Case fatality rate in COVID-19: a systematic review and meta-analysis

Chanaka N Kahathuduwa; Chathurika S Dhanasekara; Shao-Hua Chin

Results of database search, subsequent screening and eligibility assessment are Table S2 with their references. The summary 154 statistics of all covariates are summarized in Table S3 in Appendix. 155 Pooled prevalence of severe or critically severe illness among individuals with COVID-156 19 infection was estimated to be 14.6% (95%CI, 8.9%-23.1%) in the random-effects meta-funnel plot of the effect-sizes was severely asymmetric, suggesting substantial underreporting or 160 publication bias (Figure 2b ). Seven effect-sizes were imputed to correct for the publication bias. 161 When the random-effects meta-analysis was performed including these imputed effect-sizes (i.e. 162 after correcting for publication bias), the prevalence of severe or critical illness increased to 163 25.8% (95%CI, 17.2%-36.8%) (Figure 2c ). 164 Significant heterogeneity was observed among the prevalence estimates of severe illness 165 (Ï„ 2 = 1.679; I 2 = 94%, p < 0.001). Correcting for publication bias decreased this heterogeneity (I 2 166 = 85%, 95%CI, 80%-89%), however, heterogeneity remained significant (p < 0.001). 167 Exploratory univariate random-effects meta-regression analyses conducted with the aim of 168 explaining the heterogeneity using the moderator effects of the considered covariates suggested 169 that each of increasing mean age (p = 0.006) and prevalence of age > 60 years (p < 0.001), 170 hypertension (p < 0.001), chronic kidney disease (p = 0.038), malignancy (p = 0.023) and 171 chronic obstructive pulmonary disease (p = 0.025) were associated with a greater risk of severe 172 or critical illness associated with COVID-19, while the prevalence of age < 18 years (p = 0.007) 173 within a sample was associated with a reduced risk of severe or critical illness. Prevalence of the 174 presenting clinical features of fever (p < 0.001), dyspnea (p = 0.028) and diarrhea (p = 0.026); 175 laboratory findings of lymphocytopenia (p = 0.003), elevated LDH (p < 0.001), CRP (p < 0.001) 176 and D-dimer levels (p < 0.001); and bilateral lung involvement or involvement of > 3 lung lobes 177 (p = 0.006) was associated with increased risk of severe or critically severe illness, while having 178 no radiological features on chest CT was associated with decreased risk of severe illness (p = Table S4 in Appendix. 182 All rights reserved. No reuse allowed without permission. author/funder, who has granted medRxiv a license to display the preprint in perpetuity.