Prolonged symptom onset to admission time is associated with severe Coronavirus disease: A meta combined propensity‐adjusted analysis

Guan, Yingchao; Chen, Chaojin; Guo, Anping; Wei, Jingru; Cai, Jiahui; Han, Hua; Hei, Ziqing; Tan, Haizhu; Li, Xiaoyun

BACKGROUND: Patients with severe COVID‐19 are more likely to develop adverse outcomes with a huge medical burden. We aimed to investigate whether a shorter symptom onset to admission time (SOAT) could improve outcomes of COVID‐19 patients. METHODS: A single‐center retrospective study combined with a meta‐analysis was performed. The meta‐analysis identified studies published between 1 December 2019 and 15 April 2020. Additionally, clinical data of COVID‐19 patients diagnosed between January 20 and February 20, 2020, at the First Affiliated Hospital of the University of Science and Technology of China were retrospectively analyzed. SOAT and severity of illness in patients with COVID‐19 were used as effect measures. The random‐effects model was used to analyze the heterogeneity across studies. Propensity score matching was applied to adjust for confounding factors in the retrospective study. Categorical data were compared using Fisher's exact test. We compared the differences in laboratory characteristic varied times using a two‐way nonparametric, Scheirer–Ray–Hare test. RESULTS: In a meta‐analysis, we found that patients with adverse outcomes had a longer SOAT (I (2) = 39%, mean difference 0.88, 95% confidence interval = 0.47–1.30). After adjusting for confounding factors, such as age, complications, and treatment options, the retrospective analysis results also showed that severe patients had longer SOAT (mean difference 1.13 [1.00, 1.27], p = 0.046). Besides, most biochemical marker levels improved as the hospitalization time lengthened without the effect of disease severity or associated treatment (p < 0.001). CONCLUSION: Shortening the SOAT may help reduce the possibility of mild patients with COVID‐19 progressing to severe illness.