(s):

Observational Studies ◽

Clinical Laboratory ◽

Case Reports ◽

Meta Analysis ◽

Case Fatality ◽

Imaging Features ◽

Healthcare Facilities ◽

Qualitative And Quantitative ◽

Pooled Prevalence ◽

Quantitative Analyses

Introduction: An epidemic of Coronavirus Disease 2019 (COVID-19) begun in December 2019 in China, causing a Public Health Emergency of International Concern. Among raised questions, clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews have been published on this matter. 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 the pooled prevalence and 95% confidence interval (95%CI). Results: 660 articles were retrieved (1/1/2020-2/23/2020). After screening by abstract/title, 27 articles were selected for full-text assessment. Of them, 19 were 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%, 40.8-74.4%) and dyspnea (45.6%, 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), with 32.8% presenting acute respiratory distress syndrome (ARDS) (95%CI 13.7-51.8), 6.2% (95%CI 3.1-9.3) with shock and 13.9% (95%CI 6.2-21.5%) of hospitalized patients with 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 this group was associated with a CFR of over 13%. As this virus spreads globally, countries need to urgently prepare human resources, infrastructure, and facilities to treat severe COVID-19.

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The Novel Coronavirus Disease (COVID-19): A PRISMA Systematic Review and Meta-Analysis of Clinical and Paraclinical Characteristics

BioMed Research International ◽

10.1155/2020/3149020 ◽

2020 ◽

Vol 2020 ◽

pp. 1-16 ◽

Cited By ~ 3

Author(s):

Hamidreza Hasani ◽

Shayan Mardi ◽

Sareh Shakerian ◽

Nooshin Taherzadeh-Ghahfarokhi ◽

Parham Mardi

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Clinical Laboratory ◽

Meta Analysis ◽

Ct Scanning ◽

Imaging Features ◽

The Novel ◽

Laboratory Findings ◽

Global Concern ◽

Novel Coronavirus

An outbreak of pneumonia, caused by a novel coronavirus (SARS-CoV-2), was identified in China in December 2019. This virus expanded worldwide, causing global concern. Although clinical, laboratory, and imaging features of COVID-19 are characterized in some observational studies, we undertook a systematic review and meta-analysis to assess the frequency of these features. We did a systematic review and meta-analysis using three databases to identify clinical, laboratory, and computerized tomography (CT) scanning features of rRT-PCR confirmed cases of COVID-19. Data for 3420 patients from 30 observational studies were included. Overall, the results showed that fever (84.2%, 95% CI 82.6-85.7), cough (62%, 95% CI 60-64), and fatigue (39.4%, 95% CI 37.2-41.6%) are the most prevalent symptoms in COVID-19 patients. Increased CRP level, decreased lymphocyte count, and increased D-dimer level were the most common laboratory findings. Among COVID-19 patients, 92% had a positive CT finding, most prevalently ground-glass opacification (GGO) (60%, 95% CI 58-62) and peripheral distribution opacification (64%, 95% CI 60-69). These results demonstrate the clinical, paraclinical, and imaging features of COVID-19.

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The Novel Coronavirus Disease (COVID-19): A PRISMA Systematic Review and Meta-analysis of Clinical and Paraclinical characteristics

10.1101/2020.04.19.20071456 ◽

2020 ◽

Cited By ~ 1

Author(s):

Hamidreza Hasani ◽

Shayan Mardi ◽

Sareh Shakerian ◽

Nooshin Taherzadeh-Ghahfarokhi ◽

Parham Mardi

Keyword(s):

