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

Alfonso J Rodriguez-Morales, Jaime A Cardona-Ospina, Estefanía Gutiérrez-Ocampo, Rhuvi Villamizar-Peña, Yeimer Holguin-Rivera, Juan Pablo Escalera-Antezana, Lucia Elena Alvarado-Arnez, D Katterine Bonilla-Aldana, Carlos Franco-Paredes, Andrés F Henao-Martinez, Alberto Paniz-Mondolfi, Guillermo J Lagos-Grisales, Eduardo Ramírez-Vallejo, Jose A Suárez, Lysien I Zambrano, Wilmer E Villamil-Gómez, Graciela J Balbin-Ramon, Ali A Rabaan, Harapan Harapan, Kuldeep Dhama, Hiroshi Nishiura, Hiromitsu Kataoka, Tauseef Ahmad, Ranjit Sah
Travel Medicine and Infectious Disease 2020 March 13, : 101623
32179124

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 the pooled prevalence and 95% confidence interval (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%, 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), 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 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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