| Background Cases of coronavirus disease 2019（COVID-19）caused by infection with the severe acute respiratory syndrome coronavirus 2（SARS-Co V-2）virus were identified in Wuhan,China in December 2019,and subsequently across China and the rest of the world Cases were also discovered one after another,and its epidemic became a Public Health Emergency of International Concern（PHEIC）.The clinical types of disease caused by SARS-Co V-2 infection include asymptomatic infection,mild upper respiratory disease,and severe viral pneumonia with respiratory failure and even death.In the early stage of the epidemic,due to the strong invasive ability of the original SARS-Co V-2 strain and the lack of public health and clinical experience,the severe infection rate was high.In some observational studies,it has been found that some clinical symptoms,laboratory indicators and imaging characteristics of patients with severe and non-severe new coronary pneumonia are different,but the sample size is still insufficient.Therefore,it is necessary to review the published studies comparing the clinical manifestations and characteristics of severe and non-severe COVID-19 patients infected with the original strain of SARS-Co V-2 and summarize high-quality evidence.Research purpose The main purpose of this systematic review and meta-analysis is to compare the differences in clinical symptoms,comorbidities,laboratory indicators and complications between severe and non-severe COVID-19 patients in patients infected with the original strain of COVID-19,so as to gain a comprehensive understanding of COVID-19 patients The characteristics of the virus can provide a reference for the follow-up symptomatic treatment and the comparison of the infection characteristics of the new strain.Method This study used Pubmed,Web of Science,and Medline to search for studies comparing clinical characteristics,comorbidities,laboratory findings,and complications of severe and nonsevere COVID-19 patients,and conducted meta-analyses and systematic reviews.Inclusion criteria were:（1）Published before December 20,2020;（2）The study included basic demographic information of COVID-19 patients,patient symptoms and comorbidities;（3）Comparing severe and non-severe COVID-19 patients A study of clinical features,comorbidities,laboratory findings,and complications（severity of disease defined by ICU admission）.Exclusion criteria:（1）Literature review,case report,letter,comment（2）Studies reported in non-English languages;（3）Missing baseline symptom/comorbidity data on admission in the severe or non-intensive groups（ICU and non-ICU groups）.We used R studio 4.0.3 software to compare the distribution of comorbidities,clinical symptoms,laboratory findings,and complications between severe and non-severe COVID-19 patients.Odds ratios（ORs）and 95% confidence intervals（CIs）were used to describe the ratio of the probability of the occurrence of coronavirus in critically ill and non-critically ill patients.Due to heterogeneity across studies,we used I2 and P-values ??to determine whether to use a random or fixed model.A fixed-effects model was used when heterogeneity was low（I2 < 50%）,and a randomeffects model was used when heterogeneity was high（I2 ≥ 50%）.Publication bias was assessed using funnel plots and Egger’s linear regression test.P < 0.05 was considered statistically significant.Results According to the inclusion and exclusion criteria,a total of 58 studies including 11,527 patients with COVID-19 were included in this study.The results showed that compared with patients with mild new coronary pneumonia,severe COVID-19 patients were more likely to develop abdominal pain（OR=2.02,95%CI:1.33-3.08）,diarrhea（OR=1.12,95%CI:0.98-1.28）,anorexia（OR=2.44,95%CI:1.55-3.84）,cough（OR = 1.44,95% CI: 1.17-1.76）,hemoptysis（OR=2.77,95%CI:1.42-5.41）,dyspnea（OR=3.79,95%CI:2.71-5.32）,fatigue（OR=1.34,95%CI: 0.91-1.99）,fever（OR = 1.57,95% CI: 1.22-2.02）and other clinical symptoms.In addition,this study showed that hypertension（OR=2.67,95%CI:2.17-3.29）,diabetes（OR=2.37,95%CI:2.10-2.69）,cerebrovascular disease（OR=3.52,95%CI: 1.95-636）and cancer（OR=1.96,95%CI: 1.5-2.48）may be closely related to disease severity and prognosis in COVID-19 patients.From 36 published studies,we found laboratory parameters that may predict disease progression,including leukocytosis（OR=3.03,95% CI: 1.77-5.21）,lymphopenia（OR=3.27,95% CI: 2.41）-4.45),decreased albumin（OR=5.55,95% CI: 1.69-18.30）and D-D dimerization（OR=3.34,95%CI: 2.44-4.56）,increased serum and procalcitonin（OR= 5.92,95% CI 3.87-9.05）.In addition,severe COVID-19 patients were also more likely to develop complications,such as ARDS（OR=20.74,95% CI: 8.82-48.76）,shock（OR=16.28,95% CI: 6.19-42.81）,heart failure（OR=5.68,95% CI 2.55-12.64）,acute cardiac injury（OR=8.88,95% CI 4.88-16.15）,and secondary infection（OR=4.92,95% CI: 3.43-7.04）.Conclusions1.COVID-19 patients with underlying diseases,like hypertension,diabetes,and cerebrovascular disease,are at higher risk of developing severe illness.2.COVID-19 patients with initial symptoms,especially abdominal pain,dyspnea,fever,cough,hemoptysis,anorexia,diarrhoea,and fatigue,are at higher risk of developing severe illness.3.COVID-19 patients with abnormal laboratory indicators,like leukocytosis,lymphopenia,decreased albumin,and increased values of D-dimer,procalcitonin,are at higher risk of developing severe illness.4.Severe COVID-19 patients have significantly higher risks of complications such as acute heart injury,heart failure,arrhythmia,acute liver injury,shock,and secondary infection than non-severe patients. |
PDF Full Text Request