Systematic Review ◽

Observational Studies ◽

Clinical Laboratory ◽

Meta Analysis ◽

Imaging Features ◽

The Novel ◽

Laboratory Findings ◽

Global Concern ◽

Novel Coronavirus ◽

Ct Features

AbstractAn outbreak of pneumonia, caused by a novel coronavirus (COVID-19) was Identified in China in Dec 2019. This virus expanded worldwide, causing global concern. Clinical, laboratory and imaging features of this infection are characterized in some observational studies. We undertook a systematic review and meta-analysis to assess the frequency of clinical, laboratory, and CT features in COVID-19 patients.We did a systematic review and meta-analysis using three databases to identify clinical, laboratory, and CT features of rRT-PCR confirmed cases of COVID-19. Data for 3420 patients from 30 observational studies were included.Overall, the results showed that fever (84.2%, 95%CI 82.6-85.7), cough (62%, 95%CI 60-64), and fatigue (39.4%, 95%CI 37.2-41.6%) were the most prevalent symptoms in COVID-19 patients. Increased CRP level, decreased lymphocyte count, and increased D-dimer level were the most common laboratory findings. Among COVID-19 patients, 92% had a positive CT finding, most prevalently GGO (60%, 95%CI 58-62) and peripheral distribution (64%, 95%CI 60-69).These results demonstrate the clinical, paraclinical, and imaging features of COIVD-19.

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The COVID-19 pandemic: a systematic review of the current evidence

Russian Journal of Infection and Immunity ◽

10.15789/2220-7619-tcp-1508 ◽

2020 ◽

Vol 10 (4) ◽

pp. 655-663

Author(s):

R. Ghomi ◽

N. Asgari ◽

A. Hajiheydari ◽

R. Esteki ◽

F. Biyabanaki ◽

...

Keyword(s):

Systematic Review ◽

Clinical Features ◽

Clinical Laboratory ◽

Case Reports ◽

Data Extraction ◽

Radiological Finding ◽

Clinical Infectious Disease ◽

Current Evidence ◽

Primary Concern ◽

Old Patients

Introduction. An epidemic of Coronavirus Disease 2019 (COVID-19) begun in December 2019 in China, causing primary concern. One of the important issues is its rapid spread around the world. Among the questions raised, disease epidemiology, clinical, laboratory symptoms and radiological findings and treatment of COVID-19 disease have been identified in some studies. But no systematic review on current evidences about COVID-19 has been published.Objective. The aim of this study was to determine the COVID-19 epidemiology, clinical features, diagnosis and treatment.Data sources. We performed a systematic review of the literature, using the keywords: “coronavirus” and “2020”, “COVID-19” in databases: Science Direct, PubMed, Springer and Scopus during January 1, 2020 to February 23, 2020.Study Selection. All observational studies, as well as case reports and editorial that published in English were include. Data Extraction. Data on the disease control methods of COVID-19 were extracted by multiple observers.Results. 131 articles were retrieved. After screening by abstract and title, 58 articles were selected for full-text assessment. Of them, 43 were finally included for review. The COVID-19 has spread rapidly and can be transmitted via close human-to-human contact via nasopharyngeal or oropharyngeal droplets. The COVID-19, causing considerable problems, especially in patients with comorbidities and old patients. Fever, cough, sore throat and diarrhea are the main clinical features of this emerging disease. The most common radiological finding is bilateral ground-glass view and Lopinavir and Ritonavir are among the antiviral drugs used.Conclusion. COVID-19 is a new clinical infectious disease and can be a serious problem for health systems. Additional research is needed to elucidate factors that may mediate the pathogenesis of the severe and fatal associated disease.

