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

Rodriguez-Morales, Alfonso J.; Cardona-Ospina, Jaime A.; Gutiérrez-Ocampo, Estefanía; Villamizar-Peña, Rhuvi; Holguin-Rivera, Yeimer; Escalera-Antezana, Juan Pablo; Alvarado-Arnez, Lucia Elena; Bonilla-Aldana, D. Katterine; Franco-Paredes, Carlos; Henao-Martinez, Andrés F.; Paniz-Mondolfi, Alberto; Lagos-Grisales, Guillermo J.; Ramírez-Vallejo, Eduardo; Suárez, Jose A.; Zambrano, Lysien I.; Villamil-Gómez, Wilmer E.; Balbin-Ramon, Graciela J.; Rabaan, Ali A.; Harapan, Harapan; Dhama, Kuldeep; Nishiura, Hiroshi; Kataoka, Hiromitsu; Ahmad, Tauseef; Sah, Ranjit

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.