Clinical characteristics of coronavirus disease 2019 (COVID-19) in China: A systematic review and meta-analysis.

Song Fan, Huachun Zou, Yuelong Shu, Linghua Li, Xiangjun Du, Lin Zhang, Weiping Cai, Bowen Liang, Yuewei Zhan, Anping Feng, Yong Lu, Leiwen Fu, Ganfeng Luo, Qibin Duan, Yi-Fan Lin, Yiguo Zhou, Peiyang Li, Thomas Fitzpatrick, Yunlong Ao, Xiaoting Chen, Tanwei Yuan, Bingyi Wang

Journal: The Journal of infection 2020;80(6):656-665

PMID: 32283155

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Abstract

OBJECTIVE

To better inform efforts to treat and control the current outbreak with a comprehensive characterization of COVID-19.

METHODS

We searched PubMed, EMBASE, Web of Science, and CNKI (Chinese Database) for studies published as of March 2, 2020, and we searched references of identified articles. Studies were reviewed for methodological quality. A random-effects model was used to pool results. Heterogeneity was assessed using I. Publication bias was assessed using Egger's test.

RESULTS

43 studies involving 3600 patients were included. Among COVID-19 patients, fever (83.3% [95% CI 78.4-87.7]), cough (60.3% [54.2-66.3]), and fatigue (38.0% [29.8-46.5]) were the most common clinical symptoms. The most common laboratory abnormalities were elevated C-reactive protein (68.6% [58.2-78.2]), decreased lymphocyte count (57.4% [44.8-69.5]) and increased lactate dehydrogenase (51.6% [31.4-71.6]). Ground-glass opacities (80.0% [67.3-90.4]) and bilateral pneumonia (73.2% [63.4-82.1]) were the most frequently reported findings on computed tomography. The overall estimated proportion of severe cases and case-fatality rate (CFR) was 25.6% (17.4-34.9) and 3.6% (1.1-7.2), respectively. CFR and laboratory abnormalities were higher in severe cases, patients from Wuhan, and older patients, but CFR did not differ by gender.

CONCLUSIONS

The majority of COVID-19 cases are symptomatic with a moderate CFR. Patients living in Wuhan, older patients, and those with medical comorbidities tend to have more severe clinical symptoms and higher CFR.

Address: School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 510080, China.; School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 510080, China; State Key Laboratory of Food Nutrition and Safety, Tianjin University of Science & Technology, Tianjin, China; College of Food Science and Engineering, Tianjin University of Science & Technology, Tianjin, China.; Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.; Department of Internal Medicine, University of Washington, Seattle, Washington, USA.; School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 510080, China; School of Mathematical and Physical Sciences/Statistics, The University of Newcastle, Callaghan, Australia.; School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia; Kirby Institute, University of New South Wales, Sydney, Australia.; School of Public Health, Sun Yat-sen University, Guangzhou, China.; Department of Anesthesia and Intensive Care and Peter Hung Pain Research Institute, The Chinese University of Hong Kong, Hong Kong, China; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.; Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China. Electronic address: [email protected].; School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 510080, China. Electronic address: [email protected].; School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen 510080, China; Kirby Institute, University of New South Wales, Sydney, Australia; Shenzhen Center for Disease Control and Prevention, Shenzhen, China; School of Public Health, Shanghai Jiao Tong University,Shanghai, China. Electronic address: [email protected].

DOI: 10.1016/j.jinf.2020.03.041