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The toxic effects of chloroquine and hydroxychloroquine on skeletal muscle: a systematic review and meta-analysis

Scientific Reports ◽

10.1038/s41598-021-86079-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Claudia Cristina Biguetti ◽

Joel Ferreira Santiago Junior ◽

Matthew William Fiedler ◽

Mauro Toledo Marrelli ◽

Marco Brotto

Keyword(s):

Systematic Review ◽

Quantitative Analysis ◽

Qualitative Analysis ◽

Observational Studies ◽

Skeletal Muscles ◽

Case Reports ◽

Meta Analysis ◽

Toxic Effects ◽

Drug Induced ◽

Qualitative And Quantitative

AbstractThe aim of this systematic review was to perform qualitative and quantitative analysis on the toxic effects of chloroquine (CQ) and hydroxychloroquine (HCQ) on skeletal muscles. We designed the study according to PRISMA guidelines. Studies for qualitative and quantitative analyses were selected according to the following inclusion criteria: English language; size of sample (> 5 patients), adult (> age of 18) patients, treated with CQ/HCQ for inflammatory diseases, and presenting and not presenting with toxic effects on skeletal muscles. We collected data published from 1990 to April 2020 using PubMed, Cochrane Library, EMBASE, and SciELO. Risk of bias for observational studies was assessed regarding the ROBIN-I scale. Studies with less than five patients (case reports) were selected for an additional qualitative analysis. We used the software Comprehensive Meta-Analysis at the confidence level of 0.05. We identified 23 studies for qualitative analysis (17 case-reports), and five studies were eligible for quantitative analysis. From case reports, 21 patients presented muscle weakness and confirmatory biopsy for CQ/HCQ induced myopathy. From observational studies, 37 patients out of 1,367 patients from five studies presented muscle weakness related to the use of CQ/HCQ, and 252 patients presented elevated levels of muscle enzymes (aldolase, creatine phosphokinase, and lactate dehydrogenase). Four studies presented data on 34 patients with confirmatory biopsy for drug-induced myopathy. No study presented randomized samples. The chronic use of CQ/HCQ may be a risk for drug-induced myopathy. There is substantiated need for proper randomized trials and controlled prospective studies needed to assess the clinical and subclinical stages of CQ/HCQ -induced muscle myopathy.

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COVID-19 and Influenza Co-infection: A Systematic Review and Meta-Analysis

Frontiers in Medicine ◽

10.3389/fmed.2021.681469 ◽

2021 ◽

Vol 8 ◽

Author(s):

Masoud Dadashi ◽

Saeedeh Khaleghnejad ◽

Parisa Abedi Elkhichi ◽

Mehdi Goudarzi ◽

Hossein Goudarzi ◽

...

Keyword(s):

Systematic Review ◽

Case Reports ◽

Influenza Infection ◽

Meta Analysis ◽

Clinical Manifestations ◽

Case Series ◽

Influenza Viruses ◽

Original Research ◽

Respiratory Pathogens ◽

Prevalence Studies

Background and Aim: Co-infection of COVID-19 with other respiratory pathogens which may complicate the diagnosis, treatment, and prognosis of COVID-19 emerge new concern. The overlap of COVID-19 and influenza, as two epidemics at the same time can occur in the cold months of the year. The aim of current study was to evaluate the rate of such co-infection as a systematic review and meta-analysis.Methods: A systematic literature search was performed on September 28, 2019 for original research articles published in Medline, Web of Science, and Embase databases from December 2019 to September 2020 using relevant keywords. Patients of all ages with simultaneous COVID-19 and influenza were included. Statistical analysis was performed using STATA 14 software.Results: Eleven prevalence studies with total of 3,070 patients with COVID-19, and 79 patients with concurrent COVID-19 and influenza were selected for final evaluation. The prevalence of influenza infection was 0.8% in patients with confirmed COVID-19. The frequency of influenza virus co-infection among patients with COVID-19 was 4.5% in Asia and 0.4% in the America. Four prevalence studies reported the sex of patients, which were 30 men and 31 women. Prevalence of co-infection with influenza in men and women with COVID-19 was 5.3 and 9.1%, respectively. Eight case reports and 7 case series with a total of 123 patients with COVID-19 were selected, 29 of them (16 men, 13 women) with mean age of 48 years had concurrent infection with influenza viruses A/B. Fever, cough, and shortness of breath were the most common clinical manifestations. Two of 29 patients died (6.9%), and 17 out of 29 patients recovered (58.6%). Oseltamivir and hydroxychloroquine were the most widely used drugs used for 41.4, and 31% of patients, respectively.Conclusion: Although a low proportion of COVID-19 patients have influenza co-infection, however, the importance of such co-infection, especially in high-risk individuals and the elderly, cannot be ignored. We were unable to report the exact rate of simultaneous influenza in COVID-19 patients worldwide due to a lack of data from several countries. Obviously, more studies are needed to evaluate the exact effect of the COVID-19 and influenza co-infection in clinical outcomes.

