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Clinical features of severe patients infected with 2019 novel coronavirus: a systematic review and meta-analysis
Daozheng Huang1, Xingji Lian2, Feier Song3
1Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Geriatrics Institute, Guangzhou 510080, China.
Insights
Severe COVID-19 patients present with distinct clinical features and higher risks of organ complications and mortality. Identifying these characteristics is crucial for timely intervention and improved outcomes in coronavirus disease 2019 management.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Public Health
Background:
- The 2019 novel coronavirus disease (COVID-19) presents a significant global health challenge.
- Identifying and managing severe and critical COVID-19 cases is a primary clinical concern.
Purpose of the Study:
- To evaluate the clinical characteristics differentiating severe from non-severe COVID-19 patients.
- To identify risk factors and complications associated with severe COVID-19.
Main Methods:
- A systematic literature search was conducted to retrieve studies comparing severe and non-severe COVID-19 patients.
- Data extraction and quality assessment were performed independently, with meta-analysis using fixed or random-effect models.
- Publication bias was assessed using Begg's test.
Main Results:
- Analysis of five studies involving 5,328 patients revealed that severe COVID-19 cases were associated with older age, dyspnea, gastrointestinal symptoms, elevated creatinine, and specific laboratory findings.
- Severe patients exhibited significantly higher risks of acute cardiac injury, acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), shock, and in-hospital death.
- Interventions such as antiviral therapy, corticosteroids, continuous renal replacement therapy (CRRT), and invasive mechanical ventilation were more frequently required in severe cases.
Conclusions:
- Severe COVID-19 is characterized by distinct clinical and laboratory markers and a higher propensity for multiple organ complications.
- Despite increased medical interventions, severe COVID-19 patients face a substantially elevated risk of mortality.
Background:
2019 novel coronavirus disease (COVID-19) has posed significant threats to public health. To identify and treat the severe and critical patients with COVID-19 is the key clinical problem to be solved. The present study aimed to evaluate the clinical characteristics of severe and non-severe patients with COVID-19.
Methods:
We searched independently studies and retrieved the data that involved the clinical characteristics of severe and non-severe patients with COVID-19 through database searching. Two authors independently retrieved the data from the individual studies, assessed the study quality with Newcastle-Ottawa Scale and analyzed publication bias by Begg's test. We calculated the odds ratio (OR) of groups using fixed or random-effect models.
Results:
Five studies with 5,328 patients confirmed with COVID-19 met the inclusion criteria. Severe patents were older and more common in dyspnea, vomiting or diarrhea, creatinine >104 µmol/L, procalcitonin ≥0.05 ng/mL, lymphocyte count <1.5×109/L and bilateral involvement of chest CT. Severe patents had higher risk on complications including acute cardiac injury (OR 13.48; 95% CI, 3.60 to 50.47, P<0.001) or acute kidney injury (AKI) (OR 11.55; 95% CI, 3.44 to 38.77, P<0.001), acute respiratory distress syndrome (ARDS) (OR 26.12; 95% CI, 11.14 to 61.25, P<0.001), shock (OR 53.17; 95% CI, 12.54 to 225.4, P<0.001) and in-hospital death (OR 45.24; 95% CI, 19.43 to 105.35, P<0.001). Severe group required more main interventions such as received antiviral therapy (OR 1.69; 95% CI, 1.23 to 2.32, P=0.001), corticosteroids (OR 5.07; 95% CI, 3.69 to 6.98, P<0.001), CRRT (OR 37.95; 95% CI, 7.26 to 198.41, P<0.001) and invasive mechanical ventilation (OR 129.35; 95% CI, 25.83 to 647.68, P<0.001).
Conclusions:
Severe patients with COVID-19 had more risk of clinical characteristics and multiple system organ complications. Even received more main interventions, severe patients had higher risk of mortality.
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