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Prevalence and characteristics of fever in adult and paediatric patients with coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis of 17515 patients

PLoS ONE ◽

10.1371/journal.pone.0249788 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249788

Author(s):

Md Asiful Islam ◽

Shoumik Kundu ◽

Sayeda Sadia Alam ◽

Tareq Hossan ◽

Mohammad Amjad Kamal ◽

...

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Clinical Manifestations ◽

Sensitivity Analyses ◽

Clinical Feature ◽

High Grade ◽

High Grade Fever ◽

Paediatric Patients ◽

Pooled Prevalence ◽

Significant Difference

Background Coronavirus disease 2019 (COVID-19), a pandemic disease caused by the severe acute respiratory syndrome coronavirus 2 started to spread globally since December 2019 from Wuhan, China. Fever has been observed as one of the most common clinical manifestations, although the prevalence and characteristics of fever in adult and paediatric COVID-19 patients is inconclusive. We aimed to conduct a systematic review and meta-analysis to estimate the overall pooled prevalence of fever and chills in addition to fever characteristics (low, medium, and high temperature) in both adult and paediatric COVID-19 patients. Methods The protocol of this systematic review and meta-analysis was registered with PROSPERO (CRD42020176327). PubMed, Scopus, ScienceDirect and Google Scholar databases were searched between 1st December 2019 and 3rd April 2020 without language restrictions. Both adult (≥18 years) and paediatric (<18 years) COVID-19 patients were considered eligible. We used random-effects model for the meta-analysis to obtain the pooled prevalence and risk ratio (RR) with 95% confidence intervals (CIs). Quality assessment of included studies was performed using the Joanna Briggs Institute critical appraisal tools. Heterogeneity was assessed using the I² statistic and Cochran’s Q test. Robustness of the pooled estimates was checked by different subgroups and sensitivity analyses. Results We identified 2055 studies, of which 197 studies (n = 24266) were included in the systematic review and 167 studies with 17142 adults and 373 paediatrics were included in the meta-analysis. Overall, the pooled prevalence of fever in adult and paediatric COVID-19 patients were 79.43% [95% CI: 77.05–81.80, I2 = 95%] and 45.86% [95% CI: 35.24–56.48, I2 = 78%], respectively. Besides, 14.45% [95% CI: 10.59–18.32, I2 = 88%] of the adult COVID-19 patients were accompanied with chills. In adult COVID-19 patients, the prevalence of medium-grade fever (44.33%) was higher compared to low- (38.16%) and high-grade fever (14.71%). In addition, the risk of both low (RR: 2.34, 95% CI: 1.69–3.22, p<0.00001, I2 = 84%) and medium grade fever (RR: 2.79, 95% CI: 2.21–3.51, p<0.00001, I2 = 75%) were significantly higher compared to high-grade fever, however, there was no significant difference between low- and medium-grade fever (RR: 1.17, 95% CI: 0.94–1.44, p = 0.16, I2 = 87%). 88.8% of the included studies were of high-quality. The sensitivity analyses indicated that our findings of fever prevalence for both adult and paediatric patients are reliable and robust. Conclusions The prevalence of fever in adult COVID-19 patients was high, however, 54.14% of paediatric COVID-19 patients did not exhibit fever as an initial clinical feature. Prevalence and risk of low and medium-grade fevers were higher compared to high-grade fever.

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